return to: Sialography - How T and Do I Need To? Contemporary Infusion Digital Sialography

Presentation: 62 yo with one year history of recurrent right parotid swelling and pain with intermittent intraoral drainage exacerbated by meals requiring 5 separate courses of antibiotics for sequential episodes lasting up to 3 days each

Exam: Soft nontender right parotid - intraoral unremarkable; s/p left parotidectomy for tumor

CT: unremarkable

Ultrasound (POCUS): 

 

Panel Discussion Regarding Management

Sialogram: 

Performed with 24-gauge angiocatheter - following sialogram, further dilation of duct with 22-gauge angiocatheter over 0.015-inch guidewire - unable to advance 20-gauge catheter.

Outcome:

1. Immediately after sialogram in clinic: no tenderness or pain - no change from parotid which had not caused pain for a week before the sialogram
2. One month after sialogram - 'easier to expel saliva with massage' and had one episode of pain and swelling resolved immediately with massage
3. 8 months after sialogram reported one brief episode of discomfort relieved with massage 

4. 13 months after sialogram reported recurrent swelling, pain and drainage in mouth 

   Options discussed: sialendoscopy under general anesthesia (possible stent); in-clinic dilation

5. 15 months after sialogram

   In Clinic Procedure Parotid Duct Dilation (5 Fr Dilator), Cannulation and Kenalog 10 Insufflation "Ultrasound Sialogram"  (see further below)

6. 3 years 4 months after sialogram (2 years and 1 month after most recent dilation in clinic):

   No further pain or swelling to parotid - practices routine massage prophylactically.  

Procedure Note

In-Clinic 15 months after sialogram 

Ultrasound Sialography - Parotid Duct Cannulation, Dilation, with Triamcinolone Insufflation