From Big Medical Encyclopedia

SIALOGRAFIYA (Greek sialon saliva +-grapho to write, represent; synonym salivografiya) — a method of rents-genokontrastiogo or a radio isotope research of big sialadens — parotid, submaxillary (submandibular, T.) and hypoglossal.

The X-ray contrast sialografiya is the basic rentgenol. by method of a research sialadens (see). Its wide use in clinic began since the end of the 20th after emergence iodated oil, and later and water-soluble radiopaque substances (see).

Indications to S. arise at inflammatory processes and tumors of sialadens, a sialolithiasis, Shegren's syndrome, etc.

Contraindications the acute inflammation of a mucous membrane of an oral cavity and nipple of an output channel of a sialaden, and also hypersensitivity of the patient to iodine serve. A relative contraindication is the acute inflammation of a sialaden and its output channel.

The research is begun with performance of survey pictures of area of the studied gland or glands in direct and side (braid) projections. Then enter a special cannula, a thin polyethylene catheter or the blunted syringe needle into an opening of an output channel of gland. Introduction of a catheter is more preferable since facilitates further manipulations. The cannula or a catheter are advanced to the canal on depth no more than 10 mm, then through them slowly enter into the canal Iodolipolum, propilyodon or the water-soluble contrast agents (50 — 60% solution of Hypaque, Urografinum, etc.) which are previously warmed up to body temperature. A contrast agent is entered before emergence in sick feeling of a raspiraniye of gland. Usually for a research 0,5 — 1 ml of a contrast agent there are enough. After filling of channels make pictures in direct and side projections at once (at S. of submaxillary glands — also in an axial projection). If necessary the usual X-ray analysis is supplemented tomography (see), pan-tomography (see) or a X-ray analysis with direct blowup. Make pictures for assessment of secretory function of gland every 30 min. during the 2nd hour. Water-soluble drugs normal disappear from channels in 20 — 30 min., the oil iodated contrast agents, to-rye in a crust, time are applied seldom, are late in channels much longer.

Fig. 1. Sialogramma of the left submaxillary gland at a sialolithiasis: 1 — varton a channel; 2 — the defect of filling in an expanded proximal part of a vartonov of a channel caused by existence of a large concrement; 3 — channels of the second or third order (are expanded owing to disturbance of outflow of saliva).

At all forms of an inflammation of sialadens (see. Sialadenitis ) The page allows to reveal characteristic changes of output channels, to estimate disturbance of their motive function, to establish a stage of a disease, to find the abscesses and cysts connected with system of output channels. At sialolithiasis (see) by means of S. reveal low-contrast stones; besides, she helps to specify their quantity, the sizes, existence of the accompanying inflammatory changes (fig. 1). Tumors of sialadens (see) are shown at S. by defects of filling in system of salivary channels. Characteristic sialografichesky signs of a syndrome of Shegren (see. Shegrena syndrome ) narrowing of channels of sialadens and a gnezdny atrophy of their parenchyma are.

At S. are possible perforation of a channel the entered tools and short-term hypostasis of a sialaden soon after the research. In case of development of suppuration in connection with perforation of a channel treatment is carried out as at purulent sialadenitis (see).

A radio isotope sialografiya (a synonym a radiosialografiya) — a method of a research of function of sialadens with the help radio pharmaceuticals (see); it is based on ability of sialadens to accumulate and emit the administered intravenously radio headlights-matsevtichesky drug with saliva. The method is applied generally to a research parotid glands (see). As indications to a research serve various forms hron. parotitis, a xerostomia (see), sialolithiasis (see). Radio isotope S. allows to estimate as concentration, secretory, and excretory functions of big sialadens. The method has no special contraindications. At radio isotope S.'s carrying out it is necessary to consider the general requirements to work with radiofarmatsevti-chesky drugs (see. Radio isotope diagnosis ).

The superficial arrangement of parotid glands gives the chance to bring directly to them scintillation sensors and to carry out continuous graphic registration of changes of content of radionuclide in iron.

For radio isotope S. use 99m Ts-pertekhnetat (see. Technetium ), to-ry enter intravenously. After administration of radiofarmatsevti-chesky drug radiation is recorded at the same time over both parotid glands and in addition over heart or a hip (the last — for obtaining comparative data on the content of radionuclide in blood). In the 30th minute after administration of drug investigated is given 5 g of sugar for stimulation salivations (see).

Fig. 2. These radiosialografiya are normal: fat and thin solid lines — radioyeialogramma according to the right and left parotid glands; the dashed line reflects process of receipt in blood and removal from it of radio headlights-matsevtichesky drug; and — vascular — the first concentration, in — excretory — the second concentration pieces radiosialogramm; the continuous arrow specified the moment of administration of ra-diofarmatsevtichesky drug, by a dotted arrow — the moment of stimulation of salivation; on abscissa axis — time (in minutes), on ordinate axis — the level of activity.

These radiosialografiya of not changed sialaden (fig. 2) are presented in the form of three curves: two parallel, reflecting the level of accumulation of radionuclide the right and left parotid glands and the third reflecting the radioactivity of blood registered over heart or a hip.

On a radiosialogramma of each parotid gland distinguish: a) the vascular piece of a curve corresponding to the moment of intake of radionuclide in gland and surrounding fabrics; b) a concentration piece — the period of accumulation of radionuclide in a parotid gland which is lasting on average 25 — 30 min. and characterized by rather uniform radioactivity; c) an excretory piece — the period of decrease in radioactivity in iron after reception of a stimulator of salivation, allocation of a radioactive ekskret in an oral cavity and its proglatyvaniye; d) the second concentration piece (after the end of action of a food irritant).

Initial stage hron. parotitis (see) on a radiosialogramma it is characterized by the increased accumulation of radionuclide in iron and lengthening of the period of its maximum accumulation. In the subsequent stages of a disease note reduction of accumulation of drug up to total absence of accumulation at severe defeat of gland. At xerostomias (see) radiosialogram-we usually observe change of both parotid glands. At a xerostomia of the I degree accumulation of radionuclide increases whereas at II and especially the III extents of defeat considerably goes down.

An informative method of a radio isotope research of sialadens is also their dynamic stsintigrafiya on the scintillation gamma camera (see. Stsintigrafiya ).

Bibliography: Andreyeva T. B. Experience of studying of function of big sialadens of the person, Stomatology, No. 2, page 39, 1965; Zedgenidze G. A. Radiodiagnosis of diseases of sialadens, D., 1953; Lindenbratenl. And Naumov L. B. Methods of X-ray inspection of bodies and systems of the person, Tashkent, 1976; P f a n n B., Lowicke G. and Endert G. Function of parotid sialadens is normal according to a stsintigrafiya with "tts, Medical radio-gramophones., t. 22, No. 12, page 38, 1977; Yudin L. A. New tracer techniques of a research of sialadens and diagnostic opportunities, M., 1971; Diseases of the salivary glands, ed. by R. M. Rankow a. I. M. Polayes, Philadelphia, 1976; Garusi G. F. The salivary glands in radiological diagnosis, Basel — N. Y., 1964; Kitamura T. Atlas of the salivary glands, Tokyo, 1972; M a n with u-so A., Rice D. Hanafee W. Computed tomography of the parotid gland during contrast sialography, Radiology, v. 132, p. 211, 1979; Schulz H. G. Das Rontgenbild der Kopfspeicheldriisen, Lpz., 1969.

V. V. Kitayev; L. A. Yudin (I am glad.).