Salivary gland scintigraphy: Rediscovering an underutilized diagnostic aid

Learning Objectives 1. Review the anatomy and physiology of the salivary glands as well as some common problems encountered including sialadenitis, sialolithiasis, immune disorders affecting salivary gland, tumors and most importantly post chemo radiation sialoadenitis associated with xerostomia and miscellaneous oral complications. 2. Understand how salivary scintigraphy is performed, including quantitation techniques and interpretation, as well as its impact on clinical management.

DISCUSSION: Sialorrhea and xerostomia are common problem encountered by ENT physicians. Xerostomia in post chemo radiotherapy patients for head and neck tumors can be a very distressing problem and is seldom reversible. Several imaging modalities such as sonography, sialography, salivary scintigraphy, CT, PET, and MRI are utilized in evaluation of these disorders. Salivary gland scintigraphy using 99m TC-pertechnetate is a non-invasive tool for salivary function and quantitative assessment. While the other above mentioned modalities provide only anatomic assessment of the gland, scintigraphy can additionally assess the functional status of the gland. The anatomy and physiology of the salivary glands and ducts will be discussed and correlated with salivary gland scintigraphy. The role of semi-quantitative assessment will be explained. An ENT physician’s perspective on the utility of salivary scintigraphy and its role in treatment planning will be described. CONCLUSION: By the end of the presentation, readers will have a better understanding of the procedure and interpretation. Salivary scintigraphy remains an underutilized technique, but has excellent utility in diagnosis and management of certain disorders affecting the salivary glands and ducts. This important tool can be better utilized for providing high quality patient care.