Objectives <p>This study aimed to evaluate the ultrasonographic features of the parotid and submandibular salivary glands in individuals with long-term cigarette use and to investigate the effects of smoking on these glands.</p> Methods <p>A total of 120 participants were included in the study: 55 individuals who had been actively smoking for at least 5&#xa0;years and 65 healthy controls who had never smoked. The echogenicity, parenchymal architecture, glandular margins, and vascular patterns of the parotid and submandibular glands were assessed using ultrasonography. In addition, the volume of each gland was measured, and tissue stiffness (elasticity) was quantitatively evaluated using shear wave elastography. For statistical analysis, the independent samples <i>t</i>-test was used for continuous variables, and the chi-square test was applied for categorical variables.</p> Results <p>There was no statistically significant difference between groups in terms of echogenicity. However, parenchymal heterogeneity and margin irregularity were more frequently observed in smokers. Vascular assessments revealed a significant increase in peripheral vascular patterns and poor vascularity, along with a decrease in central–peripheral distribution in the smoking group. Moreover, both parotid and submandibular gland volumes were significantly higher in smokers compared to controls. Elastography analysis showed a notable increase in tissue stiffness, particularly in the left-sided glands.</p> Conclusions <p>The findings suggest that long-term cigarette use may lead to structural alterations, increased tissue stiffness, and vascular changes in the parotid and submandibular salivary glands. These changes may reflect inflammatory, fibrotic, and microcirculatory disturbances induced by smoking in the glandular parenchyma. Non-invasive imaging modalities such as ultrasonography and shear wave elastography appear to be effective tools for detecting these alterations in a reliable and early manner.</p>