Masseteric Space Abscess sonography

Definition — Masseteric Space Abscess: A masseteric space abscess is a localized collection of pus within the masseteric compartment, commonly secondary to odontogenic infection (especially mandibular molars), trauma, or spread from adjacent fascial spaces. It is characterized by painful swelling over the masseter region, trismus (restricted mouth opening), fever, and localized tenderness. Early recognition and drainage are critical to prevent extension into adjacent parapharyngeal or masticator spaces.

Ultrasound Report — Line: The masseteric space shows a well-defined hypoechoic to anechoic collection within the substance of the masseter muscle, measuring approximately 28 × 22 × 18 mm. The lesion shows internal low-level echoes and debris with posterior acoustic enhancement. Peripheral hyperechoic rim with increased vascularity on color Doppler is noted, consistent with inflammatory hyperemia. Adjacent soft tissue edema and loss of normal muscle architecture are present. No extension into the parotid or submandibular space identified. No evidence of underlying vascular thrombosis or bony erosion seen.
Conclusion: Findings are consistent with a Masseteric Space Abscess with associated cellulitis.
Recommendation: Recommend prompt clinical and surgical evaluation for incision and drainage or ultrasound-guided aspiration, depending on accessibility and clinical status.

Sonographic Features — Masseteric Space Abscess:

• Collection: Well-defined hypoechoic/anechoic lesion within masseter muscle with internal echoes and posterior acoustic enhancement.
• Rim: Peripheral hyperechoic rim with increased vascularity on color Doppler.
• Soft tissue: Surrounding inflammatory edema and loss of normal muscle echotexture.
• Associated cellulitis: Diffuse thickening of adjacent tissues with streaky hypoechoic changes.
• Extension: Evaluate for spread into submasseteric, pterygomandibular, or parapharyngeal spaces.

• Hypoechoic well-defined collection within masseter muscle.
• Internal echoes with posterior acoustic enhancement.
• Peripheral vascular rim on Doppler.
• Edema of adjacent tissues with loss of fascial definition.

Causes / Etiology — Masseteric Space Abscess:

• Odontogenic infection (mandibular molar periapical abscess — most common).
• Post-traumatic or post-extraction infection.
• Spread from adjacent fascial space infections (submasseteric, pterygomandibular, buccal).
• Systemic immunocompromised states (diabetes, immunosuppression).

Symptoms / Clinical Features — Masseteric Space Abscess:

• Swelling over masseter region.
• Pain, tenderness, erythema, and induration.
• Trismus (restricted mouth opening).
• Fever, malaise, and leukocytosis.
• May extend to parapharyngeal space if untreated.

Diagnostic Strategy — Masseteric Space Abscess:

• Ultrasound: First-line for detecting collections within the masseter muscle.
• CT/MRI: Useful to evaluate extension into masticator and parapharyngeal spaces.
• Differential diagnosis: Cellulitis, myositis, hematoma, neoplasm.

Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Masseteric Space Abscess: Definition, Sonographic Features, Case Studies, and Risk Assessment" has been prepared and compiled by me for educational purposes only. It is intended for learning, training, and academic reference. Sources and references have been acknowledged where appropriate.

Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.

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Masseteric Space Abscess — Sonography — Quiz

मैसेटेरिक स्पेस एब्सेस — सोनोग्राफी — क्विज़

10 MCQs — choose the best answer (A–D)

10 बहु-विकल्पीय प्रश्न — सर्वोत्तम उत्तर चुनें (A–D)

Created: Masseteric Space Abscess MCQ — bilingual (EN/HI)

Buccal space Subcutaneous abscess with celulitis sonography

Definition — Buccal Space Subcutaneous Abscess with Cellulitis: A localized collection of pus within the subcutaneous compartment of the buccal space associated with surrounding soft-tissue cellulitis. Commonly odontogenic in origin, it presents with focal fluctuance or a focal hypoechoic collection on imaging with adjacent inflammatory edema. Prompt identification and drainage are important to prevent spread to deep facial spaces and airway compromise.

Ultrasound Report- Line: Shows diffuse hyperechoic thickening of subcutaneous fat with linear hypoechoic streaks (“cobblestoning”), increased echogenicity of fascial planes, and ill-defined hypoechoic fluid pockets compatible withabsces measuring approximately 20 × 22 × 18 mm. Color Doppler shows hyperemia. In abscesses, focal complex fluid collections with irregular walls and peripheral vascularity are seen.

Conclusion: Sonographic appearances consistent with buccal space subcutaneous abscess with surrounding cellulitis.
Recommendation: obtain contrast CT/MRI if deeper space extension suspected; observe airway and follow up in 24–48 hours.

Sonographic Features — Buccal Space Subcutaneous Abscess with Cellulitis:

• Abscess cavity: Well-defined hypoechoic/anechoic collection, often with internal echoes/debris and posterior acoustic enhancement.
• Wall: Peripheral thickened wall may be seen; rim vascularity on color Doppler.
• Surrounding cellulitis: Ill-defined hyperechoic fat with hypoechoic streaks and soft-tissue edema extending into the buccal fat pad.
• Fascial plane: Loss or blurring of normal fascial plane delineation between buccal fat pad and adjacent soft tissues.
• Vascularity: Peripheral/juxta-lesional hyperemia; increased flow in adjacent inflamed tissues on color Doppler.
• Deep extension: Lack of clear sonographic involvement of deeper facial spaces should not exclude extension — CT/MRI if clinically suspected.

Ultrasound Examination:
High-frequency linear probe (7–12 MHz) used with graded compression and multiple orthogonal scans over the buccal region. Color and power Doppler applied to assess vascularity and rim hyperemia. Measurements of collection (max dimensions) and depth noted.

• Max dimensions of collection: -- × -- mm (measure and replace).
• Depth from skin surface: -- mm.
• Relationship to oral cavity / teeth: suggest odontogenic source if contiguous with periapical region.

Causes / Etiology — Buccal Space Abscess:

• Odontogenic infection (periapical / periodontal origin) — most common.
• Penetrating trauma, insect bite, or infected skin lesion.
• Spread from adjacent infected spaces (submandibular, canine space) or surgical site infection.
• Immunosuppression or poorly controlled diabetes increasing risk of aggressive infection.

Symptoms / Clinical Features — Buccal Space Abscess with Cellulitis:

• Focal cheek swelling with localized tenderness and erythema.
• Fluctuance or palpable mass when abscess superficial.
• Fever, malaise, trismus if adjacent muscles involved.
• Possible odynophagia, dysphagia or airway symptoms if extension occurs.

Diagnostic Strategy — Buccal Space Abscess:

• Ultrasound: First-line for superficial collections — identifies size, loculation, internal echoes and peripheral vascularity; useful for guided aspiration.
• Contrast CT / MRI: Recommended to evaluate deep-space extension, involvement of masticator or parapharyngeal spaces, and assessment prior to surgery if clinically indicated.
• Microbiology: Aspirate for Gram stain and culture to guide antibiotic therapy.
• Differential diagnosis: Hematoma, infected cyst, neoplasm, lymphadenitis.

Management Recommendations:
• Urgent ENT / Maxillofacial / Dental consultation for source control and definitive drainage.
• Perform ultrasound-guided needle aspiration or incision & drainage as appropriate; send pus for Gram stain, aerobic & anaerobic culture and sensitivity.
• Start empiric antibiotics targeting oral flora (example regimens: IV amoxicillin-clavulanate or IV clindamycin if penicillin allergy) — tailor to local antibiogram and culture results.
• Provide analgesia, hydration, and optimize glycemic control in diabetics.
• Obtain contrast CT/MRI if there is clinical suspicion of deep-space extension, trismus, systemic toxicity, or failure to improve after drainage.
• Monitor airway; escalate care immediately for dysphagia, dyspnea, drooling, or voice change.
• Follow-up clinical review and repeat ultrasound within 24–48 hours after intervention or sooner if worsening.

Prognosis:
With timely drainage and appropriate antibiotics most superficial buccal space abscesses resolve without sequelae. Delayed or inadequate treatment may result in spread to deeper fascial spaces, systemic sepsis, or airway compromise.

Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Buccal Space — Subcutaneous Abscess with Cellulitis: Definition, Sonographic Features, Case Management and Recommendations" has been prepared and compiled by me for educational and reporting purposes. Clinical correlation and appropriate specialist referral are advised.

Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.

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Buccal Space — Subcutaneous Abscess with Cellulitis — Quiz

बक्कल स्पेस — सबक्यटेनियस एब्सेस विद सेलुलाइटिस — क्विज़

10 MCQs — choose the best answer (A–D)

10 बहु-विकल्पीय प्रश्न — सर्वोत्तम उत्तर चुनें (A–D)

Created: Buccal Space Subcutaneous Abscess with Cellulitis MCQ — bilingual (EN/HI)

Buccal Space celulitis (Chick celulitis) sonography

Definition — Buccal Space Cellulitis: Buccal space cellulitis is an acute bacterial infection of the buccal soft tissues, usually originating from odontogenic sources, trauma, or adjacent soft tissue infection. It is characterized by diffuse inflammation, soft tissue edema, and pain. Early diagnosis is crucial to prevent abscess formation or spread into deep fascial spaces.

Ultrasound report- line The buccal space reveals diffuse ill-defined hyperechoic changes of the subcutaneous fat with increased echogenicity and thickening of the overlying soft tissues. There is loss of normal fascial plane differentiation with evidence of edema extending into the buccal fat pad. No well-formed fluid collection or drainable abscess is seen. Color Doppler demonstrates increased vascularity consistent with inflammatory hyperemia.
Cnclusion: Findings are consistent with buccal space cellulitis, characterized by diffuse soft tissue edema and inflammatory changes without evidence of a well-defined abscess/collection
Recommendation: Recommend clinical correlation and appropriate medical management Follow-up ultrasound may be performed if symptoms persist or worsen.

Sonographic Features — Buccal Space Cellulitis:

• Soft tissue echotexture: Ill-defined hyperechoic subcutaneous fat with loss of fascial plane clarity.
• Edema: Hypoechoic streaky areas within buccal fat pad and subcutaneous tissues.
• Wall thickening: Diffuse thickening of overlying soft tissues and skin.
• Vascularity: Increased color Doppler vascularity due to inflammatory hyperemia.
• Abscess formation (if present): Focal hypoechoic/anechoic collection with internal echoes and peripheral vascularity.

Ultrasound Examination:
High-frequency (7–12 MHz) linear probe used over buccal region.

• Diffuse ill-defined hyperechoic changes in subcutaneous tissue with hypoechoic streaks.
• Loss of fascial plane differentiation between buccal fat pad and adjacent soft tissue.
• Overlying skin and soft tissue thickening with increased vascularity on Doppler.
• No discrete drainable abscess identified.

Causes / Etiology — Buccal Space Cellulitis:

• Odontogenic infection (most common — molar/periapical abscess).
• Post-traumatic soft tissue infection.
• Spread from adjacent facial or submandibular infection.
• Systemic immunocompromised states (e.g., diabetes).

Symptoms / Clinical Features — Buccal Space Cellulitis:

• Cheek swelling, pain, and tenderness.
• Erythema, warmth, and induration of buccal tissues.
• Fever, malaise, leukocytosis.
• May progress to abscess if untreated.

Diagnostic Strategy — Buccal Space Cellulitis:

• Ultrasound: First-line imaging to detect cellulitis and early abscess.
• CT/MRI: Used for deep space involvement or when abscess suspected.
• Differential: Abscess, infected cyst, neoplasm, hematoma.

Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Buccal Space Cellulitis: Definition, Sonographic Features, Case Studies, and Risk Assessment" has been prepared and compiled by me for educational purposes only. It is intended for learning, training, and academic reference. Sources and references have been acknowledged where appropriate.

Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.

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Buccal Space Cellulitis — Quiz

बक्कल स्पेस सेलुलाइटिस — क्विज़

10 MCQs — choose the best answer (A–D)

10 बहु-विकल्पीय प्रश्न — सर्वोत्तम उत्तर चुनें (A–D)

Created: Buccal Space Cellulitis MCQ — bilingual (EN/HI)

Longitudinal Scanning of the Submandibular Gland- Color Doppler Flow Image

Scanning Method — Longitudinal Scanning of the Submandibular Gland (Color Doppler Flow Image): The transducer is positioned longitudinally along the submandibular region, parallel to the long axis of the gland. The probe marker is oriented anteriorly toward the chin. A high-frequency linear transducer (7–15 MHz) is recommended. After acquiring gray-scale images, Color Doppler is activated to assess vascular flow. The scan demonstrates the submandibular gland as an elongated, homogeneous structure with the Wharton’s duct extending anteriorly. Color Doppler highlights vascular landmarks, particularly the facial artery and vein near the gland hilum, and helps in evaluating glandular vascularity, detecting hyperemia in sialadenitis, or identifying abnormal flow patterns within masses or vascular lesions. Gentle angulation superior–inferior and slight medial tilting ensure complete coverage of the gland and duct.

Sectional Structures :
None or a few spots of blood flow Doppler signal in normal submandibular gland parenchyma. Sometimes facial artery may be shown running in the gland.

Doppler Measuring Methods — Submandibular Gland:

Color Doppler — Applied after gray-scale survey to assess overall vascularity of the gland and adjacent structures. Helps detect hyperemia (e.g., sialadenitis), avascular areas (e.g., abscess), or abnormal flow patterns in masses and lymph nodes.

Power Doppler — Used for detecting low-velocity flow in small intraglandular vessels or lymph nodes, providing higher sensitivity than color Doppler.

Spectral (Pulsed-Wave) Doppler — Measurements are obtained by placing a sample gate within a visible vessel (typically the facial artery branch at the gland hilum). Parameters recorded include:
– PSV (Peak Systolic Velocity) — highest velocity during systole.
– EDV (End Diastolic Velocity) — velocity at end-diastole.
– RI (Resistive Index) — calculated as (PSV – EDV) / PSV. Normal: 0.6 – 0.8.

Technique — Align Doppler angle ≤ 60° to the vessel, optimize gain and wall filter, and use appropriate pulse repetition frequency (PRF) to avoid aliasing. Measurements are averaged over at least 3 cardiac cycles for accuracy.

Parameter	Normal Value	Notes
PSV (Peak Systolic Velocity)	20 – 40 cm/s	Measured in facial artery branch at hilum
EDV (End Diastolic Velocity)	8 – 15 cm/s	Stable forward flow in normal state
RI (Resistive Index)	0.6 – 0.8	RI < 0.6 → hyperemia (acute inflammation); RI > 0.8 → chronic fibrosis or obstruction
Venous Flow (Facial / Submandibular Vein)	5 – 15 cm/s	Low-velocity, monophasic, continuous flow; no turbulence

Abnormal Color Doppler Findings :
Sialadenitis (Acute) — Marked hyperemia with prominent intraglandular color signals, reflecting increased vascularity.
Sialadenitis (Chronic) — Reduced or sparse parenchymal flow due to fibrosis and atrophy.
Sialolithiasis / Obstruction — Absence of flow within the calculus; increased color flow proximally in the periductal region.
Abscess / Phlegmon — Peripheral rim hyperemia with a central avascular core, creating a “ring of fire” appearance.
Benign Tumors — Mild to moderate internal vascularity, usually regular and organized in pattern.
Malignant Tumors — Chaotic or disorganized intralesional vascularity with high color flow density; possible neovascularity extending beyond gland margins.
Lymph Nodes — Reactive nodes show central hilar vascularity. Suspicious nodes show peripheral or mixed vascular patterns on color Doppler.

Longitudinal Scan of the Submandibular Gland

Definition — Longitudinal Scan of the Submandibular Gland: An ultrasound technique where the transducer is aligned parallel to the long axis of the submandibular gland, usually placed in the submandibular region below the mandible. This view demonstrates the gland as an elongated, elliptical structure with homogeneous echotexture, slightly hyperechoic relative to adjacent muscles. Wharton’s duct may be visualized as a thin hypoechoic tubular structure extending anteriorly. The longitudinal scan also depicts surrounding anatomical landmarks including the mylohyoid and digastric muscles, mandibular border (echogenic with acoustic shadowing), adjacent vessels (facial artery/vein), and regional lymph nodes when present.

Scanning mathod: The patient takes a supine position and extends the neck adequately. Probe Placement Place the linear high-frequency transducer in the submandibular region, just below the angle of the mandible, oriented parallel to the long axis of the gland (sagittal orientation). The probe marker should point anteriorly toward the patient’s chin. Gentle angulation superiorly and inferiorly allows full visualization of the gland, Wharton’s duct, and adjacent anatomical structures. Minimal pressure is advised to avoid compressing the gland or duct.

Section Structure: Submandibular gland is oval shaped with clear borders. The parenchymal echo character is the same to that of the parotid gland; echo density is higher than adjacent soft tissue and without pos terior attenuation. Facial artery sometimes can be shown in the gland. The normal submandibular duct cannot be shown in the image.
1. Subcutaneous fatt
2. LN- Lymph Node
3. SMG- Submandibular Gland
4. FA- Facial Artery

Measuring mathod and normal value: Longitudinal diameter and thickness can be mea sured on this section. The mean longitudinal diameter and thickness are 30mm and 1.5 mm and there is no significant difference between male and female.

Parameter	Measuring Method	Normal Value
Length (Long Axis)	Measured in longitudinal (sagittal) scan from anterior to posterior poles	30 – 40 mm
Width (Transverse)	Measured in transverse scan at widest portion	10 – 15 mm
Thickness (AP Dimension)	Measured anteroposteriorly in longitudinal scan	7 – 10 mm
Volume	Calculated using formula: Length × Width × Thickness × 0.52	~ 6 – 8 cm³ (adults)

Age Group	Length (mm)	Width (mm)	Thickness (mm)	Volume (cm³)
Neonates / Infants	10 – 20	5 – 8	3 – 5	~ 0.3 – 0.8
Children (2 – 10 yrs)	20 – 30	8 – 10	4 – 6	~ 1 – 3
Adolescents (11 – 18 yrs)	25 – 35	9 – 12	5 – 7	~ 3 – 5
Adults (≥ 19 yrs)	30 – 40	10 – 15	7 – 10	~ 6 – 8
Elderly (> 65 yrs)	28 – 38	9 – 13	6 – 9	~ 5 – 7 (may decrease due to fatty atrophy)

Common Pathologic Findings — Submandibular Gland:

1. Sialadenitis (Inflammation)
• Acute: Enlarged, hypoechoic gland, increased vascularity (Doppler).
• Chronic: Heterogeneous echotexture, reduced vascularity, atrophic changes.

2. Sialolithiasis (Ductal Calculi)
• Echogenic focus within Wharton’s duct or gland parenchyma.
• Posterior acoustic shadowing; ductal dilatation proximal to stone.

3. Neoplastic Lesions
• Benign: Pleomorphic adenoma (well-defined, hypoechoic, homogeneous).
• Malignant: Irregular, poorly defined, heterogeneous, possible infiltration of adjacent tissue.

4. Cysts
• Anechoic, well-defined lesion with posterior acoustic enhancement.
• May be congenital (ductal cysts) or acquired (post-inflammatory).

5. Abscess
• Hypoechoic/complex fluid collection, irregular walls, increased peripheral vascularity.
• Often associated with cellulitis or sialadenitis.

6. Lymphadenopathy
• Reactive: Oval nodes with preserved fatty hilum.
• Suspicious: Round nodes, loss of hilum, peripheral/chaotic vascularity.

7. Autoimmune Disorders
• (e.g., Sjögren’s syndrome) — Enlarged, heterogeneous gland with multiple small hypoechoic areas (“salt and pepper” or “honeycomb” pattern).

8. Trauma / Post-surgical Changes
• Heterogeneous echotexture, scar tissue, or hematoma depending on stage.

Para-parotid Gland (Transverse Scan)

Para-parotid Region — Transverse Scan (Ultrasound): The para-parotid region refers to the soft tissues immediately adjacent to the parotid gland (parotid tail, superficial fat planes, masseteric and buccal spaces, intraparotid and peri-parotid lymph nodes and adjacent fascia). A transverse (short-axis) ultrasound scan is used to assess cross-sectional anatomy, detect focal lesions that abut the gland, and evaluate lymphadenopathy or inflammatory collections in the para-parotid soft tissues.Anatomical Landmarks: On transverse scanning the key external landmarks are the zygomatic arch superiorly, the angle of the mandible inferiorly, the preauricular skin crease laterally, and the masseter muscle and mandibular ramus medially. Internally, look for the parotid parenchyma, Stensen’s duct as it crosses the masseter, superficial fascial planes, and adjacent lymph nodes.

Scanning Method: Para-parotid gland usually lies between anterior border of the main parotid gland and the masseter muscle. Probe Placement & Sweep (Transverse Technique): Place the transducer perpendicular to the long axis of the gland (short axis) across the preauricular region. Orient the probe so the image shows lateral (skin) to medial (mandible/masseter) structures. Sweep superior → inferior and anterior → posterior to include the full para-parotid space, tail of parotid, and superficial lymph node stations. Repeat the transverse sweep while angling slightly cephalad/caudad to interrogate hidden pockets or ductal segments.

Section Structure or What to Evaluate: On the transverse section, the normal para- parotid gland is a thin solid area which has a well circumference and with the same echogenic feature with the main parotid parenchyma. There is a very thin connection between the para and main parotid gland.

1. APG- Anterior parottid gland
2. PG- Parotid gland
On transverse views assess: contour and echotexture of the parotid and para-parotid fat, presence of focal masses or cysts adjacent to the gland, enlarged or abnormal lymph nodes (shape, hilum, cortical thickness), ductal dilatation, focal fluid collections/abscesses with internal echoes, and relationship of lesions to the mandible and masseter. Use color Doppler to evaluate internal vascularity (helps differentiate inflammatory vs cystic vs neoplastic processes).

Measurement mathod: Measure maximal transverse diameter of any lesion, record its depth from skin, note echotexture, presence/absence of internal vascularity (color/power), and relation to parotid gland and mandible. Compare with the contralateral side and document probe frequency, patient position, and Doppler settings used.

Notes:The connection of the para and main parotid glands shown during continuous ultrasound scan is the key point to avoid misdiagnosing the para- parotid gland as a solid neoplasm.

Normal Sonographic Appearance: Para-parotid soft tissue normally shows thin hyperechoic subcutaneous fat and anechoic/heterogeneous connective planes. Small intraparotid or peri-parotid lymph nodes (oval with echogenic hilum) may be seen. No abnormal focal mass, fluid collection, or asymmetric vascularity should be present.
Anatomimical appearance

Sonographic appearance

Common Pathologic Findings — Para-parotid Gland / Region:

• Lymphadenopathy — Most frequent finding; enlarged oval/round nodes. Reactive nodes show preserved fatty hilum and hilar vascularity, whereas suspicious nodes show loss of hilum, round shape, peripheral or chaotic vascularity.

• Abscess / Phlegmon — Irregular hypoechoic or complex collection with internal echoes and peripheral vascularity; may extend from dental, skin, or parotid infection.

• Cystic Lesions — Congenital (branchial cleft cyst) or acquired (infected cyst, lymphoepithelial cyst). Anechoic with posterior enhancement; may have internal debris if complicated.

• Benign Tumors — Lipoma (hyperechoic, compressible, no Doppler flow), Fibroma, or hemangioma. Usually well-circumscribed.

• Malignant Infiltration — Extension of parotid carcinoma, lymphoma, or metastatic nodes; appears as irregular, heterogeneous hypoechoic mass infiltrating fat planes.

• Vascular Anomalies — Prominent external carotid branches or venous malformations; tubular/serpiginous channels with flow on Doppler.

• Post-treatment Changes — Fibrosis, scarring, or necrotic nodes after radiotherapy or surgery.

Reporting: A concise report should state side examined, probe frequency, normal/abnormal findings of the para-parotid soft tissues, size and description of any focal lesion, Doppler vascularity, suggestion of likely diagnosis (e.g., reactive node, abscess, cyst, neoplasm), and recommendation for further imaging or FNAC/biopsy if indicated.

ultrasound sample reprt of cheek

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B-Mode Gray-scale ultrasound report sample of right cheek

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Patient Information
Name: __________________________
Patient ID: _____________________

Age / Sex: ______________________
Referring Doctor: ________________
Date of Exam: ___________________
Exam Performed By: ______________

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HR-Sonography of Right cheek (Parotid, Para-parotid & Submandibular Region)

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High-frequency linear probe (7–15 MHz) used. B-mode grayscale imaging performed for right cheek, parotid gland, para-parotid region, and submandibular gland. Color and spectral Doppler applied for vascular evaluation. Comparison made with contralateral side where appropriate.

Gray-scale findings
Parotid Gland: The right parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.

Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Adjacent Soft Tissues of cheek region: The adjacent soft tissues, including the overlying skin, subcutaneous tissue, and masseter muscle, appear normal in thickness and echotexture with no evidence of edema, infiltration, fluid collection, or abnormal calcification.

Regional lymph nodes: The regional lymph nodes are within normal limits, appearing small, oval in shape with preserved fatty hila and normal hilar vascularity. No enlarged or morphologically suspicious lymph nodes are seen in the examined region

Impression (Conclusion)-

Normal parotid, para-parotid, and submandibular glands.

                           OR

Diffuse heterogeneous echotexture with increased vascularity → Sialadenitis. 

                            OR

Well-defined hypoechoic lesion in right parotid superficial lobe, ___ × ___ mm, with [peripheral/internal] vascularity → Suggests pleomorphic adenoma/Warthin’s; recommend FNAC/MRI.

                           OR

Echogenic calculus ___ mm with posterior shadowing in [Stensen’s / Wharton’s duct] → Sialolithiasis with ductal dilatation.

                             OR

Irregular ill-defined lesion with heterogeneous echotexture and abnormal intralesional vascularity ± adjacent invasion → Suspicious for malignant lesion.

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B-Mode Gray-scale ultrasound report sample of left cheek

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Patient Information
Name: __________________________
Patient ID: _____________________

Age / Sex: ______________________
Referring Doctor: ________________
Date of Exam: ___________________
Exam Performed By: ______________

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HR-Sonography of Left cheek (Parotid, Para-parotid & Submandibular Region)

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High-frequency linear probe (7–15 MHz) used. B-mode grayscale imaging performed for right cheek, parotid gland, para-parotid region, and submandibular gland. Color and spectral Doppler applied for vascular evaluation. Comparison made with contralateral side where appropriate.

Gray-scale findings
Parotid Gland: The left parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.

Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Adjacent Soft Tissues of cheek region: The adjacent soft tissues, including the overlying skin, subcutaneous tissue, and masseter muscle, appear normal in thickness and echotexture with no evidence of edema, infiltration, fluid collection, or abnormal calcification.

Regional lymph nodes: The regional lymph nodes are within normal limits, appearing small, oval in shape with preserved fatty hila and normal hilar vascularity. No enlarged or morphologically suspicious lymph nodes are seen in the examined region

Impression (Conclusion)-

Normal parotid, para-parotid, and submandibular glands. Regional lymph node and soft tissue is un-remarkabale

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B-Mode Gray-scale ultrasound report sample of bilateral cheek

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Patient Information
Name: __________________________
Patient ID: _____________________

Age / Sex: ______________________
Referring Doctor: ________________
Date of Exam: ___________________
Exam Performed By: ______________

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HR-Sonography of Bilateral cheek (Parotid, Para-parotid & Submandibular Region)

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High-frequency linear probe (7–15 MHz) used. B-mode grayscale imaging performed for right cheek, parotid gland, para-parotid region, and submandibular gland. Color and spectral Doppler applied for vascular evaluation. Comparison made with contralateral side where appropriate.

Gray-scale findings
Right Parotid Gland: The right parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.
Left Parotid Gland: The right parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.

Right Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Left Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Right Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Left Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Right Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Left Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Adjacent Soft Tissues of cheek region: The adjacent soft tissues, including the overlying skin, subcutaneous tissue, and masseter muscle, appear normal in thickness and echotexture with no evidence of edema, infiltration, fluid collection, or abnormal calcification.

Regional lymph nodes: The regional lymph nodes are within normal limits, appearing small, oval in shape with preserved fatty hila and normal hilar vascularity. No enlarged or morphologically suspicious lymph nodes are seen in the examined region

Impression (Conclusion)-

Normal parotid, para-parotid, and submandibular glands. Regional lymph node and soft tissue is un-remarkabale

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Doppler ultrasound report sample of right cheek

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Patient Information
Name: __________________________
Patient ID: _____________________

Age / Sex: ______________________
Referring Doctor: ________________
Date of Exam: ___________________
Exam Performed By: ______________

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HR-Dopler Sonography of Right cheek (Parotid, Para-parotid & Submandibular Region)

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High-frequency linear probe (7–15 MHz) used. B-mode grayscale imaging performed for right cheek, parotid gland, para-parotid region, and submandibular gland. Color and spectral Doppler applied for vascular evaluation. Comparison made with contralateral side where appropriate.

Gray-scale findings
Parotid Gland: The right parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.

Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Adjacent Soft Tissues of cheek region: The adjacent soft tissues, including the overlying skin, subcutaneous tissue, and masseter muscle, appear normal in thickness and echotexture with no evidence of edema, infiltration, fluid collection, or abnormal calcification.

Regional lymph nodes: The regional lymph nodes are within normal limits, appearing small, oval in shape with preserved fatty hila and normal hilar vascularity. No enlarged or morphologically suspicious lymph nodes are seen in the examined region

Doppler Assessment
Parotid arterial branches:

PSV: ___ cm/s

EDV: ___ cm/s

RI: ___ (Normal = 0.6–0.8)

Venous flow (parotid vein): [Low-velocity monophasic continuous (~5–15 cm/s) / Abnormal turbulence / reversal]

Impression (Conclusion)-

Normal parotid, para-parotid, and submandibular glands. Regional lymph node and soft tissue is un-remarkabale

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Doopler ultrasound report sample of Left cheek

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Patient Information
Name: __________________________
Patient ID: _____________________

Age / Sex: ______________________
Referring Doctor: ________________
Date of Exam: ___________________
Exam Performed By: ______________

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HR-Doppler Sonography of Left cheek (Parotid, Para-parotid & Submandibular Region)

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High-frequency linear probe (7–15 MHz) used. B-mode grayscale imaging performed for right cheek, parotid gland, para-parotid region, and submandibular gland. Color and spectral Doppler applied for vascular evaluation. Comparison made with contralateral side where appropriate.

Gray-scale findings
Parotid Gland: The right parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.

Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Adjacent Soft Tissues of cheek region: The adjacent soft tissues, including the overlying skin, subcutaneous tissue, and masseter muscle, appear normal in thickness and echotexture with no evidence of edema, infiltration, fluid collection, or abnormal calcification.

Regional lymph nodes: The regional lymph nodes are within normal limits, appearing small, oval in shape with preserved fatty hila and normal hilar vascularity. No enlarged or morphologically suspicious lymph nodes are seen in the examined region

Doppler Assessment
Parotid arterial branches:

PSV: ___ cm/s

EDV: ___ cm/s

RI: ___ (Normal = 0.6–0.8)

Venous flow (parotid vein): [Low-velocity monophasic continuous (~5–15 cm/s) / Abnormal turbulence / reversal]

Impression (Conclusion)-

Normal parotid, para-parotid, and submandibular glands. Regional lymph node and soft tissue is un-remarkabale

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Doppler ultrasound report sample of bilateral cheek

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Patient Information
Name: __________________________
Patient ID: _____________________

Age / Sex: ______________________
Referring Doctor: ________________
Date of Exam: ___________________
Exam Performed By: ______________

---

HR-Doppler Sonography of Bilateral cheek (Parotid, Para-parotid & Submandibular Region)

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High-frequency linear probe (7–15 MHz) used. B-mode grayscale imaging performed for right cheek, parotid gland, para-parotid region, and submandibular gland. Color and spectral Doppler applied for vascular evaluation. Comparison made with contralateral side where appropriate.

Gray-scale findings
Right Parotid Gland: The right parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.
Left Parotid Gland: The right parotid gland is normal in size with smooth contour, homogeneous echotexture, and preserved glandular architecture. No focal lesion, ductal dilatation, or intraglandular calculus is seen. Color Doppler shows normal sparse parenchymal vascularity.

Right Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Left Para-parotid Region: The para-parotid region demonstrates normal soft tissue echotexture without evidence of mass, abnormal thickening, or infiltration. No pathological lymphadenopathy is identified

Right Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Left Duct (Stensen’s): Stensen’s duct is well-visualized with normal caliber, without dilatation or intraductal echogenic calculus. No peri-ductal thickening or surrounding abnormality is seen.

Right Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Left Submandibular Gland: The right submandibular gland is normal in size, with smooth margins and homogeneous echotexture. No focal lesion, intraglandular calcification, or ductal dilatation is identified. Wharton’s duct is of normal caliber without evidence of calculus. Adjacent soft tissues and regional nodes appear unremarkable.

Adjacent Soft Tissues of cheek region: The adjacent soft tissues, including the overlying skin, subcutaneous tissue, and masseter muscle, appear normal in thickness and echotexture with no evidence of edema, infiltration, fluid collection, or abnormal calcification.

Regional lymph nodes: The regional lymph nodes are within normal limits, appearing small, oval in shape with preserved fatty hila and normal hilar vascularity. No enlarged or morphologically suspicious lymph nodes are seen in the examined region

Doppler Assessment
Parotid arterial branches:

PSV: ___ cm/s

EDV: ___ cm/s

RI: ___ (Normal = 0.6–0.8)

Venous flow (parotid vein): [Low-velocity monophasic continuous (~5–15 cm/s) / Abnormal turbulence / reversal]

Impression (Conclusion)-

Normal parotid, para-parotid, and submandibular glands. Regional lymph node and soft tissue is un-remarkabale

Longitudinal Scanning of the Parotid Gland: Color Doppler Flow Image

Scanning Method: Continuous longitudinal and transverse scan of the parotid gland region is performed with patient supine (posterior part of the face, inferior to the zygomatic arch, anterior and inferior to the exter nal auditory meatus, anterior to the mastoid pro cess, superficial to the masseter muscle, posterior to the ramus and angle of mandible); jugular lymph nodes should also be examined at the same time. Minimal pressure should be used to avoid influence of the blood signal.

Section Structure:None or a few spots of blood flow Doppler signal will appear in normal parotid gland parenchyma. External carotid artery may be shown running in the deep gland occasionally.

Parotid Artery Doppler — Normal Reference Table

Parameter	Normal Range / Finding	Abnormal / Suggestive of Pathology
Peak Systolic Velocity (PSV)	20 – 40 cm/s	> 40 cm/s → hyperemia, inflammation, tumor
End Diastolic Velocity (EDV)	5 – 15 cm/s	↑ with hyperemia; ↓ with obstruction
Resistive Index (RI)	0.6 – 0.8	< 0.6 → sialadenitis, Sjögren’s > 0.8 → tumor, obstruction
Color Doppler Pattern	Sparse, fine vascular signals; symmetric	Increased focal flow or hot spots → inflammation or tumor

Parotid Vein Doppler — Normal Reference Table

Parameter	Normal Range / Finding	Abnormal / Suggestive of Pathology
Venous Flow Velocity	5 – 15 cm/s	High velocity or turbulence → vascular lesion / fistula
Flow Pattern	Monophasic, low velocity, continuous	Reversal or disturbed flow → obstruction or abnormal shunting
Symmetry	Similar venous waveform on both sides	Asymmetry → local pathology or compression

Clinical Application Value: Increase of blood signals in all kinds of inflammation

Clinical Notes:

• In sialadenitis (acute/chronic): increased vascularity, RI often decreases (<0.6)
• In tumors (e.g., pleomorphic adenoma, Warthin’s tumor, malignancy): vascularity pattern changes, RI may be >0.8
• Sjogren’s syndrome: Heterogeneous echotexture with altered vascular distribution

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Parotid Color Doppler — Quiz (Longitudinal View)

पैरोटिड कलर डॉप्लर — क्विज़ (लम्बवत दृश्य)

10 MCQs — choose the best answer (A–D)

10 बहु-विकल्पीय प्रश्न — सर्वोत्तम उत्तर चुनें (A–D)
Created: Parotid Color Doppler MCQ — bilingual (EN/HI)