Lesson 2A (Part 3)

Question 1

What is the role of US when looking at the salivary glands? (7)

Answer 1

1. Find palpable lumps in the gland/neck
2. Identify pain
3. Look for mumps
4. Look for illnesses
   - including mouth or dental infections
5. Identify mouth dryness
6. Recognize abnormality on previous x-rays, CT or sialograms
7. Guidance of injection, aspiration or biopsy

Question 2

What is a scanning technique when scanning the salivary glands in supine? (3)

Answer 2

1. Tip the patient’s head back for better access
2. Compare both sides
   - should look the same
3. Scan the entirety of the gland from midline to lateral several times

Question 3

What are you asses when you are scanning the salivary glands? (4)

Answer 3

1. Size
2. Increased vascularity
3. Any abnormality in the surrounding anatomy
   - including the lymph nodes
4. Duct dilatation
   - use Colour Doppler confirm its a duct not a vessel

Question 4

Where does the duct start?

Answer 4

From within the hilum of the gland

- follow the duct to the submental region

Question 5

Where is the kuttner lymph node located?

Answer 5

Between the parotid and submandibular gland

Question 6

What is the sonographic appearance of the glands? (2)

Answer 6

1. Hypoechoic
2. Homogeneous echotexture
   - similar to a muscle’s echogenicity

Question 7

What is the sonographic appearance of the intraglandular ducts?

Answer 7

Small linear hypoechoic parallel stripes

Question 8

How long is the submandibular duct in diameter?

Answer 8

No more than 2mm

- whole length is often not all seen

Question 9

Why should the parotid gland be more attenuative than the submandibular gland?

Answer 9

Because of its fat content

Question 10

Where does the parotid duct start?

Answer 10

From the level of the ear lobe and courses across the cheek via the accessory parotid gland
- the duct is not visible unless dilated

Question 11

When are sublingual glands typically seen on US?

Answer 11

If they have pathology

- dilated

Question 12

What is the normal size of a sublingual gland?

Answer 12

32 x 12mm

Question 13

What is the sublingual gland obsured by?

Answer 13

The mandible anteriorly

Question 14

What is the sonographic appearance of the sublingual gland? (2)

Answer 14

1. Homogeneous
2. Hyperechogenicity
   - similar to the parotid gland

Question 15

What is the best position to scan the sublingual glands?

Answer 15

Transverse and longitudinal planes from the submental position
- under the chin

Question 16

Sialography

Answer 16

Injecting contrasts into the salivary gland and tries to see what happens to the parotid gland itself
- this is usually done with x-ray