Note the submandibular ganglion, nerve to mylohyoid and how the lingual nerve swerves around the duct
The normal parotid gland appears homogeneous andof increased echogenicity relative to adjacent muscle onultrasound. This increased echogenicity is related to thefatty glandular tissue composition of the gland.
Sonography of the parotid glands in this patient reveal: a) bilateral microabscess formation with b) swollen glands c) hypoechoic lesions. These ultrasound images suggest inflammation s/o parotitis.ParotitisInflammation of one or both parotid glands is known as parotitis. The most common cause of parotitis is mumps. Widespread vaccination against mumps has markedly reduced the incidence of mumps parotitis. The pain of mumps is due to the swelling of the gland wlithin its fibrous capsule (see histology).
1) bilateral hypoechoic, well defined masses (larger on the right side) which show no significant acoustic enhancement. 2)The lesion in the right parotid measures 2.5 x 1.6 x 1.2 cms. and that on the left side measures 0.7 cms.3) Fine septae are seen within the masses. 4) Color doppler imaging shows multiple vessels within the mass with typical low velocity flow. These findings suggest either pleomorphic adenoma of the parotids or Warthin'stimour. Absence of posterior acoustic enhancement in these ultrasound images suggests that this is a Warthin's tumour of the parotid gland. Histopathological study confirmed this to be Warthin's tumour.
Sonography of the parotid gland s was done in this 2 yr. old child, to evaluate a swelling in the right parotid region. Ultrasound and Power Doppler / Color Doppler images reveal: a) Marked swelling of the right parotid gland b) multiple anechoic and hypoechoic cystic spaces within the right parotid gland c) marked augmentation of vascularity in the right parotid gland. These ultrasound images suggest right parotid abscess. The child had earlier episodes of pain and swelling in this region. The left parotid gland appears normal
ultrasound image shows a large calculus (stone) in the left submandibular duct (Wharton duct), close to its opening under the tongue (the sublingual caruncle). This orifice is close to the sublingual salivary gland. The Wharton duct calculus (CALC) is seen as a markedly hyperechoic linear structure within the dilated duct of the left submandibular salivary gland. Note also the dilatation of the intraglandular part (within the submandibular gland) of the Wharton duct. Chronic obstruction can cause infections and subsequent atrophy of the submandibular salivary gland, if left unresolved. Ultrasound image of Wharton duct calculus is courtesy of Dr. Ravi Kadasne, MD, UAE.
This elderly patient showed a gradually enlarging mass of the right parotid area. Sonography of the right parotid gland showed a 14 x 22 mm. hypoechoic, well defined mass within the parotid gland. It showed a homogenous and well encapsulated appearance. These ultrasound images favor a diagnosis of a benign tumor of the parotid salivary gland. Biopsy of the mass showed it to be Parotid gland Schwannoma (the tumor having arisen from the facial nerve within the parotid). Ultrasound and other imaging methods may not be able to accurately differentiate Schwannoma from other parotid tumors. Ultrasound images of parotid schwannoma is courtesy of Mr. Shlomo Gobi, Israel.
Conventional sialogram showing that some branch ducts arising superiorly from the hilum of the submandibular gland seemed todistribute in the cavity area
A, Plane throughsuperior part of parotid gland. Note relation of deep part of gland as it wrapsaround back of mandible passing lust anterior to tip of mastoid process andlying adjacent to styloid process which separates it from neurovascularbundle.
B, Plane through middle of parotid gland showing its relative radiolucencycompared to adjacent muscles. Retromandibular vein and externalcarotid artery branches are distinctly seen posterior to mandible. Deep lobelies immediately lateral to fat-filled lateral pharyngeal space and posterolateralto pterygoid muscles.
C, Plane through hyoid bone and middle of superficialpart of submandibular gland. Gland lies just anterior to sternocleidomastoidmuscle and is of about same radiodensity as adjacent muscle soft tissues,although shoulder artifacts make sternocleidomastoid muscle appear moredense on this illustration.
A, Plane through posteriormaxillary sinus, through middle of masseter muscle and therefore anteriorto parotid gland. Slightly irregular radiolucency of sublingual gland (andadjacent submandibular duct) just above mylohyoid muscle and lateral tointrinsic tongue muscles. (This scan is not normal; normal appearance ofmaxillary sinus is solid black.)
B, Plane through posterior part of mandibularramus includes anterior part of relatively lucent parotid gland and posteriorinferior part of masseter muscle. Uncinate part of submandibular gland isseen as it passes around back of mylohyoid muscle.
C. Plane throughposterior part of parotid gland where it is intimately related to externalauditory canal. Note its close approximation to skull base and C1.
A pleomorphic adenoma in the superficial lobe of the left parotid gland of a 70-year-old woman. (a) An axial T1W image (500/14, TR/TE) showing a mass lesion that is hypointense (arrow) to gland parenchyma and isointense compared with muscle. (b) An axial T2W image (3800/90, TR/TE) showing a mass lesion that is isointense (arrow) with gland parenchyma and hyperintense compared with muscle. (c) An apparentdiffusion coefficient (ADC) map showing a solid lesion (arrow) with high ADC (1.5461023 mm2 s21).
An adenocarcinoma located in the deep lobe of the left parotid gland of a 62-year-old man. (a) A non-contrast axial T2W image (3800/90, TR/TE) showing a heterogeneous hypointense mass (arrows) relative to the gland parenchyma. Note the ill-defined contour of the lesion. (b)A non-contrast axial T1W image (500/14, TR/TE) showing mass (arrows), hypointense to gland parenchyma. (c) An apparent diffusion coefficient (ADC) map image showing the lesion (arrows) with an intermediate ADC of 1.19 6 1023 mm2 s21.
OVERVIEW OF ANATOMY
1)- DEVELOPMENTAL AND GROSS ANATOMY
2)- ULTRASOUND FEATURES
3)- X RAY
4)- CT AND MRI ANATOMICAL LOCATION
• Appear early - sixth week of prenatal age.
• The epithelial buds of these glands are located on the inner
part of the cheek, near the labial commissures of the
• Grow posteriorly toward the otic placodes of the ears and
branch to form solid cords with rounded terminal ends near
the developing facial nerve.
• 10 weeks of prenatal development, these cords are
canalized and form ducts, with the largest becoming the
parotid duct for the parotid gland.
• Secretion by the parotid glands via the parotid duct begins
at approximately 18 weeks of gestation.
Inferior and anterior to the external acoustic meatus and
posterior to the mandibular ramus and anterior to the
mastoid process of temporal bone.
• The vestibule of oral cavity through Stensen duct or
parotid duct that emerges from the anterior border of the
gland, superficial to the masseter muscle pierces the
buccinator muscle, then opening up into the oral cavity on
the inner surface of the cheek, usually opposite the
maxillary second molar.
• The parotid papilla is a small elevation of tissue that marks
the opening of the parotid duct.
Surfaces and borders
• The gland has four surfaces superficial or
lateral,superior, anteromedial and
• The gland has three borders anterior, medial and
• The Parotid gland has two ends: superior end in
the form of small surface and an inferior end
Structures that pass through the gland
These are from lateral to medial:
(1) Facial nerve
(2) Retromandibular vein
(3) External Carotid artery
(4) Superficial temporal artery
(5) branches of the great auricular nerve
The gland is mainly irrigated by External Carotid
artery via the posterior auricular artery and the
Venous return is to the Retromandibular vein.
The gland is mainly drained into the preauricular or
parotid lymph nodes which ultimately drain to the
deep cervical chain.
• Develop later than the parotid glands and appear late in the sixth
week of prenatal development.
• They develop bilaterally from epithelial buds in the sulcus
surrounding the sublingual folds on the floor of the primitive
• Arise of solid cords branch from the buds and grow
posteriorly, lateral to the developing tongue. The cords of the
submandibular gland later branch and then become canalized to
form the ductal part.
• The submandibular gland acini develop from the cords’ rounded
terminal ends at 12 weeks, and secretory activity via the
submandibular duct begins at 16 weeks. Growth of the
submandibular gland continues after birth.
• Lying superior to the digastric muscles, divided into
superficial and deep lobes, which are separated by the
• The superficial lobe comprises most of the gland, with the
mylohyoid muscle runs under it. The deep lobe is the
In the evaluation of the functional integrity of the salivary glands
In case of obstructions
To evaluate the ductal pattern
In case of facial swellings, to rule out salivary gland pathology
In case of intra-glandular neoplasms.
Persons who are allergic to iodine and/or contrast medium.
Cases where there is acute infection,
patients with thyroid function tests
When calculi are located in anterior part of the salivary gland duct
CT OF SLIVERY GLAND
It is a fatty glandular tissue that is encased in a dense
capsule. Because of this, the parotid gland on CT is
consistently more lucent (-25 to 10 Hounsfield units
[H]) than surrounding muscles (35-60 H) and likewise
is distinctly more radiodense than adjacent fat in the
subcutaneous tissues, infratemponal fossa, and
lateral pharyngeal space(-125 to -50 H)(figs.
1A, 1B, and 2B).