Imaging Sci Dent.  2019 Sep;49(3):201-208. 10.5624/isd.2019.49.3.201.

Evaluation of oral and maxillofacial swellings using ultrasonographic features

• Abdelsalam TA
• Amer ME
• Mahrous A
• Abdelkader M

• KMID: 2458368
• DOI: http://doi.org/10.5624/isd.2019.49.3.201

Abstract

PURPOSE
The aim of this study was to evaluate the characteristic features of oral and maxillofacial swellings that could be seen on ultrasonographic examinations.
MATERIALS AND METHODS
Fifty patients with oral and/or maxillofacial swellings were randomly selected, thorough case histories and clinical examinations were done, ultrasonographic examinations with Doppler imaging were performed, and the features of every group were studied. Finally, histopathological evaluations were performed to identify the final diagnosis, according to which patients were classified into 5 groups; group I: inflammatory/space infection and abscess swellings, group II: cystic swellings, group III: lymph node swellings, group IV: benign swellings, and group V: malignant neoplastic swellings.
RESULTS
A significant association (P<0.05), with a contingency coefficient of 0.88, was found between the histopathological and ultrasonographic diagnoses, with ultrasonography having a diagnostic accuracy of 89% in diagnosing maxillofacial swellings. The diagnostic accuracy of ultrasonography was 100% for lymph node and malignant swellings, followed by 98% for inflammatory and cystic swellings and 92% for benign swellings. The sensitivity of the ultrasonographic diagnosis was 100% for cystic, lymph node, and malignant swellings, followed by 91% for inflammatory swellings and 86% for benign swellings.
CONCLUSION
Ultrasonographic features with Doppler imaging greatly aid in obtaining accurate diagnoses of oral and maxillofacial swellings. Ultrasonography is a recommended imaging tool for differentiating maxillofacial swellings and classifying them accurately.

Keyword

Ultrasonography; Biopsy, Fine Needle; Sensitivity and Specificity

MeSH Terms

Abscess
Biopsy, Fine-Needle
Diagnosis
Humans
Lymph Nodes
Sensitivity and Specificity
Ultrasonography

Figure

• 

  Fig. 1 Ultrasonography-guided diagnosis (USGD) versus histopathological diagnosis. Group I: inflammatory/infection/abscess swellings, group II: cystic swellings, group III: lymph node swellings, group IV: benign swellings, and group V: malignant neoplastic swellings.

• 

  Fig. 2 A. A case of epidermoid cyst in a 35-year-old male patient who complained of a right-sided, painless mass that appeared inferior to the auricle 2 years previously. B. A transverse ultrasonographic image showed a large, well-defined oblong shaped cystic lesion (large arrowheads) with heavy internal echogenicity and posterior enhancement (small arrowheads) involving the right inferior auricle region and closely related to the right temporomandibular joint (arrows).

• 

  Fig. 3 A. A case of ossifying fibroma in an 18-year-old female patient with a right-sided maxillary swelling. B. A transverse ultrasonographic image reveals a homogenous, abnormal, hypoechoic lesion occupying and distending the right maxillary region with no evident bone destruction. C. Note the normal features of the contralateral left side.

• 

  Fig. 4 A. A case of squamous cell carcinoma (grade II) in a 59-year-old female patient who presented with an eroded, indurated, ulcerated, necrotic, and recurrent right-sided facial swelling after an excisional biopsy had been performed 2 months previously. B. Transverse ultrasonographic images reveal a large, soft-tissue mass lesion seen at the right mandibular region with evident bone destruction. C. The lymph nodes are seen to be enlarged with distorted architecture, including a destroyed fatty hilum and thickened cortex with a healthy right submandibular salivary gland (arrows). D. The intact left side of the mandible.

Reference

1. Oysu C, Aslan I, Bilgic B, Yazicioglu E. Malignant triton tumour of the parapharyngeal space. J Laryngol Otol. 2001; 115:573–575.

2. Pallagatti S, Sheikh S, Puri N, Mittal A, Singh B. To evaluate the efficacy of ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings. Eur J Radiol. 2012; 81:1821–1827.

3. Chandak R, Degwekar S, Bhowte RR, Motwani M, Banode P, Chandak M, et al. An evaluation of efficacy of ultrasonography in the diagnosis of head and neck swellings. Dentomaxillofac Radiol. 2011; 40:213–221.

4. Akinbami BO, Ugboko VI, Owotade EJ, Obiechina AE, Adetiloye VO, Ayoola O. Applications of ultrasonography in the diagnosis of soft tissue swellings of the cervicofacial region. West Afr J Med. 2006; 25:110–118.

5. Sangeetha P, Maragathavalli G. Ultrasonographic characterization of jaw swellings - a systematic review. IOSR J Dent Med Sci. 2014; 13:74–85.

6. Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG, Omnell KA, et al. Imaging of the temporomandibular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83:609–618.

7. Thomas AE, Kurup S, Jose R, Soman C. Facial swelling as a primary manifestation of multiple myeloma. Case Rep Dent. 2015; 2015:319231.

8. Paesani D, Westesson PL, Hatala MP, Tallents RH, Brooks SL. Accuracy of clinical diagnosis for TMJ internal derangement and arthrosis. Oral Surg Oral Med Oral Pathol. 1992; 73:360–363.

9. Bagewadi SB, Mahima VG, Patil K. Ultrasonography of swellings in orofacial region. J Indian Acad Oral Med Radiol. 2010; 22:18–26.

10. Oeppen RS, Gibson D, Brennan PA. An update on the use of ultrasound imaging in oral and maxillofacial surgery. Br J Oral Maxillofac Surg. 2010; 48:412–418.

11. Bhardwaj D, Rakareddi M, Barthunia B, Mishra R, Singla M, Chavda S. Efficacy of ultrasonography in head and neck swellings and compare with histopathological and clinical diagnosis. IOSR J Dent Med Sci. 2017; 16:104–116.

12. Raitz R, Correa L, Curi M, Dib L, Fenyo-Pereira M. Conventional and indirect digital radiographic interpretation of oral unilocular radiolucent lesions. Dentomaxillofac Radiol. 2006; 35:165–169.

13. Shimizu M, Ussmüller J, Hartwein J, Donath K. A comparative study of sonographic and histopathologic findings of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88:723–737.

14. Rastogi A, Sharma K, Gauba N. Evaluation of efficacy of ultrasound in diagnosis of neck swellings. Int J Otorhinolaryngol Head Neck Surg. 2018; 4:169–175.

15. Sivarajasingam V, Sharma V, Crean SJ, Shepherd JP. Ultrasound-guided needle aspiration of lateral masticator space abscess. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88:616–619.

16. Baurmash HD. Ultrasonography in the diagnosis and treatment of facial abscesses. J Oral Maxillofac Surg. 1999; 57:635–636.

17. Mehdizadeh M, Movahedian B, Mehdizadeh M, Babasafari M, Mohammadi P. Comparison ultrasound, indirect digital panoramic radiography in differtional radiolucent mandible lesions. Res J Biol Sci. 2009; 4:1169–1170.

18. Bassiony M, Yang J, Abdel-Monem TM, Elmogy S, Elnagdy M. Exploration of ultrasonography in assessment of fascial space spread of odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107:861–869.

19. Dangore SB, Degwekar SS, Bhowate RR. Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy. Dentomaxillofac Radiol. 2008; 37:205–212.

20. Shah JS, Asrani VK. Clinical applications of ultrasonography in diagnosing head and neck swellings. J Oral Maxillofac Radiol. 2017; 5:7–13.

21. Shahidi S, Shakibafard A, Zamiri B, Mokhtare MR, Houshyar M, Mahdian S. The feasibility of ultrasonography in defining the size of jaw osseous lesions. J Dent (Shiraz). 2015; 16:335–340.

22. de Ru JA, van Leeuwen MS, van Benthem PP, Velthuis BK, Sie-Go DM, Hordijk GJ. Do magnetic resonance imaging and ultrasound add anything to the preoperative workup of parotid gland tumors? J Oral Maxillofac Surg. 2007; 65:945–952.

23. Ariji Y, Sakuma S, Izumi M, Sasaki J, Kurita K, Ogi N, et al. Ultrasonographic features of the masseter muscle in female patients with temporomandibular disorder associated with myofascial pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98:337–341.

24. Karthik R, Mohan N, Ravikumar PT, Fenn SM, Gokulraj S, Subbulakshmi C. Ultrasonography in maxillofacial imaging - a review. Int J Maxillofac Imaging. 2016; 2:63–68.

25. Nawaz MK. Role of ultrasound as a diagnostic tool in superficial facial space infections. Int J Sci Study. 2015; 3:41–47.