To begin, turn the patient's head to the opposite side of the gland being examined. Place the transducer longitudinally along the anterior border of the parotid gland, just anterior to the ear and parallel to the tragus, and move it from the superior to the inferior pole of the gland. To obtain the standard view, place the probe transversely at the angle of the mandible to obtain the transverse scan.
Ideally, the parotid gland is located between the mastoid and mandible ramus in a transverse view. Scan the parotid gland transversely from the superior to the inferior pole. Slide the probe below the mandibles ramus to visualize the parotid glands deep part, which the mandible could partially obscure.
Place the probe between the mastoid process and the angle of the mandible. Save and label the images in both the longitudinal and transverse views. Assess the size of the parotid gland.
Compare the echogenicity with that of the thyroid gland, which is similar to the normal parotid gland. Turn on the color doppler to differentiate blood vessels from the dilated intraglandular duct, the retromandibular vein and external carotid artery divide the superficial and deep parotid lobes. Capture the degree of in homogeneity, the clearness of the gland margin, and the presence of hypo or anechoic areas.
Note the presence of focal lesions and document the size, location, shape, and echogenicity. Turn on the color doppler to look for vascularity. Score the degree of sonographic involvement on a scale of zero to three as defined on the screen.
The presence of lymph nodes within the parotid gland could be normal and common, especially when located in the superficial lobe. Measure the diameter of the lymph nodes. Evaluate the shape, echogenicity, and preservation of fatty hillam.
Repeat the scanning at the contralateral parotid gland and compare the size and echo texture between the two parotid glands. Normal parotid glands appeared homogenous with clear demarcation with overlying tissues and muscles.
