Salivary Gland Inflammation (Sialadenitis): Diagnostic Tests

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic workup

X-ray

  • Panoramic overview radiograph
    • Rarely indicated as a conventional blank image.
    • In sialolithiasis (salivary stone): shadowing – concretions are detectable only with sufficient calcium content and a minimum size of 2-3 mm.
    • For clarification of dentogenic ( “starting from the teeth”) contexts required.
  • Oral floor overview image
    • In case of sialolithiasis of the submandibular gland or sublingual gland.
  • Mandibular bite record

Sialography

  • Sialography (salivary gland imaging) is a contrast medium imaging of the salivary gland excretory ducts. Ascending (ascending) contrast agents introduced into the ductal system make the salivary glands visible on radiographs. The procedure is now rarely indicated; instead, sonography, computed tomography (CT) and magnetic resonance imaging (MRI) are used for diagnosis.
  • Contraindications:
    • Acute inflammation
  • Possible indications:
    • Detection of inflammatory changes
      • Pathological parenchymal changes
      • Gait system
        • Drainage obstructions
          • Sialolithiasis (salivary calculus): contrast medium recess in the area of the calculus.
          • Prestenotic dialatation (dilatation before constriction).
        • Anomalies
          • Gangetic ectasias (ductal dilatations)
            • Megastenone – nodular dilatation of the parotid duct in chronic parotitis of the ductogenic type.
            • In chronic recurrent sialadenitis.
          • Strictures (high-grade stenosis).
            • In chronic parotitis
    • Chronic myoepithelial sialadenitis (Sjögren’s syndrome).
      • “leafy tree”
    • Sialadenoses (degenerative salivary gland diseases).
      • “defoliated tree”
    • Delineation of periglandular diseases
    • Demarcation tumor events
      • Intraglandular (within the gland) space-occupying lesion.
      • Ganglion abruptions
      • Parenchyma representation

Computed tomography (CT)

  • If sonography does not provide sufficient clarification.
  • With and without contrast medium
  • For differentiation between cystic, tumorous and inflammatory changes.
  • To exclude malignant (malignant) diseases.

Digital volume tomography (DVT)

Magnetic resonance imaging (MRI)

  • If sonography does not provide sufficient clarification.
  • In chronic recurrent sialadenitis of the submandibular gland: only in complicated cases.
  • To exclude malignant diseases

Sonography (ultrasound)

  • B-scan sonography
  • Usually as the first imaging procedure
  • Non-invasive
  • Especially parotid gland (parotid gland) well accessible
  • For ultrasound-targeted fine needle biopsy
  • inflammatory processes of the glandular parenchyma.
    • Acute: echo poor
    • In case of abscess (transformed pus cavity): echo empty/complex.
    • Enlargement
  • Inflammatory accompanying reactions of the ductal system.
  • Sialolith (salivary stone)
    • 90% detection reliability
    • Hard echocomplex with dorsal (“backward”) edge shadow
    • Unlike native radiography, sonographic evidence of non-shadowing stones is detectable.
    • Distinction between intraductal (“within the duct”) and intraglandular (“within the gland”) location possible.
    • Internal texture: homogeneous
    • Accumulation of the duct system
  • Chronic recurrent sialadenitis
    • Enlargement
    • Internal texture: inhomogeneous
    • Gangetic ectasia (ductal dilation)
    • Detection of obstruction (occlusion)
    • Chronic recurrent parotitis:
      • Usually normal sonogram in the interval.
  • Exclusion of tumor events
    • Benign:
      • smooth bounded
        • Echoarm
        • Echoarm
    • malignant (malignant):
      • Blurred limited
      • Inhomogeneous

Sialoscintigraphy

  • Salivary gland functional scintigraphy (synonym: salivary gland sequential scintigraphy):
    • Radioactive technetium is concentrated by the salivary glands with a factor of 100 from blood serum. After intravenous administration of the radionuclide (nuclide which it is unstable and therefore radioactive; 99mTc-pertechnetate), it initially accumulates in the glands and is excreted in saliva in response to a stimulus. This allows accurate information about the state of blood flow and secretion performance.
  • Quantitative sialoscintigraphy:
    • Employs an algorithm to objectively and measurably determine the secretory output of a gland
  • Indications:
    • For diagnosis of chronic or acute sialadenitis.
    • Precise especially for parotid glandula (parotid gland) and submandibular glandula (submandibular gland)
    • For sicca symptoms (Sjögren’s syndrome, sicca syndrome, Heerfordt syndrome).
    • For the detection of parenchymal damage due to radioiodine therapy.
    • For sialolithiasis (salivary stones
    • In the case of suspected tumor activity

Sialometry

Different methods for saliva flow rate measurement – e.g.:

  • Unstimulated salivary secretion:
    • Collection of saliva 2 min
  • Stimulated salivary secretion:
    • 30 sec chewing stimulation
    • Discard saliva
    • Collect saliva 2 min without stimulation
  • Evaluation:
    • Normal salivation: 1.0 to 3.5 ml/min
    • Hyposalivation (reduced saliva production): 0.5 to 1.0 ml/min
    • Xerostomia (dry mouth): < 0.5 ml/min