General examination methods
These techniques are used during the initial appointment and serve as the basis for making a preliminary diagnosis. They include basic clinical procedures: patient interview, visual inspection, palpation, as well as standard urine and blood tests.
During the anamnestic interview, the physician pays attention to the patient's complaints, among which the following are particularly important:
- feeling of dryness in the oral cavity;
- pain or enlargement of the glands, especially in connection with food intake or exposure to cold;
- time of onset and growth dynamics of any mass lesions.
During inspection and palpation, the consistency of the glandular tissue, the presence of swelling, and the condition of the skin over them are assessed. The mucous membrane of the mouth, lips, and vestibule is necessarily examined, the appearance of the excretory duct orifices is checked, and the volume and nature of the saliva produced are recorded.
Specific methods
If a basic examination is insufficient, more targeted procedures are resorted to.
- Duct probing. Performed with blunt-ended probes. The method helps detect strictures, areas of complete duct obliteration, or obstructions in the form of calculi.
- Radiography. Aimed at finding foreign bodies, stones, or petrificates. For the parotid gland, an anterior direct projection is used, and for the submandibular gland, a lateral projection and a projection of the floor of the mouth.
- Sialography. This is an X-ray examination using an oil-based or water-soluble contrast agent. It details the internal architecture of the ducts and parenchyma.
- Sialometry. Assessment of functional activity. Secretion is collected for 20 minutes using special cups or cannulas. The normal volume for the parotid gland ranges from 1.0 to 2.0 ml, and for the submandibular gland, from 1.0 to 4.0 ml.
Laboratory assessment of secretion
The obtained saliva undergoes comprehensive analysis:
- Visual inspection determines transparency, color, and the presence of foreign impurities.
- Using pHmetry and viscosimetry, the acidity and viscosity of the fluid are determined.
- Spectrophotometry allows for the precise calculation of the concentration of key electrolytes: sodium, potassium, and calcium.
- Cytological examination of a smear (Romanowsky-Giemsa staining) should normally show only isolated epithelial cells of the excretory ducts (squamous and columnar), as well as a small number of lymphocytes and leukocytes.
Special diagnostic methods
These examinations are prescribed for the precise determination of the form and stage of the disease.
- Computed sialotomography provides cross-sectional slices ideal for finding tumors and stones.
- Sialoscintigraphy (or radiosialography) is used for an in-depth assessment of secretory function.
- Ultrasound (sialosonography) visualizes the macrostructure, shape, boundaries of formations, and sclerotic processes.
- Thermosialography registers temperature anomalies. Hot zones are typical for acute and chronic sialadenitis, as well as malignant neoplasms.
- Diagnostic puncture serves to obtain morphological material using an injection needle.
Briefly: answers to topical questions
What specific contrast agents are used for sialography?
Fat-soluble (oil-based) and water-soluble contrast agents are used for sialography.
- Fat-soluble — Iodolipol.
- Water-soluble — Iohexol, Urografin, Verografin, sodium amidotrizoate.
Water-soluble agents are preferred because they have a less traumatic effect on the salivary gland tissue. The introduction of the contrast medium is carried out into the gland duct through special cannulas, after which radiography is performed to assess the state of the ducts and parenchyma.
What radiopharmaceuticals are used during sialoscintigraphy?
During scintigraphy (sialoscintigraphy) to assess the functional state of the salivary glands, the radiopharmaceutical Technetium [99mTc] sestamibi is used. The essence of the method lies in measuring the uptake time of this radiopharmaceutical by the salivary gland directly from the patient's blood. The higher the functional activity of the studied salivary gland, the less time is required for drug uptake.
What specific cups are used for isolated saliva collection during sialometry?
For isolated (separate) saliva collection, special Lashley-Krasnogorsky suction cups are used. Special T.B. Andreeva cannulas are also used. Secretion collection is carried out from the excretory ducts of the glands for 20 minutes.
Class and exam questions
How long does sialometry take?
Secretion collection for quantitative evaluation lasts strictly 20 minutes.
What cells can be found in a normal saliva cytogram?
Normally, only isolated cells of columnar and squamous epithelium, as well as isolated leukocytes and lymphocytes, are found.
What does thermosialography show?
It reveals a local temperature rise over the gland, which is characteristic of sialadenitis and malignant tumors.
What else to study on this topic
- Salivary gland involvement in systemic diseases (Sjögren's, Mikulicz's, etc.)
- Classification and etiology of acute and chronic sialadenitis
- Specific sialadenitis: actinomycosis, tuberculosis, syphilis
- Sialolithiasis and localization of calculi
- Classification of salivary gland cysts and tumors
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Other topics in the section "Chapter 10. Diseases and injuries of the salivary glands (V.V. Afanasiev)"
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