Submandibular Gland Ultrasound; The submandibular gland is located in the posterior part of the submandibular triangle. The borders of the submandibular triangle are formed by the anterior and posterior bellies of the digastric muscle and the body of the mandible. The space in front of the submandibular gland is occupied by connective tissue and lymph nodes.
The submandibular duct (Wharton’s duct) extends from the hilum region of the submandibular gland along the border of the mylohyoid muscle, then curves around the free portion of the mylohyoid muscle and extends medially to its opening at the sublingual caruncle.
In some patients (obese patients, those who have undergone neck irradiation), the submandibular parenchyma can suppress ultrasound waves to such an extent that not only deeper structures but also the contours of the submandibular gland cannot be visualized.
Acute Inflammation
Acute inflammation typically causes painful swelling of the salivary glands, usually bilaterally.
In acute inflammation, the salivary glands enlarge and are hypoechoic. They may be heterogeneous, containing multiple small, oval, hypoechoic areas. Enlarged lymph nodes with increased central blood flow can be seen in acute inflammation of the salivary glands.
Abscess
Abscess formation may occur during acute sialadenitis. On ultrasound, abscesses appear as hypoechoic or anechoic lesions with ill-defined margins and posterior acoustic enhancement.
Sialolithiasis
Salivary stones are most commonly found in the submandibular gland (in 60% – 90% of cases) and can be multiple in number.
On standard radiographs, intraglandular and small stones may be missed, and only about 20% of sialoliths are radiopaque. Computed tomography allows visualization of larger stones. Ultrasound is a non-invasive method and is used as the primary imaging technique in cases of clinical suspicion of a stone.
Sialolithiasis causes total or partial obstruction of the salivary duct, resulting in recurrent swelling of the salivary gland during meals.
Sialoliths in the distal part of the submandibular duct (Wharton’s duct) may be palpable on the floor of the mouth. However, sialoliths in the proximal part of the duct or within the parenchyma of the salivary glands can only be demonstrated radiologically.
The ultrasound features of sialolithiasis show hyperechoic lines or foci with distal acoustic shadowing, representing the stones. Enlarged ducts are seen in symptomatic cases with duct obstruction.
In about 50% of patients, sialolithiasis is found alongside inflammation. Hyperechoic air bubbles mixed with saliva can mimic stones in Wharton’s duct and can thus be a diagnostic pitfall.
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Dr. Abdullah Cevahir
Radiology Specialist
Hekimoğlu Imaging and Diagnostic Center