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

Presentation: 45 yo with left parotid swelling and pain beginning 6 months previously with episodes lasting 2 hours (4-6/10 pain) with baseline discomfort (2-3/10 pain) not clearly associated with meals.

Exam: clear saliva expressed from ducts of all four glands, left parotid slightly tender otherwise normal to palpation 

CT: Unremarkable - no gland abnormality and no stone

Ultrasound (POCUS):

Sialogram: 

reported the infusion caused discomfort of the same quality and same location as presenting complaint

Click on video below:

Managment:

Modify parotid massage technique to grasp the oral commissure and pull forward to straighten duct while performing massage of the gland: the "Molotkova Maneuver"

Outcome:

Reported using the technique on multiple occasions "made a huge difference", and that it “worked wonders” to relieve minor parotid discomfort and prevent progression to swelling and pain. 

References

Stephens EM, Nesmith WE, Ogden MA, Chang JL. Masseter Muscle Size in Chronic Parotid Sialadenitis. Laryngoscope Investig Otolaryngol. 2025 Jun 10;10(3):e70160. doi: 10.1002/lio2.70160. PMID: 40497034; PMCID: PMC12150150.

Wenzel PA, Thorpe RK, Maley JE, Policeni BA, Beichel RR, Henkle KD, Hoffman HT. Stensen's Duct Dynamic Anatomy Assessed with Sialography. Ear Nose Throat J. 2024 Aug 27:1455613241272451. doi: 10.1177/01455613241272451. Epub ahead of print. PMID: 39192625.