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Maxillofacial inflammations visualized with ultrasonography. Description of the imaging features and literature review based on a characteristic case series

Antigoni Delantoni
Antigoni Delantoni
, 
Apostolos Sarafopoulos
Apostolos Sarafopoulos
, 
Natalia Giannouli
Natalia Giannouli
 and 
Vasileios Rafailidis
Vasileios Rafailidis
   | May 11, 2023
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Article Category: Review paper
Published Online: May 11, 2023
Page range: e80 - e89
Received: Dec 13, 2022
Accepted: Jan 12, 2023
DOI: https://doi.org/10.15557/jou.2023.0015
Keywords
© 2023 Antigoni Delantoni et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Periapical abscess. B-mode (A) Transverse view of the left buccal region shows a well-defined anechoic cavity with thickened hypoechoic wall of ill-defined borders, adjacent to the mandible. Color Doppler (B) No internal blood flow within the cavity, with vascularity of the surrounding tissue
Periapical abscess. B-mode (A) Transverse view of the left buccal region shows a well-defined anechoic cavity with thickened hypoechoic wall of ill-defined borders, adjacent to the mandible. Color Doppler (B) No internal blood flow within the cavity, with vascularity of the surrounding tissue

Fig. 2.

Comparison with the normal contralateral side. B-mode (A) Sagittal scans of the same area on both sides demonstrating aperiapical abscess on the left. Color Doppler (B) Increased vascularity of the surrounding inflammatory tissue. Note the appearance of adjacent subcutaneous tissues, which are more hyperechoic, and the loss of differentiation on the left due to edema from associated cellulitis
Comparison with the normal contralateral side. B-mode (A) Sagittal scans of the same area on both sides demonstrating aperiapical abscess on the left. Color Doppler (B) Increased vascularity of the surrounding inflammatory tissue. Note the appearance of adjacent subcutaneous tissues, which are more hyperechoic, and the loss of differentiation on the left due to edema from associated cellulitis

Fig. 3.

Intraparotid abscess. B-mode (A) Enlarged heterogeneous right parotid gland. Hypoechoic lesion with irregular margins, internal septations and echoes within the superficial lobe of the gland with some extension to the deep lobe. Color Doppler (B), power Doppler (C) Peripheral vascularity of the lesion with no internal blood flow and significantly increased vascularity of the surrounding inflammatory parenchyma
Intraparotid abscess. B-mode (A) Enlarged heterogeneous right parotid gland. Hypoechoic lesion with irregular margins, internal septations and echoes within the superficial lobe of the gland with some extension to the deep lobe. Color Doppler (B), power Doppler (C) Peripheral vascularity of the lesion with no internal blood flow and significantly increased vascularity of the surrounding inflammatory parenchyma

Fig. 4.

Comparison with the normal contralateral side. B-mode (A) Right parotid gland with intraparotid abscess. B-mode (B) Left normal parotid gland. Note the heterogeneity and increased size of the right parotid gland in comparison with the left, but also the thickening and distortion of the surrounding subcutaneous tissue. On the left side, the subcutaneous tissues are more hypoechoic, with normal hyperechoic septations within the adipose tissue
Comparison with the normal contralateral side. B-mode (A) Right parotid gland with intraparotid abscess. B-mode (B) Left normal parotid gland. Note the heterogeneity and increased size of the right parotid gland in comparison with the left, but also the thickening and distortion of the surrounding subcutaneous tissue. On the left side, the subcutaneous tissues are more hypoechoic, with normal hyperechoic septations within the adipose tissue

Fig. 5.

Adjacent cervical lymphadenopathy. B-mode (A) Enlarged hypoechoic lymph nodes with oval shape and an echogenic hilus. Spectral Doppler (B) These reactive lymph nodes show hilar vascularity with low resistance index (RI) of 0.49
Adjacent cervical lymphadenopathy. B-mode (A) Enlarged hypoechoic lymph nodes with oval shape and an echogenic hilus. Spectral Doppler (B) These reactive lymph nodes show hilar vascularity with low resistance index (RI) of 0.49

Fig. 6.

Cervical abscess. B-mode (A) Multilobulated anechoic lesion with relatively well-defined borders, viscous content, internal debris and acoustic enhancement. Hypoechoic appearance of the circumjacent tissue. Color Doppler (B) No internal blood flow within the abscess cavity. B-mode (C) Heterogeneous appearance and thickening of the muscles, representing myositis. Hyperechoic subcutaneous tissue with hypoechoic striations, indicating adjacent cellulitis
Cervical abscess. B-mode (A) Multilobulated anechoic lesion with relatively well-defined borders, viscous content, internal debris and acoustic enhancement. Hypoechoic appearance of the circumjacent tissue. Color Doppler (B) No internal blood flow within the abscess cavity. B-mode (C) Heterogeneous appearance and thickening of the muscles, representing myositis. Hyperechoic subcutaneous tissue with hypoechoic striations, indicating adjacent cellulitis

Fig. 7.

Odontogenic abscess in the submandibular region. B-mode (A) Hypoechoic heterogeneous lesion with ill-defined/infiltrative borders. The lesion extends from the surface of the mandible to the surface of skin. Color Doppler (B) No blood flow within the lesion, increased vascularity of the surrounding tissue and two reactive lymph nodes next to it (level IB)
Odontogenic abscess in the submandibular region. B-mode (A) Hypoechoic heterogeneous lesion with ill-defined/infiltrative borders. The lesion extends from the surface of the mandible to the surface of skin. Color Doppler (B) No blood flow within the lesion, increased vascularity of the surrounding tissue and two reactive lymph nodes next to it (level IB)

Fig. 8.

Bone involvement. The hypoechoic lesion is in direct contact with the cortex of the mandible, forming small bony deficits
Bone involvement. The hypoechoic lesion is in direct contact with the cortex of the mandible, forming small bony deficits

Fig. 9.

Intraparotid abscess. B-mode (A, B) Anechoic lesion with irregular shape, ill-defined borders and internal echoes within the right parotid gland. Note the heterogeneity of the gland and the hyperechoic subcutaneous tissue
Intraparotid abscess. B-mode (A, B) Anechoic lesion with irregular shape, ill-defined borders and internal echoes within the right parotid gland. Note the heterogeneity of the gland and the hyperechoic subcutaneous tissue

Fig. 10.

Intraparotid abscess. B-mode (A) Anechoic cavity with internal debris represents the abscess. Color Doppler (B) No internal blood flow and peripheral hyperemia
Intraparotid abscess. B-mode (A) Anechoic cavity with internal debris represents the abscess. Color Doppler (B) No internal blood flow and peripheral hyperemia

Fig. 11.

Adjacent cervical lymphadenopathy. B-mode (A) Multiple hypoechoic lymph nodes ipsilateral to the intraparotid abscess. Spectral Doppler (B) These reactive lymph nodes have oval shape and hilar vascularity with low resistance index (RI) of 0.5
Adjacent cervical lymphadenopathy. B-mode (A) Multiple hypoechoic lymph nodes ipsilateral to the intraparotid abscess. Spectral Doppler (B) These reactive lymph nodes have oval shape and hilar vascularity with low resistance index (RI) of 0.5

Fig. 12.

Maxillary abscess. B-modeshows a large hypoechoic multiloculated mass with viscous content and internal debris. The inflammation extends to the surrounding soft tissues, causing a distorted echotexture. Hyperechoic appearance and hypoechoic striations seen in the subcutaneous tissues, indicating cellulitis
Maxillary abscess. B-modeshows a large hypoechoic multiloculated mass with viscous content and internal debris. The inflammation extends to the surrounding soft tissues, causing a distorted echotexture. Hyperechoic appearance and hypoechoic striations seen in the subcutaneous tissues, indicating cellulitis

Fig. 13.

Maxillary abscess. Color Doppler shows no internal blood flow with increased vascularity of the surrounding tissue
Maxillary abscess. Color Doppler shows no internal blood flow with increased vascularity of the surrounding tissue

Fig. 14.

Intraparotid abscess with sialolithiasis. B-mode (A) Hypoechoic heterogeneous intraparotid mass located in the deep lobe of the right parotid gland. It has poorly defined margins, thick internal echoes and hyperechoic foci representing small stones (microlithiasis). B-mode (B) Enlarged right parotid gland with moderately dilated ducts and edematous appearance of Stensen’s duct
Intraparotid abscess with sialolithiasis. B-mode (A) Hypoechoic heterogeneous intraparotid mass located in the deep lobe of the right parotid gland. It has poorly defined margins, thick internal echoes and hyperechoic foci representing small stones (microlithiasis). B-mode (B) Enlarged right parotid gland with moderately dilated ducts and edematous appearance of Stensen’s duct

Fig. 15.

Intraparotid abscess. B-mode (A) Anechoic lesion with a thickened wall and internal septations. Color Doppler (B) Increased vascularity of the round tissue
Intraparotid abscess. B-mode (A) Anechoic lesion with a thickened wall and internal septations. Color Doppler (B) Increased vascularity of the round tissue
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