Identification of feeding arteries to establish the intra- or extraparotid location of jugulodigastric nodules: value of color Doppler sonography

OBJECTIVE

The objective of our study was to determine the value of color Doppler imaging as an adjunct to gray-scale sonography to reveal the intra- or extraparotid origin of jugulodigastric nodules of uncertain location.

SUBJECTS AND METHODS

Forty nodules in the jugulodigastric area from 38 patients were imaged with gray-scale, color, and power Doppler sonography. Nodules receiving vessels from salivary glands were assumed to be intraglandular; those accepting vessels from paraparotid spaces were considered to arise from outside the gland. Imaging results were correlated with biopsy and surgical findings.

RESULTS

In 38 of 40 cases, color and power Doppler sonography displayed discrete feeding arteries leading to the nodules: 25 nodules had one supplying artery, nine received two arteries, and four had three or more arteries. Intraparotid nodules received vessels from the gland in 20 cases. In two cases, the source of vessels was indeterminate. In two malignant tumors, multiple arteries derived from both the parotid and the neck spaces. All 14 extraparotid nodules received the arterial supply from paraparotid spaces. Color Doppler sonography enabled prediction of the intraglandular location of the nodules in 91% of cases and the extraglandular location in 87.5% of cases. The correct diagnosis was achieved in 34 of 40 nodules, with a global accuracy of 85%.

CONCLUSION

Color Doppler sonography can help to assess the intra- or extraparotid location of jugulodigastric nodules. In practice, this technique can support the diagnosis when gray-scale sonography raises doubts about the origin of a jugulodigastric nodule.

Anterior facial vein and submandibular gland together: predicting the histology of submandibular masses with CT or MR imaging

PURPOSE

To test the hypothesis that the relationship of the anterior facial vein to the submandibular salivary gland and a mass in the submandibular fossa could help identify the origin of the mass at computed tomography (CT) or magnetic resonance (MR) imaging.

MATERIALS AND METHODS

Thirteen patients with 14 palpable submandibular masses, surgical and histologic confirmation, and contrast material-enhanced CT images (12 patients) or MR images (one patient) that showed the anterior facial vein were identified with review of files from 1985 to 1997. Six patients had submandibular gland disease: three with primary neoplasms, two with metastatic tumor invading the gland, and one with chronic sialoadenitis. Eight patients had masses arising outside the gland (seven with lymphadenopathy, one with a plexiform neurofibroma).

RESULTS

The anterior facial vein did not separate primary tumors, tumors invading the gland, or lobulations of the enlarged gland from the body of the gland. The vein was identified between enlarged lymph nodes and the gland. The vein did not separate the gland from the neurofibroma, but this tumor was medial to the gland; the vein runs lateral to the gland.

CONCLUSION

The anterior facial vein is a useful landmark in determining the origin of a submandibular mass. Primary disease of the gland is never separated from the gland by the vein. The vein does separate lymphadenopathy from the gland and, theoretically, separates the gland from soft-tissue tumors lateral to the gland.

Salivary gland tumours: is colour Doppler imaging of added value in their preoperative assessment?

Using a Toshiba SSA-270A Colour Duplex Scanner, 15 patients with suspected parotid and submandibular gland tumours had preoperative duplex scanning done. Peak systolic doppler shifts (fmax) were recorded and their vascularity was also subjectively scored. There were no arteries identified within the substance of contralateral normal glands. All recordings were analysed retrospectively and an independent histological assessment of tumours was made. Pleomorphic adenomas (n = 9) had a median peak systolic frequency (fmax) of 0.8 kHz, while adenolymphomas (n = 4) had a fmax of 1.65 and the two malignant tumours had fmax of 4.5 (P = 0.007 Kruskal-Wallis test). There appears to be a strong correlation between the fmax and the subjective vascular score (Corr 0.92). Colour duplex scanning is a non-invasive procedure which may be of help in the preoperative assessment of salivary gland tumours.