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This page is a 4th menu tier: Small Parts--->Salivary Glands---->Parotid Gland---->Normal
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[parotitis]-------------> [parotitis hl]
U/S OF THE PAROTID GLAND PROTOCOL
ROLE OF ULTRASOUND
Intraglandular and extraglandular lesions to be localised and differentiated.
To identify the cause of:
- A lump in the gland/neck. The patient can sometimes palpate a stone under the mandible.The stone can block the duct causing infection and swelling.
- Illness, including mouth or dental infections
- Mouth dryness
- Abnormality on previous xrays,CT or sialogram
- Guidance of injection, aspiration or biopsy
- Low collared shirt
- May have to remove jewellery
- Towel across the chest/shoulders
- Lie the patient so their head is at the top of pillow and tipped right back.
- A pillow or towel can be placed under the shoulders.
EQUIPMENT SELECTION AND TECHNIQUE
Use of a high resolution 7-14mHz linear transducer. You may need to use a lower frequency or curved linear probe (5-7MHz)to visualise the deep portion of the submandibular or parotid glands.
Good colour / power / Doppler capabilities when assessing vessels or vascularity of a structure.
Be prepared to change frequency output of probe (or probes) to adequately assess both superficial and deeper structures.
- Tip the patient's head back for better access.
- Assess the gland's echogenicity. It should be hypoechoic with a homogeneous echotexture compared to the surrounding tissue, similar to a muscle's echogenicity.
- Due to it's fat content, the parotid will be more attenuative than the submandibular gland.
- Compare both sides
Scan the entirety of the gland from midline to lateral several times to assess :
- The size
- For increased vascularity
- Any abnormality in the surrounding anatomy including the lymph nodes.
- Duct dilatation (use Colour Doppler so you do not mistake a vessel to be a dilated duct)
- The duct runs from the deep gland into the lingual frenulum.
- The Duct starts from the level of the ear-lobe and courses across the cheek via the accessory parotid gland (the duct generally will not be visible unless dilated).
- The Kuttner lymph node is between the parotid and submandibular gland.
BASIC HARD COPY IMAGING
A salivary gland series should include the following minimum images:
- Submandibular gland, Long & trans
- Submandibular duct
- Parotid gland, long & trans
- Accessory parotid gland
- Right side of the neck and lymph nodes
- Left side of the neck and lymph nodes
- Document the normal anatomy. Any pathology found in 2 planes, including measurements and any vascularity