Srinivas K, Sumanth K N, Chopra S S
Department of Oral Medicine and Radiology, Oxford Dental College & Hospital, Bangalore, India.
Indian J Dent Res. 2009 Oct-Dec;20(4):458-62. doi: 10.4103/0970-9290.59454.
The main objective of the study was a) to differentiate cellulitis and abscess in buccal space region, b) to study the ultrasonographic anatomy of cheek region and c) to investigate the use of ultrasound in the diagnosis of inflammatory swellings of cheek region.
The study consisted of 25 patients with unilateral buccal space inflammatory swellings of odontogenic origin. The contra lateral side was used as control. Toshiba ultrasonographic device with a linear array transducer (5-8 MHz) was used. The areas of interest were scanned under both transverse and longitudinal sections and were interpreted by a single observer. The clinical diagnosis of cellulitis or abscess was confirmed by the absence or presence of pus respectively both sonographically and by aspiration. Also various anatomical structures present in buccal space were studied.
Clinically 23 (92%) were diagnosed as buccal space abscess and 2 (8%) were cellulitis. Ultrasonographically and therapeutically 24 (96%) were buccal space abscess and 1 (4%) was cellulits. The sensitivity of clinical criteria over ultrasonographic diagnosis was 96% with a specificity of 100%. Also the cheek thickness in males and females varied from 8.2 to 17.1 mm with a mean of 11.6 mm+/-2.1 (SD) and 8.2 mm to 14.2 mm with a mean of 11+/-1.8 (SD). The subcutaneous tissue appeared moderately echogenic, buccinator--highly echogenic, deep adipose tissue--less echogenic and parotid duct was appreciated as a thin hyperechogenic band crossing the buccinator muscle. Buccal space, masticator space and parotid space were appreciated.
This study supports the ultrasonographic method of imaging of orofacial inflammatory swellings with high sensitivity and specificity. This imaging modality can also help in aspiration of pus in different spaces. We have described the ultrasonographic anatomy of the above mentioned spaces which can help a beginner in this field.
本研究的主要目的是：a）鉴别颊间隙区域的蜂窝织炎和脓肿；b）研究颊部区域的超声解剖结构；c）探讨超声在颊部区域炎性肿胀诊断中的应用。
本研究纳入25例单侧源于牙源性的颊间隙炎性肿胀患者。对侧作为对照。使用配备线性阵列换能器（5 - 8MHz）的东芝超声设备。在横切和纵切面上扫描感兴趣区域，并由一名观察者进行解读。蜂窝织炎或脓肿的临床诊断分别通过超声检查及穿刺抽吸有无脓液来确认。同时研究了颊间隙中存在的各种解剖结构。
临床上23例（92%）被诊断为颊间隙脓肿，2例（8%）为蜂窝织炎。超声检查及治疗结果显示，24例（96%）为颊间隙脓肿，1例（4%）为蜂窝织炎。临床诊断标准相对于超声诊断的敏感性为96%，特异性为100%。此外，男性和女性的颊部厚度在8.2至17.1mm之间，平均为11.6mm±2.1（标准差），女性在8.2至14.2mm之间，平均为11±1.8（标准差）。皮下组织呈中等回声，颊肌呈高回声，深部脂肪组织回声较低，腮腺导管表现为一条穿过颊肌的细高回声带。观察到了颊间隙、咀嚼肌间隙和腮腺间隙。
本研究支持超声检查作为颌面炎性肿胀的成像方法，具有高敏感性和特异性。这种成像方式还有助于在不同间隙抽吸脓液。我们描述了上述间隙的超声解剖结构，这对该领域的初学者有帮助。
