GI Radiography

Case 2 :
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A 22 year old male presented with history of pain in the lower jaw while eating. Following a detailed history, a submandibular sialogram was performed.
What is the diagnosis ?

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Answer : Sialogram of the submandibular gland revealed an irregular narrowing of the submandibular duct, suggestive of a stricture with a commuunicating abscess cavity.

Discussion :

Back to basics (anatomy) :

The three paired salivary glands are responsible for the major production of saliva. Accessory salivary tissue is found throughout the mucosal membranes of the mouth and oropharynx, and the rest of the upper aerodigestive system.
The parotid glands are found inferior to the preauricular area wrapping around the posterior aspect of the ramus of the mandible. The gland rests posteriorly on the sternocleidomastoid and the posterior belly of the digastric muscles. The facial nerve exits the sternomastoid foramen and enters the gland where it bracnhes. The gland is divided into a superficial and deep portion: the superficial portion is lateral to the mandible resting against the masseter muscle while the deep portion extends behind the mandible in front of the styloid process, this part reaches the para pharyngeal spaces. Scattered lymph nodes can be found throughout the gland.
The submandibular gland is the size of a walnut wrapping around the posterior margin of the mylohyoid muscle ans sits between the mandible and the hyoglossus muscle toward the sublingual space. The submandibular duct runs towards the papilla surrounded by the sublingual salivary glands.

Pathology :

Intermittent swelling any of the major salivary glands, often related to food intake, is seen in obstruction of the major duct by a calculus or stricture (following chronic recurring attacks of calculi and obstruction). Causes of sialectasis and strictures include inflammatory disorders and infections such as viruses (mumps), bacterial diseases due to poor oral hygiene, granulomatous diseases such as tuberculosis, sarcoid, cat scratch disease and toxoplasmosis). Common predisposing factors include stenosis or obstruction of the duct, debilitation, dehydration, irradiation, drug suppression of salivary secretions and immunosuppression.

Imaging Findings :

In addition to the radiographic appearances of duct enlargement and strictures, conventional sialography may also show generalized patchy or deficient acinar opacification; extravasation of contrast material is common in inflammed or infected salivary glands and abscesses may be seen as masses or they may fill up with contrast material if they communicate with a duct. Conventional sialography is indeed infrequently performed in view of the other imaging modalities available today (USG/ CT/ CT-Sialo/ MRI).

Contribution : Dr.K Rathod, Gujarat.