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Sialography Indications — MFDS Part 1 MCQ

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ModerateOral MedicineSialography IndicationsMFDS Part 1

A 46-year-old patient reports recurrent unilateral submandibular swelling and discomfort during meals. Between episodes, there is no fever, purulent duct discharge or palpable glandular mass. Which underlying abnormality is conventional contrast sialography best suited to demonstrate?

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Correct answer: B — Salivary duct obstruction caused by a calculus or stricture

Conventional sialography involves cannulation of a major salivary duct followed by injection of radiographic contrast, allowing detailed assessment of the ductal system. Recurrent meal-related swelling is characteristic of impaired salivary outflow, and sialography can demonstrate obstructing calculi, filling defects, duct strictures and associated duct dilatation. A solid salivary mass is initially assessed with ultrasound, with MRI or CT used when deeper extension requires evaluation. MRI is the investigation of choice for temporomandibular joint internal derangement, while CT is used for clinically significant maxillary sinus disease. Acute suppurative sialadenitis is not the principal indication for invasive contrast duct imaging.

Reference: East Lancashire Hospitals NHS Trust. Clinical Radiology Referral Guidelines: Head & Neck Referrals, section 'Salivary obstruction'. June 2024. https://elht.nhs.uk/download_file/view/4447/5019