[Downloaded free from http://www.nigerianjsurg.com on Thursday, February 7, 2019, IP: 197.90.36.231] Original Article Efficiency of Ultrasonography in Swellings of Orofacial Region Sameer Ramesh Zope, Abhishek A Talathi1, Avadhut Kamble, Selabh Thakur2, Pradeep Dilip Taide3, Vaibhav Kumar4, Harkanwal Preet Singh5 Department of Oral Medicine Introduction: Ultrasonography (USG) is found to be important in identifying and Radiology, 1Public Health various soft‑tissue pathologies in the orofacial region. Therefore, its features should Dentistry, 2Department of Pedodontics and Preventive be studied and documented in these lesions so that a more appropriate provisional Dentistry, 3Department of diagnosis can be made. Aim: This study aims to study ultrasonographic features in Abstract Prosthodontics, Yogita Dental various kinds of swellings in the orofacial region. Materials and Methods: The College and Hospital, Khed, study grouped consists of 30 patients of both sexes (20 males and 10 females) Ratnagiri, Maharashtra, with an age range of 15–70 years complaining of swellings in the orofacial region. 4Public Health Dentistry, All the patients in the study were explained the need of tests and subjected to Divya Jyoti College of Dental Sciences and clinical, ultrasonographic, and histopathologic examination. Sonosite Micromaxx Research, Modinagar, Uttar sonography machine was used with a linear array transducer of 13‑6 MHz Pradesh, 5Oral Pathology frequencies. Ultrasonographic diagnosis is then correlated with clinical and and Microbiology, Dasmesh histopathologic diagnosis. Chi‑square test and contingency coefficient tests Institute of Research and were used. Results: A significant association was observed between clinical Dental Sciences, Faridkot, and ultrasonographic diagnoses (contingency = 0.872, P < 0.05) and between Punjab, India ultrasonographic and histopathologic diagnoses (contingency = 0.904, P < 0.05). There was 100% congruency between clinical diagnosis and ultrasonographic diagnosis in all the cases except in cases of cysts, abscess, and sialadenitis. Reliability of USG was found to be 97% in diagnosing all the cases with respect to histopathological diagnosis, while it was 90% with respect to clinical diagnosis. Conclusion: USG was found to be a reliable diagnostic modality in the diagnosis of orofacial swellings. Keywords: Anechoic, hyperechoic, hypoechoic, ultrasonography Introduction chronic inflammation, abscess formation, deep‑seated or he definitive diagnosis of any disease or pathology infected cystic lesion, and neoplasm, clinical examination T is obtained with the help of various diagnostic does not provide complete assessment of the exact origin aids such as imaging, laboratory, and histopathological and nature of swellings; such cases require additional investigation. radiological imaging. Therefore, to get a final diagnosis, clinical examination must be joined with various Computed tomography and magnetic resonance imaging investigative procedures such as USG.[2] are valuable diagnostic aids, which are expensive and not universally available. Ultrasonography (USG) is USG is a study of internal organs or blood vessel using an alternative diagnostic tool that is widely available, high‑frequency sound waves, the actual test called relatively inexpensive, noninvasive, and easily ultrasound scan or sonogram. Frequencies between reproducible.[1] Address for correspondence: Dr. Harkanwal Preet Singh, In evaluation of jaw swellings, detailed case history Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India. and clinical examination are the most important and E‑mail: [email protected] mandatory steps. However, in some cases, such as This is an open access journal, and articles are distributed under the terms of the Creative Access this article online Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and Quick Response Code: the new creations are licensed under the identical terms. Website: www.nigerianjsurg.com For reprints contact: [email protected] How to cite this article: Zope SR, Talathi AA, Kamble A, Thakur S, Taide PD, DOI: 10.4103/njs.NJS_38_17 Kumar V, et al. Efficiency of ultrasonography in swellings of orofacial region. Niger J Surg 2018;24:82-9. 82 Nigerian© 2018 Nigerian Journal Journalof Surgery of Surgery ¦ Volume | Published 24 ¦ Issue by 2Wolters ¦ July-December Kluwer - Medknow 2018 Nigerian Journal of Surgery ¦ Volume 24 ¦ Issue 2 ¦ July-December 2018 83 [Downloaded free from http://www.nigerianjsurg.com on Thursday, February 7, 2019, IP: 197.90.36.231] Zope, et al.: Ultrasonography in orofacial swellings 1 and 10 MHz are mainly used for the purpose of walled,” “irregular walled,” “well defined,” and “poorly diagnostic ultrasound. Diagnostic USG is an accurate defined.” The “internal echo” pattern includes “four” and noninvasive procedure which is capable of showing terms – “hyperechoic,” “hypoechoic,” “isoechoic,” and fine structure in considerable detail. With development “anechoic” [Figure 1]. The “distribution of internal of more sophisticated techniques and instrumentation, echoes” includes “two” terms – “homogeneous” new applications of its use as an adjunct to clinical and “heterogeneous.” The “posterior wall echoes” practice continue. includes “four” terms – “enhanced,” “intermediate,” High‑resolution real‑time USG is found to be important “unchanged,” and “unable to classify.” The vascularity in identifying various soft‑tissue pathologies in the includes “two” terms – “avascular” and “increased.” orofacial region. Therefore, its features should be The sonographic pictures were interpreted by the studied and documented in these lesions so that a more operator (sonologist), and findings were entered. The appropriate diagnosis can be made. ultrasonographic diagnosis was obtained and noted on the pro forma. With this in mind, the present study was undertaken to study ultrasonographic features in various kinds Then, the patients were made to undergo FNAC of swellings in orofacial region and to evaluate the and/or biopsy for histopathologic examination and reliability of USG as a diagnostic aid for diagnosis of confirmation of diagnosis. The results of ultrasound swellings in orofacial region. were correlated with clinical and histological findings and were statistically analyzed using Chi‑square test and Material and Methods contingency coefficient. Ethical approval was obtained from the Institutional Review Boards. The study group consists of 30 patients Results of both sexes and different age groups complaining of Age and sex distribution swellings in the orofacial region. The study participants were totally 30 in number and were in the age range of 15–70 years with average Convenience sampling protocol was administered to age 31.91 ± 15.55 years. There were 20 (66.67%) recruit the individuals. All orofacial swellings were males (age – 31.53 ± 12.91) and 10 (33.3%) considered except swellings due to allergic reactions and insect bite. The individuals were explained about females (age – 32.40 ± 19.20) with a male to female the need and design of the study, and written informed ratio of 2:1 [Table 1]. consent was obtained from them before enrollment. Distribution of swellings according to Potential benefits of undergoing thorough clinical, ultrasonographic diagnosis ultrasonographic investigations and fine needle Chi‑square value obtained is 27.60 and P value for this aspiration cytology (FNAC)/biopsy procedures were Chi‑square test is less than that of 0.05. It indicates that explained. Sonosite Micromaxx sonography machine the cases are not equally distributed in all categories, and was used with a linear array transducer of 13‑6 MHz the study had maximum number of patients with cysts frequencies. followed by lymphadenitis. Among 30 patients in the study group, 14 (46.7%) were Distribution of swellings according to diagnosed ultrasonographically as cystic swellings, histopathological diagnosis 8 (26.7%) as lymphadenitis, 1 (3.3%) as sialadenitis, Chi‑square value obtained is 22.80 and P value for this 5 (16.7%) as abscess, 1 (3.3%) as benign salivary gland Chi‑square test is less than that of 0.05. It indicates that tumor, and 1 (3.3%) as benign odontogenic tumor, while the cases are not equally distributed in all categories and histopathologically, 13 (43.3%) were diagnosed as cystic the study had maximum number of patients with cysts swellings, 8 (26.7%) as lymphadenitis, 1 (3.3%) as followed by lymphadenitis. sialadenitis, 5 (16.7%) as abscess, 1 (3.3%) as benign salivary gland tumor, and 2 (6.7%) as benign odontogenic tumor. Table 1: Gender distribution among study Gender Sample size, n (%) Age (mean±SD) In the study, “six” ultrasonographic parameters were Male 20 (66.7) 31.53±12.91 used. The “shape” includes “five” terms – “round,” Female 10 (33.3) 32.40±19.20 “oval,” “lobular,” “polygonal,” and “unable to classify.” Total 30 (100) 31.91±15.55 The “boundary echo” includes “four” terms – “smooth SD: Standard deviation 82 Nigerian Journal of Surgery ¦ Volume 24 ¦ Issue 2 ¦ July-December 2018 Nigerian Journal of Surgery ¦ Volume 24 ¦ Issue 2 ¦ July-December 2018 83 [Downloaded free from http://www.nigerianjsurg.com on Thursday, February 7, 2019, IP: 197.90.36.231] Zope, et al.: Ultrasonography in orofacial swellings Clinical diagnosis versus ultrasonographic diagnosis (contingency = 0.904, P < 0.05). There was diagnosis [Table 2] 100%