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TECHNICAL NOTES
Vol. 115
graphy with Xylocaine injection to localize the source of obscure pain in patients with previous calcaneal fractures. This distinction is not academic; stenosing peroneal tenosynovitis may require only excision of a protruding calcaneal spicule or fibular tip whereas "subtalar" arthritis may necessitate an extensive arthrodesis.
REFERENCES 1. Bassett 0: A Stereoscopic Atlas of Human Anatomy. Portland, Sawyer's Inc., 1962 2. Burman M: Stenosing tendovaginitis of the foot and ankle; studies with special reference to the stenosing tendovaginitis of the peroneal tendons at the peroneal tubercle. Arch Surg 67:686-698, Nov 1953
Technical Notes
3. Deyerle, WM: Long term follow-up of fractures of the os calcis. Diagnostic peroneal synoviagram. Orthop Clin North Am 4: 213-227, Jan 1973 4. Garcia A, Parkes J: Fractures of the foot. (In1 Foot Disorders, Medical and Surgical Management, ed. by N Giannestras. Philadelphia, Lea & Febiger, 1973 5. Grant JCB: An Atlas of Anatomy. Baltimore, Williams and Wilkins, 6th ed, 1972 6. Romanes G.: Cunningham's Textbook of Anatomy. London, Oxford University Press, 10th ed, 1964 7. Webster FS: Peroneal tenosynovitis with pseudotumor. J Bone Joint Surg [A mer] 50:153-157, Jan 1968 1 From the Department of Radiology, Veterans Administration Hospital, and University Hospital, University of California, San Diego, Calif. Accepted for publication in December 1974. dk
TECHNICAL NOTES
Instrumentation for Salivary Duct Cannulation 1 Barry H. Martin, M.D. The use of lacrimal probes to locate and dilate the ducts of major salivary glands is described. This technique greatly facilitates cannulation for sialography. INDEX TERMS:
Salivary glands, radiography
Radiology 115:213. April 1975
=====(~~ . ==== Fig. 1.
When the orifice of a major salivary duct is large and prominent, sialography is easily performed. However the opening is often barely visible and will not accommodate the commonly used sialography cannula- or needles. The value of lacrimal probes'' to locate and dilate the duct is well known to otolaryngologists but not appreciated by many radiologists.
Lacrimal probes.
Patient, gentle, blind probing for the orifice is done with the size 0000 probe at the center of the papilla beside the frenulum of the tongue or opposite the second upper molar tooth. The probe will fall into the duct much as a selective vascular catheter enters an aortic branch vessel. Further dilatation and cannulation is then rapidly accomplished. Lacrimal probes are available in sizes 0000 through 8 (Fig. 1). Only the smallest caliber probe ends are useful in sialography.
REFERENCE TECHNIQUE The patient sucks a wedge of lemon briefly after which a number 0000 lacrimal probe is inserted into the duct. The duct is dilated by successively larger caliber probes until the cannula just fits snugly in the duct. Injection and filming can then be accomplished with the cannula securely in place and without significant leakage of contrast material. This technique is usually successful even when the duct of Stensen or (more commonly) Wharton is not visible.
1. Meine FJ, Woloshin HJ: Radiologic diagnosis pf salivary gland tumors. RadiolClin North Am 8:475-485. Dec 1970
1 From the Department of Radiology, Clara Maass Memorial Hospital, Belleville. N. J. Address reprint requests to 28 Notch Hill Dr., Livingston, N. J. 07039. Accepted for publication in October 1974. 2 Sialography set, No. SCS-T-32, Cook, Inc., Bloomington, Ind. 3 Bowman lacrimal probes, 6-160 through 6-165, Edward Week and Co., Inc., Long Island, N. Y. vb