Are you having salivary gland and duct issues such as a blockage from a salivary stone or narrowing which is causing you pain and your doctor has suggested to you, to have a sialogram x-ray test to help diagnose any issues affecting the area.
As a diagnostic radiographer who works with a team which performs these procedures. I do hear many questions from people wondering how a sialogram test is done and what to expect after the procedure.
So, in the article I will answer the most frequently asked questions relying on my experience and scientific studies on the subject matter.
Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: November, 2025. Written by Juliet Semakula, a diagnostic radiographer.
| Summary: A sialogram is performed to investigate and diagnose problems with the salivary glands and their ducts, such as blockages, stones, infections, inflammation, or tumours.This test provides detailed information about the structure of the glands and ducts, helping doctors determine the cause of symptoms like pain and swelling during meal times, and to decide on further treatment options. |
▶️What is a sialogram?
A sialogram is an X-ray procedure that uses a special X-ray dye (contrast medium) to visualize the salivary glands and their ducts, typically to diagnose issues that may be affecting the glands and ducts.
The mouth has parotid or submandibular glands which help to drain saliva into your mouth through small tubes called ducts.
The duct openings are located in your cheeks and under your tongue.
These ducts are not easy to see on ordinary x-ray images, so a contrast medium x-ray dry is used to see them more clearly on the images.
▶️There are three different types of imaging that can be used to perform these procedures.
1️⃣Conventional or fluoroscopic sialography.
2️⃣ CT sialography (ultrafast technique)
3️⃣MR sialography. This uses a heavily T2-weighted sequence to demonstrate the salivary ducts, thus may or may not need canalization.
However, for this article focus is on the fluoroscopic sialography which we normally perform.
▶️Why would your doctor request a fluoroscopic sialogram test?
When you have salivary glands which are swollen and painful for some time and your doctor thinks there may be something causing the symptoms.
He will request a sialo-gram to help determine what is causing the swelling and pain.
Here are some of the symptoms that may lead to a sialogram.
🔴Pain and swelling in the month or around the glands especially during eating or after which could be caused by infection in the ductal system.
🔴Difficulty opening your mouth when eating, this could be caused by blockages interfering with saliva production which is a necessity for eating and digestion.
🔴Suspected Blockage: Help identify blockages like salivary stones.
🔴Narrowing (Stricture: A sialogram can identify narrowing or strictures within the salivary ducts, which can impede saliva flow.
🔴Non-tumour inflammatory and obstructive salivary gland pathologies such as sialadenitis, sialolithiasis, sialadenosis, ductal strictures.
Kandula,2023
A sialogram test will help to check for any blockages in your salivary glands and help doctors to plan the best treatment for you.
▶️How accurate is a sialogram x-ray test?
A sialogram X-ray is a highly accurate test for identifying larger salivary duct issues such as:
➡️Detects blockages in the salivary gland ducts.
➡️ Identifies stones or strictures.
The X-ray images offer detailed information about the structure of your salivary glands and ducts which helps in treatment and diagnosis.
The dye used helps visualize abnormalities within the salivary glands and ducts, like a stone (calculus) or a narrowing of the duct (stricture).
However, its accuracy varies depending on the specific condition being investigated research done by Thorpe et al 2021, that analysed over 337 patients who reported salivary symptoms such as pain swelling and discomfort prior to their sialogram
A sialography test was done to identify parotid and submandibular ductal issues.
Had these observations:
➡️ 50 to 75% had a moderate narrowing of a duct within, leading to impaired flow of the fluid it carries and potentially causing symptoms or complications.
Here is an example of a case study of a patient who had a sialogram test done and confirmed the presence of a submandibular duct stone located at the hilum of the gland
Action taken:
The duct was subsequently cannulated, and the stone removed fluoroscopically.
Image 1 shows a plan x-ray without contrast and image 2 shows contrast x-ray dry of A sialo gram confirming the presence of a submandibular duct stone located at the hilum of the gland (image from radiopaedia)
▶️Preparation for a sialogram test?
Before you come in for the procedure you will normally be given these instructions.
⚫If you have had a recent infection involving your salivary gland within six weeks of your appointment, you should let the doctor know before the test.
We may need to postpone your test until the infection has completely gone.
Reason being if you have an active infection, to prevent complications, such as the contrast agent potentially leaking into the tissue, causing severe pain and a foreign body reaction.
You will have to wait for the infection to resolve until the salivary duct system is clear and allows for an accurate and safer examination, leading to better treatment planning.
⚫If you are or think you may be pregnant, this test uses radiation, so there is a risk to your unborn baby. For safety reasons, the test is postponed until after you give birth.
⚫ If you are allergic to iodine or contrast medium the liquid used during the test, let the team know before the test if.
⚫Eating and drinking You may eat and drink normally before the test.
⚫ If you are on any medications, you normally continue to take all your normal medications unless your doctor says no.
⚫Jewellery, please remove necklaces, earrings and nose studs before you come to your appointment.
▶️How is a sialogram test performed?
These tests are performed by trained radiologists and radiographers.
Steps taken:
1️⃣The test will explain to you to make sure you fully understand the procedure before asking you for your consent to proceed.
2️⃣You will then be asked to lie on an examination table flat on your back. This will allow x-ray images to be taken from different angles.
3️⃣ You will be asked to open your mouth wide to identify the duct opening of the problematic salivary gland.
4️⃣To help find the duct opening, you will be given some lemon juice, as this will open your salivary ducts.
5️⃣Once the duct opening is located, a catheter (a thin, plastic tube) will be inserted.
6️⃣When the catheter is in place, a small amount of contrast medium will be injected through it to fill the gland.
7️⃣During the process x-ray images will be taken in different angles and the catheter will be removed.
8️⃣At the end of the test, you will be given more lemon juice to drink. This will encourage your gland to drain the contrast medium into your mouth.
9️⃣ Patients normally claim the lemon test is bitter but there are no harmful side effects from swallowing it.
Once your gland is empty, final x-ray images are taken and the whole procedure is done which normally takes 15 minutes.
The lemon juice test in your mouth usually takes 30 minutes to disappear. And the contrast dry leaves your system within 24 hours through urination.
▶️Is a sialogram painful?
I have always had people ask if the sialogram test is painful, the answer to this is NO.
Patients normally experience some mild pressure in the salivary gland when the contrast medium is injected.
And others claim a slight swelling after the test. This may be a little uncomfortable, but not painful.
Note! You will NOT NEED to have any anaesthetic (medications used during tests and surgical operations to numb sensation in certain areas of the body or induce sleep).
▶️What should I expect after a sialogram?
Normally after your procedure you will be advised to go home or return to work (you can resume normal activities immediately after the test).
You will be advised to drink plenty of fluids after the test to keep hydrated and massage the gland that has been examined to ensure it drains wells. This will also reduce the chance of developing an infection.
Normally some radiologists may tell you what they have seen on the x-ray, but a full report will be sent to the doctor who requested the test within two weeks or less.
▶️ Are there risks with a sialo-gram?
As with any medical procedure, there are some possible risks, and side effects you may have after the procedure though very rare.
Here are some of the side effects I normally see some patients have:
🔵 Slightly swollen glands which can be managed by massaging the gland after the test, this helps to reduce swelling.
🔵Have an allergic reaction to the contrast medium used during the test, however before it is given a checklist of any allergies and other medical conditions you may have which may increase your risk of having an allergic reaction.
However, it is still possible to have an allergic reaction to the contrast medium without having an underlying health condition.
If you do have an allergic reaction, it will normally happen straightaway, and you will be given treatment straight away in the radiology department.
Other delayed reactions may include:
🔵Nausea (feeling sick) and vomiting (being sick)
🔵Diarrhoea
🔵Abdominal pain
🔵Dizziness
🔵Headache
These symptoms are rare and usually disappear within a few hours without treatment.
However, if you have any concerns about your symptoms always contact your GP or nearest emergency department for advice.
🔵Some patients normally have a concern of being exposed to radiation during the procedure.
The truth is we do take precautions during x-ray, and we will not expose you to any more radiation than is necessary.
Here is another article about radiation safety during x-ray procedures.
We have come to the end of this article and I hope I have given some reassurance on what to expect. Wishing you a quick recovery!🙋
📚Source:
Thorpe RK, Foggia MJ, Marcus KS, Policeni B, Maley JE, Hoffman HT. Sialographic Analysis of Radioiodine-Associated Chronic Sialadenitis. Laryngoscope. 2021 May;131(5):E1450-E1456. doi: 10.1002/lary.29279. Epub 2020 Nov 17. PMID: 33200832; PMCID: PMC10049839.
Kandula S, Nagi R, Nagaraju R. Sialography: a pictorial review. Oral Radiol. 2023 Apr;39(2):225-234. doi: 10.1007/s11282-022-00668-1. Epub 2022 Dec 23. PMID: 36562930.
Images from : https://radiopaedia.org/cases/submandibular-duct-stone