Return to: Salivary Duct Stenosis (or click for more detail: Etiology / Classification / Management) 

Evaluation based on presenting signs and symptoms

1. Ultasound considered first (and sometimes last) radiographic evaluation
2. In our practice - Hoffman et al (Thorpe 2020, Foggia 2020, Truong 2018) we begin with ultrasound and consider CT or MRI and commonly perform a sialogram
   1. The duct cannulation and dilation are all done with microscopic control by the surgeon in the radiology suite
   2. Radiocontrast dye (water soluble Isovue 370) is instilled by radiology with assistance by the surgeon
   3. Example (Blake Sullivan 2018): Parotid Sialogram with Foreign Body

Role for sialography (see: Sialograms and Sialography)

1. According to many it is "a difficult invasive procedure with radiation exposure and therefore is not indicated"
2. According to practice at the University of Iowa it is not considered difficult nor invasive 
   1. Valuable in delineating ductal anatomy in a way not possible by other means
   2. Useful in identifying accessibility to the duct under local anesthesia before subjecting a patient to a general anesthesia
   3. May be therapuetic by the process of dilating the distal duct (relieving distal stricture) and flushing the gland with radiocontrast
   4. Useful in identifying normal ductal anatomy to redirect evaluation of pain away from salivary origin (ddx now directed to TMJ, dental, 'atypical facial pain')
   5. Identify abnormalities that can be addressed w/o sialendoscopy (normal duct anatomy with acinar abnormalities treated in clinic with steroid infusion)
   6. Prepare surgical approach (open vs endoscopic) – assist in patient counseling

References

Goncalves M, Mantsopoulos K, Schapher M, Iro H, Koch M. Ultrasound in the diagnosis of parotid duct obstruction not caused by sialolithiasis: diagnostic value in reference to direct visualization with sialendoscopy. Dentomaxillofac Radiol. 2020 Oct 8:20200261. doi: 10.1259/dmfr.20200261. Epub ahead of print. PMID: 33002385.

Koch M, Iro H. Salivary duct stenosis: diagnosis and treatment. Acta Otorhinolaryngol Ital. 2017 Apr;37(2):132-141. doi: 10.14639/0392-100X-1603. PMID: 28516976; PMCID: PMC5463521.

Thorpe RK, Foggia MJ, Marcus KS, Policeni B, Maley JE, Hoffman HT. Sialographic Analysis of Radioiodine-Associated Chronic Sialadenitis. Laryngoscope. 2020 Nov 17. doi: 10.1002/lary.29279. Epub ahead of print. PMID: 33200832.

Foggia MJ, Peterson J, Maley J, Policeni B, Hoffman HT. Sialographic analysis of parotid ductal abnormalities associated with Sjogren's syndrome. Oral Dis. 2020 Jul;26(5):912-919. doi: 10.1111/odi.13298. Epub 2020 Mar 3. PMID: 32031309.

Truong K, Hoffman HT, Policeni B, Maley J. Radiocontrast Dye Extravasation During Sialography. Ann Otol Rhinol Laryngol. 2018 Mar;127(3):192-199. doi: 10.1177/0003489417752711. Epub 2018 Jan 7. PMID: 29308655.

Blake Sullivan C, Hoffman H. Dynamic imaging with sialography combined with sialendoscopy to manage a foreign body in Stensen's duct. Am J Otolaryngol. 2018 May-Jun;39(3):349-351. doi: 10.1016/j.amjoto.2018.03.001. Epub 2018 Mar 3. PMID: 29525141.