Evaluation of ultrasonography as a diagnostic tool in the management of head and neck facial space infections: A clinical study

Abstract

Introduction:Superficial facial space infections represent a significant amount of the dental problems that present to hospital. Determining whether an odontogenic swelling is a cellulitis or abscess is difficult, but important as both may require different treatments. The use of an ultrasound may aid in differentiating cellulitis and abscess. This study was done to compare the accuracy of clinical examination alone versus ultrasonography (USG) in the diagnosis of cellulitis and abscess in symptomatic patients with a diagnosis of superficial facial space infection.Materials and Methods:Twenty patients (1870 years) diagnosed as superficial facial space infections by clinical and radiographic examinations were included in the study and patients with significant medical conditions were excluded. The provisional clinical diagnosis was made after a thorough history was taken and clinical examination was performed to determine if the swelling was a cellulitis or abscess. Swelling was then evaluated using the ultrasonic transducer which was placed over the swelling to aid the diagnosis which was again recorded. An incision and drainage procedure was performed after the administration of local anesthesia. The success of the ultrasound intervention versus clinical examination was based on whether frank exudation was detected during incision and drainage of such swellings.Results:The statistical analysis found that USG is a valuable diagnostic aid for detection of abscess or cellulitis in head and neck facial space infections.Interpretation and Conclusion:The findings of this prospective analysis indicate that there was statistical difference between clinical examination alone and USG in making the correct diagnosis. The sensitivity, specificity, positive predictive, negative predictive, and accuracy were not similar for all methods tested. From the results of this study, ultrasound is recommended as an adjunct to clinical examination in differentiating between cellulitis and abscess.

Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging

“…Analysis with SPSS software found that USG precisely distinguished 84% of all included fascial spaces and 100% of included superficial spaces. These results were in near approximation to previous studies[ 4 , 5 , 18 , 19 ]. One previous study showed a significant association between histological findings and ultrasonography of oral maxillofacial swelling[ 20 ].…”

“…Previous studies have involved differentiating cellulitis from abscesses by clinical examination and USG. The diagnosis was correct 68% of the time with clinical examination alone and 70% of the time using clinical examination plus USG[ 5 , 17 ].…”

“…Some authors have suggested that abscesses should be drained and cellulitis treated with antibiotics, but others have suggested draining for both. Clinical diagnosis of both conditions is often difficult, and delayed diagnosis and treatment may lead to emergency complications and greater expense[ 5 ]. Odontogenic infections have been evaluated with various diagnostic tools, including routinely employed conventional radiographs.…”

Point-of-care ultrasound for oral and maxillofacial surgeons

“…A recent study by Shah et al 10 found that ultrasound was a useful adjunct to clinical examination in differentiating cellulitis from an abscess. Several other studies have also shown that ultrasound is a reliable tool in detecting pus in the head and neck [11][12][13] with a sensitivity of 96% and specificity of 82%.…”

Musculoskeletal ultrasound for traumatic and torsional alterations

“…32,33 Ultrasound can be used to assist the clinical assessment of infections, including cellulitis, and help determine if the infection extends into the deeper layers. [34][35] Cellulitis is often seen sonographically as a poorly defined hyperechoic signal within the subcutaneous tissue. The neighboring deeper tissues should be inspected for potential involvement.…”