ULTRASOUND OF

THE SUBMANDIBULAR SALIVARY GLANDS - Normal

   

 

For normal anatomy and scanning protocol

 

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Submandibular Gland scan plane Submandibular Gland scan plane

Submandibular Gland scan plane

The normal submandibular gland is homogeneous in echotexture.

Intra-oral scanning:

  •     Can assist with assessing the ampulla and papilla.
  •     Use a probe with a small footprint (hockey stick is ideal).
  •     Some patients will not be able to tolerate this technique as they feel like "gagging".
  •     Remove any false teeth as this will improve the area for you to scan in.
  •     Get the patient to roll their tongue back out of the way.
  •     Ensure the probe is covered in a non latex cover .
  •     The patient is required to hold a small amount of water in floor of their the mouth to scan to scan through.
  •     Inform the patient to tap you on the arm if they need you to stop or they need to swallow.


Intra-oral view of the Wharton's duct ampulla.

 

U/S OF THE SUBMANDIBULAR GLAND - PROTOCOL

ROLE OF ULTRASOUND

Intraglandular and extraglandular lesions to be localised and differentiated.
To identify the cause of:

  • A palpable lump in the gland/neck.
  • The patient can sometimes palpate a stone under the mandible or under their tongue. The stone can block the duct causing infection and swelling.
  • Pain
  • Mumps
  • Illness, including mouth or dental infections
  • Mouth dryness
  • Abnormality on previous xrays,CT or sialogram
  • Guidance of injection, aspiration or biopsy

PATIENT PREPARATION

  • 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.

SCANNING TECHNIQUE

  • Supine position.
  • 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.
  • The intraglandular ducts are small linear hypoechoic parallel stripes.
  • 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 starts from within the hilum of the gland , follow the duct to the submental region .It is easiest to find it in the superficial portion of the duct which is the medial part of the submandibular gland and runs around the posterior border of the myohyoid muscle. Then medial to the sublingual gland to the papilla at the floor of the mouth.
  • The Kuttner lymph node is between the parotid and submandibular gland.

Optional Intra-oral scanning:

  • Can assist with assessing the ampulla and papilla.
  • Use a probe with a small footprint (hockey stick is ideal).
  • Some patients will not be able to tolerate this technique as they feel like "gagging" .
  • Remove any false teeth as this will improve the area for you to scan in.
  • Performed with the patient erect
  • Get the patient to roll their tongue back out of the way.
  • Ensure the probe is covered in a non latex cover.
  • The patient is required to hold a small amount of water in floor of their the mouth to scan to scan through.
  • Inform the patient to tap you on the arm if they need you to stop or if they need to swallow.

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
  • Left side of the neck
  • Document the normal anatomy. Any pathology found in 2 planes, including measurements and any vascularity.

 

 
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