return to: Sialography - How To and Do I Need To?

Presentation: 67 yo with painful swelling left submandibular gland preceding 2 years with intermittent pain "7 / 10" radiating to left ear

Exam: clear saliva expressed from right but not left smg; o/w unremarkable

CT: Unremarkable - no gland abnormality and no stone

Ultrasound (POCUS): 

Sialogram

Outcome: 

Presentation to Clinic June 2022: Painful swelling left submandibular gland preceding 2 years with intermittent pain "7 / 10" radiating to left ear

Sialogram August 2022: pre-stricture (proximal) ductal dilation - no perceived benefit in symptoms from sialogram

Sialendoscopy under general anesthesia with dilation and steroid insufflation January 2023: at best offered only minor improvement with still ongoing concerns that may have improved slightly but her perception that she is not getting saliva from that gland

In-Clinic Ultrasound guided botulinum (Botox®) injection: persistence of submandibular pain and swelling after sialendoscopy warranted further treatment including option of gland resection - chose in-clinic botulinum injection

Follow-Up 3 Months After Botox Injection: "feeling a lot better" following the Botox injection by way of 30 units delivered with ultrasound guidance to the left submandibular gland June 4, 2024. Still sometimes "get achy when she gets too tired" but relates it is relieved the constant and intense pain that she had previously sufficiently to the point that when I identified the potential value for a second injection, she felt she was not there yet, but should symptoms recur she may contact us.

Follow-Up 12 Months After Initial Botox Injection received second botulinum toxin injection (40 units in 0.4 cc)