Ultrasound-guided needle aspiration of lateral masticator space abscess

Orofacial fascial space abscess disguised as temporomandibular disorder: a report of 3 cases and literature review

Fascial space abscess is a condition in which infections spread into fascial spaces. It is a severe and life-threatening disease unless treated at an early stage. Due to the similarity of clinical symptoms, fascial space abscesses in the orofacial area are often disguised as other diseases, such as temporomandibular disorder (TMD). In this case series, we report three cases of fascial space abscesses disguised as TMD. In all cases, patients complained of severely limited mouth opening and pain in the temporomandibular joint (TMJ) and masseter muscles, which led clinicians to diagnose them with TMD. After two patients showed facial swelling and the third complained of dyspnea, clinicians realized the possibility of an orofacial fascial space abscess. On further evaluation, all patients showed increased C-reactive protein in blood tests, and the location of the fascial space abscess was confirmed by enhanced computed tomography images. Moreover, all patients had suspicious sources of odontogenic infections in panoramic images, periapical abscess on maxillary molars and periodontal disease on maxillary and mandibular molars, which were not appropriately evaluated at the first visit. This case series emphasizes the need for clinicians to realize the possibility of orofacial fascial space abscesses based on: clinical symptoms of severely limited mouth opening (< 15 mm) with pain in the facial area, including TMJ or masseter muscle, and possible sources of infection such as odontogenic infection, other infectious lesions, trauma, or invasive treatments. These clinical insights will enable the early detection of fascial space abscesses.

Infratemporal Fossa Abscesses: A Systematic Review of Cases

OBJECTIVES

We have attempted to characterize the clinical presentations and management of infratemporal fossa abscesses with the goal of improving awareness and promoting earlier diagnosis and treatment for this rare condition.

METHODS

an extensive systematic search was performed through Pubmed/Medline, CINAHL (EBSCOhost), and Web of Science. Two authors screened out studies by abstracts, and a third resolved any conflicts. The remaining studies were assessed by full-text assessment, leaving 43 studies for data extraction.

RESULTS

sixty-seven patients were included from the final 43 studies. The patients were predominantly male (56.7%), and the average age of patients was 44.3 years (standard deviation (SD) 19.8 years). Risk factors most commonly odontogenic, whether the etiology was through tooth extraction (n = 30, 44.8%) or infection (n = 17, 25.4%). Symptoms on presentation included pain (n = 40, 83.3%), swelling (n = 39, 81.3%), and trismus (n = 36, 75.0%). Twenty-two (32.8%) patients were managed with intraoral incision and drainage (I&D), 18 (26.9%) with extraoral I&D. After treatment, 45 of the 48 (93.8%) patients from the case reports and series were deemed to have achieved complete resolution.

CONCLUSIONS

Infratemporal fossa abscesses are rare, but they may be associated with serious neurologic and systemic complications. Although prompt diagnosis paramount in avoiding these sequelae, patients often experienced delays in diagnosis. Surgical drainage and extended antibiotic therapy is recommended.

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

BACKGROUND

The introduction of modern diagnostic tools has transformed the field of maxillofacial radiology. Odontogenic infection and fascial space involvement have been evaluated with many diagnostic tools, including ultrasonography (USG) and magnetic resonance imaging (MRI).

AIM

To explore USG as an alternative model to MRI in the detection of fascial space spread of odontogenic infections.

METHODS

Among 20 patients, 50 fascial spaces were clinically diagnosed with odontogenic infection and included in this prospective study. Fascial space infection involvement was examined by USG and MRI. Results were compared for both and confirmed by microbiological testing.

RESULTS

Ultrasonography identified 42 (84%) of 50 involved fascial spaces. Whereas MRI identified all 50 (100%). USG could stage the infections from edematous change to cellulitis to complete abscess formation.

CONCLUSION

MRI was superior in recognizing deep fascial space infections compared to USG. However, USG is a significant addition and has a definite role in prognosticating the stage of infection and exact anatomic location in superficial space infections.

Evaluation of oral and maxillofacial swellings using ultrasonographic features

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.

Introduction to Clinical Microbiology for the General Dentist

Clinical oral microbiology may help dental professionals identify infecting pathogenic species and evaluate their in vitro antimicrobial susceptibility. Saliva, dental plaque biofilms, mucosal smears, abscess aspirates, and soft tissue biopsies are sources of microorganisms for laboratory testing. Microbial-based treatment end points may help clinicians better identify patients in need of additional or altered dental therapies before the onset of clinical treatment failure, and help improve patient oral health outcomes. Microbiological testing appears particularly helpful in periodontal disease treatment planning. Further research and technological advances are likely to increase the availability and clinical utility of microbiological analysis in modern dental practice.

Is ultrasonography-guided drainage a safe and effective alternative to incision and drainage for deep neck space abscesses?

Background:

Deep neck space abscesses are common head and neck surgery emergencies. Traditionally, surgical incision and drainage has been the main treatment for deep neck abscesses. Recently, it has been suggested that ultrasound-guided drainage of neck abscesses can be an effective and less invasive alternative to incision and drainage.

Methods:

Patients with deep neck space abscesses referred to the emergency department of Amiralam Hospital were assessed and enrolled to the study if they met the inclusion criteria. Patients were randomly assigned to incision and drainage or ultrasound-guided drainage groups using sealed envelopes.

Results:

Sixty patients were evaluated, with 30 patients in each group. There was a significant difference (p < 0.001) in mean length of hospital stay between patients who underwent ultrasound-guided drainage (5.47 days) and those who underwent incision and drainage (9.70 days).

Conclusion:

Ultrasound-guided drainage is an effective and safe procedure, leading to shorter hospital stay, and thus may be a suitable alternative to incision and drainage of deep neck abscesses.

Role of ultrasonography in oral and maxillofacial surgery: a review of literature

Maxillofacial surgery, like any other surgical specialty is greatly dependent on the discipline of radiology. This poses a greater challenge because of the complex anatomy of this region. Various investigation modalities have been applied in diagnosing various diseases which are found in the maxillofacial region, including IOPA, PET, USG, CT, MRI and panoramic radiographs. Of these, USG can easily diagnose non invasive and soft tissue diseases. It is very useful in diagnosing the diseases which are not usually evident on a conventional radiograph. However; many of the dentists are not aware of the benefits of USG in diagnosis of oral diseases. In this article, the use of ultrasound in diagnosing the various pathologies of maxillofacial region is elaborated.

Masticator space abscess in a 47-day-old infant

A 47-day-old male infant presented with fever, poor oral intake, irritability, and right-sided bluish buccal swelling. Contrast-enhanced computed tomography of the neck showed a round mass lesion of about 2.0×1.5 cm that suggested abscess formation in the right masticator space. Ultrasound-guided extraoral aspiration of the abscess at the right masseter muscle was successful. Staphylococcus aureus was identified in the culture from the aspirated pus and blood. Appropriate antibiotics were given and the patient recovered. The patient underwent follow-up ultrasonography that showed an improved state of the previously observed right masseter muscle swelling at about 1 month after hospital discharge. A masticator space abscess usually originates from an odontogenic infection in adults. We report a case of masticator space abscess in a 47-day-old infant in whom septicemia without odontogenic infection was suspected.

An evaluation of efficacy of ultrasonography in the diagnosis of head and neck swellings

OBJECTIVE

The aim of this study was to evaluate the efficacy of ultrasonography in the diagnosis of swellings in the head and neck regions.

METHODS

For this study, 70 cases with clinically obvious swellings in head and neck regions were selected randomly. The ultrasonographic features considered were shape, boundary, echo intensity, ultrasound architecture of lesion, posterior echoes and ultrasound characteristic of tissues. Intergroup comparisons were made between four different types of swellings: inflammatory; cystic; benign; and malignant.

RESULTS

A comparison was made between benign and malignant neoplasms, and the criteria of boundary, echo intensity and ultrasound architecture of lesions are statistically significant as the P-value is <0.05. The comparison of inflammatory swellings and malignant neoplasms shows that criteria of boundary and ultrasound architecture of lesions are statistically significant. The comparison of cystic swellings and benign neoplasms concluded that only the criterion of ultrasound characteristics of tissues is statistically significant. The comparison of inflammatory swellings and benign neoplasms shows that the criteria of boundary and echo intensity are statistically significant. The comparison of inflammatory swellings and cystic swellings concluded that the criteria of boundary, shape, echo intensity, posterior echoes and ultrasound characteristics of tissues are statistically significant. The comparison of cystic swellings and malignant neoplasms concluded that the criteria of ultrasonography, boundary, shape, echo intensity, ultrasound architecture of lesion, posterior echoes and ultrasound characteristics of tissues are statistically significant as the P-value is <0.05.

CONCLUSION

It can be concluded that clinical diagnosis had a sensitivity and accuracy of 85.7% and ultrasonographic diagnosis had a sensitivity and accuracy of 98.5%.

Ultrasonographic evaluation of mandibular ameloblastoma: a preliminary observation

OBJECTIVE

The purpose of this study was to demonstrate ultrasonographic characteristics of mandibular ameloblastoma and assess the value of ultrasonography in diagnosis of the tumor.

STUDY DESIGN

Nineteen subjects with ameloblastomas in the mandibles were examined with ultrasonography. Locations, sizes, internal echoes, boundaries, and blood flow of the tumors were observed and documented. Ultrasonographic appearances of the tumors were compared with histopathological findings. Sensitivity and specificity of Doppler flow signals for prediction of active tumor proliferations were calculated.

RESULTS

The main sonographic features of the tumor appeared as a complex cystic mass with solid contents. Most tumors (15/19, 79%) showed no or minimal flow signals on color Doppler flow imaging (CDFI), whereas the remaining 4 lesions demonstrated abundant flow signals. The sensitivity and specificity of the Doppler flow signals for prediction of active tumor proliferations were 100% and 94%, respectively. The ultrasonographic appearances could be classified into 4 types: multilocular (10/19, 53%), honeycomb (4/19, 21%), unilocular (3/19, 16%), and local severe destructive (2/19, 10%).

CONCLUSION

Ultrasonography can be used as an effective supplementary diagnostic method for mandibular ameloblastomas. CDFI of tumor vascularity could be used to predict active tumor proliferations.

Ultrasound-guided drainage of submasseteric space abscesses

PURPOSE

The oral approach for incision and drainage (I and D) in patients presenting with submasseteric space (SMS) abscesses and marked trismus is more difficult and requires a general anesthetic, necessitating an anesthetist experienced in fiberoptic-guided nasal intubation. In such patients, ultrasound-guided drainage (USGD) has been attempted to obviate this need. The purpose of this trial was to report our experience with the surgical management of 11 SMS abscesses, with special reference to their USGD.

MATERIALS AND METHODS

Seven men and 4 women ranging in age from 18 to 41 years (average age, 25 years) participated in this trial. They were initially examined with US, and their abscesses were subsequently drained under US guidance using a 16-gauge intravenous catheter. An antibiotic regimen was prescribed, and arrangements were made to see the patients daily for 5 days. USGD was repeated after 24 hours, and 24 hours later the infection course was monitored in each patient. Patients with nonresolving infection had their abscesses formally incised and drained extraorally. The source of infection was removed as soon as the acute phase of infection passed and the interincisal opening (IIO) allowed. The catheter or corrugated drain was removed when the discharge ceased or became minimal. Patients were then instructed to continue a 3-day course of an antibiotic and to return after 1 week and then after 1 month.

RESULTS

Resolution of infection was successfully achieved by USGD with no need for I and D in 8 of the 11 patients (73%). In those patients, the average total amount of pus removed was 8.5 mL, and the average IIO was 17.4 mm immediately after an average initial aspirate of 4.5 mL of pus. I and D was required in the remaining 3 patients (27%). In those patients the average total amount of pus removed was 17.5 mL, and the average IIO was 7.7 mm immediately after an average initial aspirate of 9.3 mL of pus.

CONCLUSIONS

Resolution of infection with USGD is more probable if there was an immediate improvement of the IIO to about 1.5 cm or more after an initial aspiration of 5 mL of pus.

Subacute infratemporal fossa cellulitis with subsequent abscess formation in an immunocompromised patient

OBJECTIVES

To present a case of subacute infratemporal fossa cellulitis with subsequent abscess formation to show important anatomic relationships as they effect presentation and treatment of infections in this area.

STUDY DESIGN

Case report and brief literature review.

METHODS

The case of an immunocompromised patient who developed subacute infratemporal fossa cellulitis with subsequent abscess formation is presented. A literature review discusses etiology, diagnosis, and treatment of these infections.

RESULTS

Careful history and physical examination revealed unilateral facial pain, swelling, and trismus to be caused by an infratemporal fossa abscess. Intraoral drainage and intravenous antibiotic therapy led to resolution of the infection.

CONCLUSION

Infratemporal fossa abscesses are potentially dangerous complications of odontogenic infections. Although clinical diagnosis may be difficult, knowledge of relevant anatomy and pathways of spread allow more effective diagnosis and treatment of these infections.

Characterization of maxillofacial soft tissue vascular anomalies by ultrasound and color Doppler imaging: an adjuvant to computed tomography and magnetic resonance imaging

PURPOSE

The special imaging and physical properties of ultrasound and color Doppler offer opportunity for continued investigation in oral and maxillofacial surgery. This study prospectively investigated ultrasound and color Doppler in addition to computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of several vascular or suspected vascular anomalies and assesses the value of ultrasound and color Doppler in their diagnoses.

PATIENTS AND METHODS

Six patients with vascular or suspected vascular anomalies seen between 1997 and 1999 composed the study group. All patients were clinically evaluated, imaged by CT with contrast and/or MRI with contrast, ultrasound, and Doppler (including color, spectral, and power). Ultrasound studies were performed in the presence of the referring oral and maxillofacial surgeons to provide consultation on anatomy and differential diagnosis as well as to witness the dynamic study. Three patients were further studied by angiography. The Mulliken/Glowacki classification (Plast Reconstr Surg 69:412, 1982) and designations and the Jackson et al modification (Plast Reconstr Surg 91:1216, 1993) are used in this study.

RESULTS

A spectrum of lesions emerged in this small case series. Detailed clinical and imaging findings and a summary of diagnostic impressions allowed general and specific observations and permitted assessment of the value of ultrasound and color Doppler in the diagnosis of these lesions. The diagnostic accuracy of ultrasound and Doppler was equal to or better than that of CT and/or MRI in 4 of 6 cases. In the other 2 cases ultrasound did not specifically diagnose the lesions but did allow assessment of vascularity. In one of these cases the correct diagnosis was made by a combination of CT and angiography, and in the other the diagnosis was made by nonenhanced MRI. An ancillary study showed that the combination of nonenhanced MRI with ultrasound and Doppler provides more information than contrast-enhanced MRI alone and is more cost effective.

CONCLUSIONS

1) A single imaging modality is frequently unable to provide sufficient diagnostic information to allow confident clinical management of a vascular malformation. 2) A team approach and conferencing between imaging specialists and clinicians promote better diagnosis and management. 3) Nonenhanced MRI with ultrasound/color Doppler can be substituted for enhanced MRI to provide the best diagnostic information and at reduced cost. 4) Ultrasound/color Doppler is an important adjuvant to CT and MRI in the diagnosis of vascular or suspected vascular anomalies.

Intraoperative ultrasound imaging to aid abscess drainage--a technical note

Diagnostic ultrasound is used widely to identify the presence of fluid collections preoperatively. Although its role in other parts of the body is well established, this report describes the technique of using diagnostic ultrasound intraoperatively to aid drainage of a large fascial space abscess in the head and neck. Following previously inadequate drainage of a large superficial abscess from a blindly placed drain, a second procedure was carried out, using ultrasound imaging to locate the persisting abscess. Furthermore, ultrasound demonstrated the adequacy of drainage and helped the surgeon to position the drain in the correct tissue space. We consider that intraoperative use of ultrasound has a role as a guidance tool to drain superficial fascial space abscesses in the head and neck region.

Ultrasound-guided surgical drainage of face and neck abscesses

An ultrasound-guided surgical drainage technique in which grey-scale and colour Doppler ultrasonography were combined is described. The technique was performed for eight deep subcutaneous abscesses subsequent to odontogenic infection, and provided easy detection and accurate, reliable penetration of abscesses that were difficult to locate by physical examination. Colour Doppler ultrasonography is particularly useful for differentiating blood vessels from the static space of abscesses.