This is Dr. Steve Winer and the first area we're going to scan with our Clarius is going to be the mandible and parotted area. This is an area where it it's great to start to learn your anatomy and how to use your scanner. So, make sure that the little nub is pointed to the patient's right. And here we go. So, the very bottom of the screen you're going to see the mandible. It's the hypercoic area. Okay. So bone is going to be very white because the sound bounces off of it very well. Now I want you to clinch your teeth. And you see the master clinch and relax. Clinch and relax. And that's a really good way to sort of get oriented um is to actually ask the person to use the muscles in the area that you're examining. So we see the massitor lying on the mandible. And if we go a little more posterior, we see an isooic area which is the parotted. And the parotted area I'll show you is right in the middle here. So this is the parotted. And the parotted lies on the massitor um and the posterior aspect of the jawline. So let's go up a little more superior. And you actually see within the parotted gland in this patient, there's actually a little bit of hyaluronic acid. And that actually is fairly common when you're injecting in this area. I'm finding that on ultrasound and I'm actually delivering a talk about this at the MCATs coming up. So she has a little bit of HA a little bit superficial to the parotted but if you go a little bit deeper you see some HA within the parotta gland. Now the parotic gland also has uh lymph nodes within it and sometimes HA could be a little bit confusing with lymph nodes but lymph nodes are going to have a hilum to them and they're going to have a little bit of vascularity to them. So let's turn on the vascular. Let's go with power Doppler and let's look to see if there's any vascular structures in this area. and we don't really see that. And then there's this um FFIT where we can actually see if this is HA or not. And you ask the patient to hum. So can you hum for me? So this is amazing. Okay. So what you saw is that when she hums the HA is outlined by the power Doppler. And so that sort of confirms that this is HA. And uh my friend Alfredo uh described this phenomenon. So this is called FFIT. And if you can see it on the video here, let me go back. I'm going to show you that again. So when she's humming, there we go. So when she's humming, you're going to see the outline of the HA. Perfect. Perfect example of FFIT. But you'll also notice that when you're in this area, let me put it back to uh B mode, that there really isn't a lot of area to inject. And that's why the parotta does get injected frequently. You need to inject in this area right here which is between the skin and the parotta gland and sometimes that's as small as one millimeter. It's particularly uh scarred in patients who have had a facelift. So just be careful when you're injecting this area about injecting too deeply. You want to be just below the skin surface, just below the dermis. So just finishing up on the mandible here. Here's the bone hyperaccoic and over here is the massitor and this is the fascia that overlies the massitor which is the parotted masoteric fascia. So that concludes the evaluation of the posterior jawline and the parotted area.
