Position the patient in the supine position with the head maximally tilted to the back. To obtain the transverse view of the submandibular gland, position the transducer just below the angle of the mandible at the submandibular area. Examine the entire submandibular gland from anterior to posterior, the mandible, mylohyoid muscles, and the anterior belly of the digastric muscles bound it.
Obtain the longitudinal view by placing the probe medial to the horizontal body of the mandible. Visualize the facial artery in this plane. Save and label the images in both transverse and longitudinal views of the submandibular gland.
Assess the size of the submandibular gland. Examine the echogenicity of the submandibular gland, which is usually less echogenic than the parotid gland. Assess the degree of inhomogeneity, the clearness of the gland margin and the presence of hypo or an-echoic areas within the glands.
Note the presence of focal lesions. Grade the degree of inhomogeneity using the OMERACT score. If the evaluation of the gland is not possible due to qualitative parameters, follow the alternate grading parameters.
Measure the size of the submandibular lymph nodes, evaluate fatty hilums, shape, echogenicity and preservation. Repeat the scanning at the contralateral submandibular gland and compare the size and echo texture between the two submandibular glands. Normal submandibular glands demonstrated a clear demarcation with the overlying structures.
