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Ultrasonography In Dentomaxillofacial Diagnostics

The book examines the relationship between clinical features, diagnosis, and choice of minimally invasive technique for a range of dentomaxillofacial disorders and provides information on post-treatment therapy. Accurate interpretation of indications for treatment is the cornerstone of success in medicine, and as such, the book explains how the selection of imaging technique is closely linked to clinical and diagnostic aspects and how recognition of this relationship forms the foundation for optimal outcomes. In addition to examining the various modalities, the book highlights the role of the latest USG imaging techniques. Further, it discusses in detail the pathology, treatment, and prognosis of common and rare diseases, as well as congenital/developmental malformations in the dentomaxillofacial, an area that is often underestimated and largely ignored by dentists.

Ultrasonography in Dentomaxillofacial Diagnostics

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This systematic review assessed the diagnostic value of ultrasonography in maxillofacial fractures. A computerized literature search of MEDLINE, PubMed and GoogleMed databases was conducted for publications on diagnostic ultrasound and maxillofacial fractures in English. Search phrases were 'maxillofacial fractures' or 'midfacial fractures' or 'zygomatic complex fractures' or 'nasal bone fractures' or 'orbital fractures' or 'mandibular fractures' combined with 'ultrasound' or 'ultrasonography'. The Boolean operator 'AND' was used to narrow the searches. 17 articles published between 1992 and 2009 were reviewed: two on midfacial fractures, nine on orbital fractures, three on nasal fractures, and two on mandibular fractures. One article described case series of ultrasonographic diagnosis of mandibular and midfacial fractures. The sensitivity and specificity of ultrasound in detecting orbital fractures were 56-100% and 85-100%, respectively, whilst that of nasal fractures were 90-100% and 98-100%, respectively. Sensitivity and specificity of ultrasonography in detecting zygomatic fractures were >90%. For mandibular fractures, the sensitivity and specificity was 66-100% and 52-100%, respectively. Much evidence justifies the use of diagnostic ultrasonography in maxillofacial fractures, especially fractures involving the nasal bone, orbital walls, anterior maxillary wall and zygomatic complex. The sensitivity and specificity of ultrasonography is generally comparable with CT.

Use of ultrasonography (US) in dentomaxillofacial region became popular in recent years owing to increasing radiation dose concerns and economic limitations. It helps to visualize fine detail of the surface structure of the oral and maxillofacial tissues without ionizing radiation. In diagnostic ultrasound, high frequency sound waves are transmitted into the body by a transducer and echoes from tissue interface are detected and displayed on a screen. Sound waves are emitted via piezoelectric crystals from the ultrasound transducer. US technique can be used in dentomaxillofacial region for the examination of bone and superficial soft tissue, detection of major salivary gland lesions, temporomandibular joint imaging, assessment of fractures and vascular lesions, lymph node examination, measurement of the thickness of muscles and visualization of vessels of the neck. It has the potential to be used in the evaluation of periapical lesions and follow up of periapical bone healing. Also, it may be used for the evaluation of periodontal pocket depth and for the determination of gingival thickness before dental implantology.

Diagnostic value of ultrasonography in maxillofacial practice: A narrative review George Ewansiha1, Anas Ismail2, Mohammed Kabir Saleh2, Adeola Ladeji3, Babatunde Olamide Bamgbose4, Jun-ichi Asaumi5, Abdulmannan Yahya6 1 Department of Oral Diagnostic Sciences, Aminu Kano Teaching Hospital, Kano, Nigeria2 Department of Radiology, Faculty of Clinical Sciences, Bayero University Kano, Kano, Nigeria3 Department of Oral Pathology and Oral Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria4 Department of Oral Diagnostic Sciences, Aminu Kano Teaching Hospital, Kano; Department of Oral Diagnostic Sciences, Faculty of Dentistry, Bayero University Kano, Kano; Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Nigeria5 Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama, Nigeria6 Department of Child Dental Health, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria Date of Submission04-Sep-2020Date of Decision07-Mar-2021Date of Acceptance20-Apr-2021Date of Web Publication10-Dec-2021

Ultrasonography [12] is a widely available method that can be performed bedside in ED with no radiation exposure, and is inexpensive. Previous studies show the benefits of using ultrasonography as an alternative method for investigating facial fracture [9, 13,14,15]. Inferior orbital rim fracture can be diagnosed by using curved array ultrasound [16]. However, most of the ultrasound machines which have been used for trauma patients in ED do not have curved array, and mainly use a linear probe.

Fractures of the inferior orbital rim are easily detected by ultrasonography (35). The ultrasonography was performed with a 7.5 MHz curved array transducer with a sensitivity of 94% and a specificity of 92%, and a diagnostic accuracy of 92%. The positive predictive value (PPV negative predictive value (NPV) were 91% and 92%, respectively. We tested the performance of linear-probe ultrasound which is always available in ED and used for trauma patients. The diagnostic results in this study showed that a linear-probe ultrasound is not inferior to a curved array transducer; its sensitivity (92.9%), specificity (90%), PPV (86.7%), NPV (94.7%) and accuracy (79%) were significantly better than those of plain film X-ray.

This study compared the results obtained by a radiologist and senior plastic resident as examiners. Although ultrasonography is operator dependent and requires experienced personnel, there is very good interobserver reliability. Senior plastic resident may represent a non-boarded radiologist or general practitioner who practices in the ED and can use a linear probe to screen patients with clinically suspected infra orbital rim fracture during primary or secondary survey of advance trauma life support process. It has the advantage of screening in short duration of time and can performed in emergency room. The resident who participated in the study has said that they feel more confident when they have more experience while they performed using ultrasonography.

From the results, it could be concluded that ultrasonography is also helpful in screening and diagnosis of infraorbital rim fracture in some situations. It is particularly useful in a rural hospital where a confirmed diagnosis is necessary before transferring the patient to a hospital with government insurance. If the focus is only on inferior orbital rim, ultrasonography can replace plain film X-ray. Ultrasonography also can measure the gap and stepping of fracture site that can help to assess bone displacement. However, weakness of linear probe cannot detect the orbital floor fracture when compared with curvilinear array endocavity ultrasound, but it is rarely available in the emergency room. In severe orbital trauma or injuries to the skull and central nervous system, CT remains the standard option, because intra-cranial injuries and compressions of the optic nerve cannot be adequately evaluated by ultrasonography. Our study limitation is that we did not use intraoperative findings as a gold standard. In this regard, further studies may be required to provide acceptable results using US methodology.

The story of application of Ultrasonography (USG) in imaging goes back a long way in history. Strictly speaking, the term Ultrasound (US) refers to acoustic waves which correspond to the upper limit of sounds audible to humans (>20 KHz), whereas the USG refers to the use of an Ultrasound for diagnostic purpose. It has been deemed useful in various situations and has evolved over time to a more sophisticated and precise modality. Some of the advances are in the form of newer and more useful equipment increasing its pertinence in dentistry and medicine. Currently it is being used in various head and neck pathologies owing to its non-invasive nature and has gained a wider acceptance in maxillofacial imaging. Applications of USG imaging particularly in dentomaxillofacial region include head and neck pathologies, examination of bone and superficial soft tissue, detection of major salivary gland lesions, temporomandibular joint imaging, implant imaging, assessment of fractures and vascular lesions, lymph node examination, measurement of the thickness of muscles and visualization of vessels of the neck. 041b061a72


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