Patient Preparation: No specific fasting or systemic preparation is required. Patients are advised to remove external objects such as spectacles, earrings, or nose pins that may interfere with probe contact. The skin surface should be free from cosmetics, creams, or ointments to allow optimal gel coupling. The procedure is explained beforehand to ensure patient comfort and cooperation. In rare cases of intraoral scanning, a sterile probe cover may be used, and topical anesthetic can be applied if the patient is sensitive.
Probe selection (high-frequency linear):Use a high-frequency linear transducer (7–15 MHz) for optimal superficial detail. A small-footprint linear or hockey-stick probe is preferred for deep anterior cheek or intraoral ductal evaluation.
Patient Positioning: The patient is placed in a comfortable supine position on the examination couch. A small pillow under the shoulders may be used to slightly extend the neck. The head is turned gently to the opposite side of the area being examined, exposing the cheek region fully. Facial muscles should be relaxed, with the mouth closed but not clenched. For intraoral approaches, the patient may be positioned supine or seated upright with the mouth slightly open.
Abbreviations:
PG Patotid gland
ECA External carotid gland
APG Para-parotid gland
LN Lymph node
FA Facial artery
SMG Submandibular gland
Scanning Technique: Apply gel on the cheek and perform external transcutaneous scanning in both transverse and longitudinal orientations. This approach evaluates soft tissues, buccinator muscle, ducts, and surrounding salivary glands.
1. Longitudinal Scanning of the Parotid Gland
2. Longitudinal Scanning of the Parotid Gland: Color Doppler Flow Image
3. Para-parotid Gland (Transverse Scan)
4. Longitudinal Scan of the Submandibular Gland
5. Longitudinal Scanning of the Submandibular Gland: Color Doppler Flow Image
External cheek approach: A high-frequency linear transducer (7–15 MHz) is applied over the cheek with acoustic gel. Longitudinal and transverse scans are performed, with comparison to the contralateral side to detect asymmetry. The technique allows detailed visualization of soft tissue, ducts, vascularity, and focal lesions.
Intraoral approach (optional, for ductal detail): AFor ductal or minor salivary gland detail, insert a hockey-stick or small-footprint probe into the oral cavity using a sterile probe cover. This allows evaluation of Stensen’s duct, sialoliths, and peri-ductal inflammation.
Scan planes: transverse & longitudinal: Use transverse (axial) and longitudinal (sagittal) scans through the buccal space. Perform oblique sweeps if necessary for complete lesion evaluation and ductal mapping.
Use of color Doppler for vascularity and duct evaluation: Apply color or power Doppler to assess vascularity, detect hyperemia in inflammatory conditions, and differentiate vascular from solid lesions. Keep PRF low for superficial slow-flow lesions. Doppler can also demonstrate salivary flow and duct patency.
Dynamic maneuvers: Ask the patient to puff the cheeks, clench the teeth, or move the jaw. These maneuvers demonstrate lesion mobility, relation to muscles, and ductal patency under dynamic conditions.
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