Stensen's Duct Dynamic Anatomy Assessed with Sialography

Area of Science:

• Radiology
• Medical Imaging
• Anatomy

Background:

• Static imaging methods for sialography obscure distal ductal anatomy.
• Dynamic changes in the flexible salivary ductal system are not well-assessed by current techniques like cone beam computed tomography and magnetic resonance sialography.

Purpose of the Study:

• To introduce and evaluate a novel approach using dynamic infusion digital sialography to analyze the complete Stensen's duct.
• To identify dynamic changes in the parotid gland's Stensen's duct anatomy.

Main Methods:

• Retrospective review of 409 parotid sialograms, selecting 14 cases (7 normal, 7 with strictures).
• Dynamic (fluoroscopic) infusion sialography with contrast (iopamidol/gadolinium) was performed.
• Measurements of duct length and masseteric bend angle were taken in repose, during catheter withdrawal (stretch), and after withdrawal (recoil).

Main Results:

• Stensen's duct length increased by a median of 6.3% during catheter withdrawal (P < .001).
• The angle of the masseteric bend significantly increased from 117.7° in repose to 155.4° during catheter withdrawal (P < .001).
• This dynamic technique allowed unobstructed visualization of the distal duct.

Conclusions:

• Dynamic infusion digital sialography with fluoroscopic recording during catheter removal enables unobstructed assessment of the distal duct.
• The technique effectively captures the dynamic nature, varying length, and angulation of Stensen's duct.
• This method offers a comprehensive analysis of parotid gland ductal anatomy.