An update on the use of ultrasound imaging in oral and maxillofacial surgery. Br J Oral Maxillofac Surg. 2010;48:412-418. [PMID: 19939526 DOI: 10.1016/j.bjoms.2009.10.022]

Evaluation of submandibular and parotid salivary glands by ultrasonography in patients with diabetes

BACKGROUND

Microvascular complications of diabetes mellitus (DM) include oral manifestations and complications, including xerostomia, reduced salivary flow, susceptibility to infection, periodontal disease and salivary gland enlargement.

OBJECTIVE

The present study aims to evaluate B-mode ultrasonography (USG) parameters such as size, volume and echogenicity of the submandibular and parotid salivary glands on both sides, shear-wave elastography (SWE) value and colour Doppler properties in patients with DM and healthy control groups.

METHODS

In total, 160 right and left submandibular glands and 160 right and left parotid glands of 80 patients, 40 patients (20 type 1 DM, 20 type 2 DM) and 40 healthy control group, between the ages of 18-70 were examined by USG. Echogenicity, parenchyma internal structure, margin and dimensional measurements (antero-posterior length, supero-inferior length, medio-lateral length and volume) and colour Doppler with 'ML 6-15-D Matrix Array (4-15 MHz)' probe, shear-wave elastography '9L-D (2-8 MHz)' probe was investigated.

RESULT

Statistically significant difference was observed in echogenicity in the right submandibular gland, echogenicity in the right parotid gland, margin characteristics, parenchymal homogeneity and colour Doppler characteristics between the type 1 DM, type 2 DM and control groups (p < .05). It was observed that the size, volume and SWE values of both submandibular and parotid glands were higher in the DM patient group than in the control group. Higher values were observed in type 2 DM compared to type 1 DM in the patient group.

CONCLUSION

USG is an effective imaging technique in investigating the effects of diabetes on the submandibular and parotid salivary glands.

Anatomical consideration of ultrasonography-guided intraoral injection for temporal tendinitis

Temporal tendinitis is characterized by acute inflammation often resulting from mechanical stress, such as repetitive jaw movements associated with jaw opening and closing and teeth clenching. Treatment for temporal tendinitis typically involves the administration of local anesthetic or corticosteroid injections. However, the complex anatomical structure of the coronoid process, to which the temporalis tendon attaches, located deep within the zygomatic arch, poses challenges for accurate injections. In this study, we aimed to establish guidelines for the safe and effective treatment of temporal tendinitis by using intraoral ultrasonography (US) to identify the anatomical structures surrounding the temporalis tendon and coronoid process. US was performed using an intraoral transducer on 58 volunteers without temporomandibular joint disease. The procedure involved placing the transducer below the occlusal plane of the maxillary second molar. Measurements were taken for the horizontal distance from the anterior border of the coronoid process, observed at the midpoint (MP) of the US images, and the depth of the coronoid process and temporalis muscle from the oral mucosa. The anterior border of the coronoid process was visualized on all US images and classified into three observed patterns at the MP: type A (anterior to the MP, 56.2%), type B (at the MP, 16.1%), and type C (posterior to the MP, 27.7%). The temporalis muscle was located at a mean depth of 3.12 ± 0.68 mm from the oral mucosa. The maxillary second molar is an intraoral landmark for visualizing the anterior border of the coronoid process. The new location information obtained using intraoral US could help identify the safest and most effective injection sites for the treatment of temporal tendinitis.

Ultrasonographic evaluation of the masseter muscle in patients with temporomandibular joint degeneration

Purpose

Sonographic elastography can be used to evaluate the hardness of muscle tissue through the application of compression. Strain elastography gauges hardness through the comparison of echo sets before and after compression. This study utilized ultrasonography to measure the thickness and hardness of the masseter muscle in individuals with temporomandibular joint (TMJ) osteoarthritis.

Materials and Methods

This study included 40 patients who presented with joint pain and were diagnosed with TMJ osteoarthritis via diagnostic cone-beam computed tomography, along with 40 healthy individuals. The thickness and hardness of each individual's masseter muscle were evaluated both at rest and at maximum bite using ultrasonography. The Mann-Whitney U test and the chi-square test were employed for statistical analysis, with the significance level set at P<0.05.

Results

The mean thickness of the resting masseter muscle was 0.91 cm in patients with osteoarthritis, versus 1.00 cm in healthy individuals. The mean thickness of the masseter muscle at maximum bite was 1.28 cm in osteoarthritis patients and 1.36 cm in healthy individuals. The mean masseter elasticity index ratio at maximum bite was 4.51 in patients with osteoarthritis and 3.16 in healthy controls. Significant differences were observed between patients with osteoarthritis and healthy controls in both the masseter muscle thickness and the masseter elasticity index ratio, at rest and at maximum bite (P<0.05).

Conclusion

The thickness of the masseter muscle in patients with TMJ osteoarthritis was less than that in healthy controls. Additionally, the hardness of the masseter muscle was greater in patients with TMJ osteoarthritis.

Evaluation of the validity of mental foramen USG measurements by comparison with CBCT and determination of blood flow

OBJECTIVES

To examine mental foramen (MF) morphology and morphometry in comparison with ultrasonography (USG) and cone-beam computed tomography (CBCT), and to determine the relationship between mental artery blood flow parameters and age, gender, dental status, alveolar crest height, mandibular cortical index (MCI) with USG.

METHODS

A total of 120 MF and mental arteries of 60 patients (21 males and 39 females), including 20 patients in each group, aged 18-39, 40-59, and 60 years and above, were evaluated. The horizontal and vertical diameter of the MF and the distance between it and the alveolar crest were evaluated with USG and CBCT. In addition, mental artery blood flow parameters were examined by USG.

RESULTS

When the horizontal diameter values of MF were compared in USG and CBCT measurements; the diameter was significantly lower in the measurements obtained by USG (p < 0.05). It was observed that there were no mental arteries whose blood flow could not be recorded, 31 (25.8%) had strong blood flow and 89 (74.2%) had weak blood flow. No significant correlation was observed between gender and blood flow parameters (p > 0.05).

CONCLUSIONS

Considering that CBCT images are used as gold standard in our study, it may be said that USG is not as reliable as CBCT in evaluating the MF dimensions in the maxillofacial region. Nevertheless, USG is a suitable technique for determining the visualizing and blood flow of the MF.

Management of fascial space infections using ultrasonography as a surgical guide for drainage - A case series

Fascial space infections are common emergencies presented to a maxillofacial surgeon. Space infection requires early diagnosis and prompt management. When left untreated, space infection spreads and involves not just one space, but also its adjacent spaces. Abscess in the head and neck region are treated by surgical incision and drainage, along with antibiotics and removal of the causative factor. The surgical incision and drainage of an abscess, if carried out based on physical examination may result in, excessive pain, tissue trauma, unnecessary extensive incisions, excess time and failure to locate and evacuate the abscess fluid. To avoid all such complications, ultrasonography is not only an invaluable diagnostic tool but also aids in ultrasonography guided drainage of fascial space infections.

In vitro Comparison of Cone Beam Computed Tomography and Ultrasonography Imaging Methods in the Evaluation of Artificial Mandible Intraosseous Lesions

Statement of the Problem:

Intraosseous lesions of jaws can be imaged by cone beam computed tomography (CBCT) and ultrasonography (USG). The knowledge of imaging features of these two methods about intraosseous jaw lesions is important for dental radiology.

Purpose:

The aim of this study is to evaluate artificial mandible intraosseous lesions by using CBCT and USG.

Materials and Method:

In this in vitro study, intraosseous lesions containing water, milk, olive oil, and liver were evaluated in 60 artificial mandibles by using CBCT and USG. Lesion sizes were compared between CBCT and USG. Lesion sizes were measured on the anterior-posterior, bucco-lingual, and superior-inferior sides. Hounsfield unit (HU) values of the lesions in CBCT images were compared between different materials. Echogenicity of the lesions were evaluated in USG images. One sample t and one-way Anova tests were used for the statistical analysis of the study (p< 0.05).

Results:

In all size measurements of the lesions, mean CBCT values were statistically higher when compared with USG. In CBCT images, statistically difference was found between the HU values of lesions containing olive oil and other lesion contents. In USG images, echogenicity of water, milk and olive oil was found to be anechoic and the echogenicity of liver was found to be hypoechoic.

Conclusion:

CBCT was found to be more accurate than USG in measurement of the size of mandibular intraosseous lesions. According to the results of our study, it was thought that only oil content could be differentiated by using CBCT HU values. It was found that lesions with liquid and non-liquid contents could be differentiated with their echogenicity difference in USG images.

Evaluation of the visibility of peri-implant bone defects using ultrasonography with two types of probes

Background: The aim of the present study was to evaluate the efficacy of intraoral and extraoral ultrasonography evaluations performed with two different types of probes (linear and “hockey stick”) for the visibility of peri-implant bone defects. Material and methods: Fourteen implants were inserted into sheep heads. Peri-implant bone defects were created without knowing the depth, which served as the gold standard for the defects. The defects were scanned with two different probe types (linear and hockey stick probes) extraorally and intraorally, using two different ultrasonography systems. For intra- and interobserver agreements for each probe types, Kappa coefficients were calculated. Results: The lowest ICC values were found in both intra- (ICC = 0.696) and interobserver reliability (ICC = 0.762) obtained with the extraorally used linear probe. There was a high agreement with the gold standard when using hockey sticky probes intraorally. For both linear probes, there were no significant differences in agreement among the two observers and the gold standard (p >0.05). Conclusions: High agreement was found when using high-frequency hockey stick probes intraorally, which means that they can be used with good effect for the evaluation of the visibility of peri-implant bone defects. To the best of our knowledge, this study is the first one on this subject. Thus, it can be stated that US can be an alternative method of examining defects. However, further studies are needed to evaluate the effectiveness of US in visualizing peri-implant bone defects.

Oral cancer awareness in North-Western Spain: a population-based study

Background

An early diagnosis depends greatly on patient awareness. Thus, the aim of this study was to investigate general awareness of oral cancer and knowledge about its risk factors, signs and symptoms.

Material and Methods

Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016.

Results

A total of 5,727 people entered the survey (response rate: 53%). When asked what cancers participants had heard about, 20.3% mentioned oral cancer. Regarding risk factors, tobacco was mentioned by 55.3% of the sample (n=3,169), followed by alcohol (12.5%; n=708), poor oral hygiene (10.8%; n=618), diet (6.5%; n=377), and genetics (4.5%; n=248).

Conclusions

General population has low awareness of oral cancer with poor knowledge of risk factors and main alarm signs. In addition, individuals in the risk group scored lower values in the main variables analysed; even those highly educated showed insufficient awareness and knowledge of oral cancer. In these circumstances, there is clear need for educational interventions tailored to the target audience and aimed at increasing knowledge and awareness of oral cancer to promote primary prevention of oral cancer and minimising the time interval of patients with symptomatic oral cancer in their path to treatment.

Key words:Oral cancer, awareness, risk factors, surveys and questionnaires, Spain.

Comparison of postoperative morbidity between piezoelectric surgery and conventional rotary instruments in mandibular third molar surgery: a split-mouth clinical study

Background

The extraction of impacted third molar teeth is a common procedure in maxillofacial surgery. The aim of this study was to compare of piezoelectric surgical technique with the one with conventional rotary instruments in terms of edema, trismus and pain, in mandibular third molar surgery.

Material and Methods

20 individuals with symmetrically impacted lower mandibular third molars and 40 teeth were included in the study. Third molars on the left side of each patient were removed with piezosurgery, while the counterparts on the right side were removed with conventional rotary instruments. Postoperatively, the same antibiotic, analgesic, and mouthwash were recommended to both groups. Ultrasound, edema, trismus measurements were performed before surgery, postoperative, postoperative day 2 and postoperative day 7. VAS scale was used to evaluate the pain.

Results

The average age of 20 individuals included in the study was found to be 21.85 ± 3.08 years. The operation time of the individuals who underwent the surgery with conventional rotary instruments was found to be 12 minutes 31.70 ± 167.03 seconds, and the operation time in the Piezosurgery group was 19 minutes 10.60 ± 306.59 seconds. There was no significant difference between the two groups in terms of trismus, edema, and pain.

Conclusions

Piezosurgery is a safe method that can be used in molar removal, but in this split-mouth study, it is not found advantageous in terms of postoperative morbidity due to the longer working time compared to the one performed with conventional rotary instruments.

Key words:Edema, impacted third molar, pain, piezosurgery, trismus.

Estimation of Accuracy of B-Mode Sonography and Elastography in Differentiation of Benign and Malignant Lymph Nodes With Cytology as Reference Standard: A Prospective Study

Purpose: To prospectively estimate the reliability of B-mode ultrasonography and sonoelastography in differentiating benign and malignant cervical lymph nodes with cytological findings as to the reference standard.

Materials and Methods: A total of 50 patients referred for sonography for enlarged cervical lymph nodes were included in the study. They were subjected initially to B-mode ultrasonography and sonoelastography and later underwent fine-needle aspiration cytology (FNAC) in the same sitting. Sensitivity, specificity, and accuracy were compared.

Results: Out of 50 cases, 33 were males, and 17 were females. On B-mode ultrasonography, 15 enlarged cervical lymph nodes were benign-looking and 35 were malignant-looking. When studied on elastography, 12 were benign-looking and 38 showed features of malignancy. However, when studied histopathologically, 18 were benign and 32 were malignant. The sensitivity, specificity, and diagnostic accuracy were compared, and the results were better in sonoelastography than B-mode ultrasonography. When both B-mode and sonoelastography were combined, an increase in the sensitivity for differentiation was achieved. However, a decrease in specificity was noted when both modalities were combined in our study, probably due to a significant number of patients with tuberculous cervical lymphadenopathy.

Conclusion: In countries like India, where granulomatous infection like tuberculosis is prevalent, the combination of sonoelastography with B-mode ultrasonography has decreased specificity in the differentiation of benign and malignant cervical lymph nodes, and histopathology is always needed for the final confirmation of diagnosis. The decreased specificity on elastography is attributed to simultaneous coexisting inflammation and fibrosis in chronic granulomatous lymphadenopathy.

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.

A Transoral Excision of a Deep Parotid Lobe Lesion Using Ultrasound-Guided Wire Localization: A Multi-disciplinary Team Approach

Purpose

Removing deep parotid lobe lesions often requires a mandibulotomy procedure which carries with it a risk of significant morbidity. A transoral approach may help mitigate against complications but is technically demanding due to limited access in an area with a close relation to the internal carotid artery.

Methods

We describe a multi-disciplinary approach with the use of intraoral ultrasound-guided wire localization of a low-grade acinic cell carcinoma located in the deep lobe of the right parotid gland.

Results

Our multi-disciplinary approach facilitated the complete removal of this deep lobe parotid lesion via a transoral approach with minimal post-operative sequelae or complications.

Conclusion

In selected cases, with appropriate expertise, this dynamic approach can potentially be used even for malignant disease to limit post-operative morbidity when managing small deep parotid lobe lesions.

Laryngeal Spindle Cell/Pleomorphic Lipoma: A Case Report. An In-Depth Review of the Adipocytic Tumors

Spindle cell and pleomorphic lipomas (SC/PLs) are a rare form of lipomatous tumors. They typically occur as a slow-growing localized mass in the subcutaneous fatty tissue of the posterior neck, back, and shoulders. This benign variant represents less than 1.5% of all lipomas and is relatively uncommon in the head and neck area. A manifestation in the larynx is even rarer. Unlike other anatomic locations, laryngeal lipomas can pose life-threatening symptoms secondary to acute obstruction of the upper aerodigestive tract. This report presents a case of a large SC/PL of the larynx associated with hoarseness, dysphagia, globus sensation, and neck fullness. The tumor was successfully removed through an anterior transcervical approach with infrahyoid myotomy. The authors review the literature concerning head and neck adipocytic tumors with spindle cells and discuss the difficulties in distinguishing SC/PLs from liposarcomas. To the best of the authors' knowledge, this is the first case to be reported in the oral and maxillofacial surgery literature.

Review on the applications of ultrasonography in dentomaxillofacial region

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.

Effect of Cortical Bone Thickness on Detection of Intraosseous Lesions by Ultrasonography

Background. Usefulness of ultrasound (US) in detection of intrabony lesions has been showed. A cortical bone perforation or a very thin and intact cortical bone is prerequisite for this purpose. Objective. The current in vitro study was aimed at measuring the cut-off thickness of the overlying cortical bone which allows ultrasonic assessment of bony defects. Materials and Methods. 20 bovine scapula blocks were obtained. Samples were numbered from 1 to 20. In each sample, 5 artificial lesions were made. The lesions were made in order to increase the overlying bone thickness, from 0.1 mm in the first sample to 2 mm in the last one (with 0.1 mm interval). After that, the samples underwent ultrasound examinations by two practicing radiologists. Results. All five lesions in samples numbered 1 to 11 were detected as hypoechoic area. Cortical bone thickness more than 1.1 mm resulted in a failure in the detection of central lesions. Conclusion. We can conclude that neither bony perforation nor very thin cortical bones are needed to consider US to be an effective imaging technique in the evaluation of bony lesion.

Ultrasound analysis of mental artery flow in elderly patients: a case-control study

OBJECTIVES

Mental artery flow decreases with age and may have an aetiological role in alveolar ridge atrophy. The aim of this study was to identify factors associated with alterations of mental artery flow, assessed by ultrasonography.

METHODS

This case-control study was conducted on elderly patients (aged above 60 years) at the beginning of dental treatment. Intraoral B-mode Doppler ultrasonography was used to assess mental artery flow. The cases were defined as patients with a weak/absent ultrasound signal, whereas the controls presented a strong ultrasound signal. Demographics and radiographic findings (low bone mineral density on dual-energy X-ray absorptiometry and mandibular cortical index on panoramic radiographs) were analysed as risk factors for weak/absent ultrasound signal and were calculated as adjusted odds ratios (AORs) with 95% confidence intervals (CIs) using conditional logistic regression. In addition, the Student's t-test was used to compare the mean alveolar bone height of the analysed groups. A p-value <0.05 was considered statistically significant.

RESULTS

A total of 30 ultrasound examinations (12 cases and 18 controls) were analysed. A weak/absent mental artery pulse strength was significantly associated with edentulism (AOR = 3.67; 95% CI = 0.86-15.63; p = 0.046). In addition, there was a significant difference in alveolar bone height between edentulous cases and controls (p = 0.036).

CONCLUSIONS

Within the limitations of this study, the present results indicate that edentulism is associated with diminished mental artery flow, which, in turn, affects alveolar bone height.

Salivary gland disorders: A comprehensive review

Salivary glands are complex in nature. They could be either tubulo acinar, merocrine or exocrine glands secreting mainly saliva. Salivary gland is one of the main soft tissue structures in the maxillofacial area. Saliva is a clear, slightly acidic muco serous fluid that coats the teeth, mucosa and thereby helps to create and maintain a healthy environment in the oral cavity. Salivary glands may be affected by a number of diseases: local and systemic and the prevalence of salivary gland diseases depend on various etiological factors. The glands may be infected by viral, bacterial, rarely fungal or its ductal obstruction which may cause painful swelling or obstruction, affecting their functions. The salivary gland may also be affected by a various benign and malignant tumours. This review article briefly describes about the various salivary gland disorders, diagnostic techniques and their management including the recent advances and the future perspective.

Contribution of Ultrasonography to the Diagnosis of Submucosal and Subcutaneous Nodular Lesions of the Oral and Maxillofacial Region: Analysis of Cases

OBJECTIVE

The aim of this study was to evaluate the contribution of ultrasonography in the establishment of the diagnosis of nonspecific nodular lesions of the oral soft tissues. We determined the indication of use and reliability of ultrasonography in the field of dentistry, considering whether it was of value in the conclusive diagnosis of these pathologies.

MATERIALS AND METHODS

We recruited 65 patients from the Oral Medicine Unit of São Lucas Hospital, who had submucosal and subcutaneous nodules, without established diagnosis. They were subjected to ultrasonography of the lesion, carried out with standardization of the protocol and equipment, utilizing a Doppler system. The ultrasonographic report was prepared by an experienced professional, noting the imaging characteristics as well as the possibility of diagnosis. Two calibrated examiners analyzed the data, comparing the ultrasonographic report with the final diagnosis. Accordingly, we used established scoring, where zero corresponded to no contribution to the final diagnosis, 1 helped in the management of the case, and 2 when imaging determined the diagnosis.

RESULTS

A zero score was obtained for 12.3 % of the examinations performed, and 1 and 2 accounted for respectively 41.5 and 46.1 %, totaling a contribution of about 88 %. Ultrasonography was of value in the diagnosis of vascular lesions in 93.3 % and of neoplasms in 87.5 %. In the salivary gland diseases, it contributed to the final diagnosis in 75 %.

CONCLUSION

The results demonstrated that ultrasonography is an effective tool in the determination of the definitive diagnosis of nonspecific nodular lesions of the soft tissues of the oral and maxillofacial region.

Recent advances of ultrasound imaging in dentistry--a review of the literature

Ultrasonography as an imaging modality in dentistry has been extensively explored in recent years due to several advantages that diagnostic ultrasound provides. It is a non-invasive, inexpensive, painless method and unlike X-ray, it does not cause harmful ionizing radiation. Ultrasound has a promising future as a diagnostic imaging tool in all specialties in dentistry, for both hard and soft tissue detection. The aim of this review is to provide the scientific community and clinicians with an overview of the most recent advances of ultrasound imaging in dentistry. The use of ultrasound is described and discussed in the fields of dental scanning, caries detection, dental fractures, soft tissue and periapical lesions, maxillofacial fractures, periodontal bony defects, gingival and muscle thickness, temporomandibular disorders, and implant dentistry.

Full length articles published in BJOMS during 2010-11--an analysis by sub-specialty and study type

Full length articles such as prospective and retrospective studies, case series, laboratory-based research and reviews form the majority of papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS). We were interested to evaluate the breakdown of these types of articles both by sub-specialty and the type of study as well as the proportion that are written by UK colleagues compared to overseas authors over a 2 year period (2010-11). A total of 191 full length articles across all sub-specialties of our discipline were published, with 107 papers (56%) coming from UK authors. There were proportionately more oncology papers arising from the UK than overseas (60 and 30% of total respectively) while the opposite was found for cleft/deformity studies (10% and 22%). There was only one laboratory-based study published from the UK compared with 27 papers from overseas. The number of quality papers being submitted to the Journal continues to increase, and the type of article being published between UK and overseas probably reflects different practices and case-loads amongst colleagues. The relatively few UK laboratory based studies published in BJOMS compared to overseas authors are most likely due to authors seeking the most prestigious journals possible for their work.

What are we reading? A study of downloaded and cited articles from the British Journal of Oral and Maxillofacial Surgery in 2010

A large number of papers related to oral and maxillofacial surgery are published in many specialist journals. With the ever-increasing use of the internet it is easy to download them as part of a journal subscription on a fee per paper basis, or in some cases for free. Online access to the British Journal of Oral and Maxillofacial Surgery (BJOMS) is free to British Association (BAOMS) members with a $30 fee per paper download for non-members. Many colleagues use the online version of the journal, and this provides valuable information about downloading trends. Other data on articles that have been cited in subsequent publications are also readily available, and they form the basis for the calculation of a journal's impact factor. We evaluated the top 50 downloaded papers from the BJOMS website in 2010 to ascertain which articles were being read online. We also obtained data on the number of citations for papers published in 2009-2010 to see whether these papers were similar to the articles being downloaded. In 2010 there were over 360000 downloaded articles. The most popular papers were leading articles, reviews, and full length articles; only one short communication featured in the top 50 downloads. The papers most cited in subsequent publications were full length articles and leading articles or reviews, which represent 80% of the total citations of the 50 papers. Ten papers were in both the top 50 downloaded and most cited lists. We discuss the implications of this study for the journal and our readers.

Elastography: the next step

In the past few decades, various tools have emerged that claim to enhance detection of oral cancer. The most important prognostic factor in patients with oral cancer is lymph node status: the presence of nodal spread decreases the 5-year survival rate by approximately 50%. Differentiation between reactive and metastatic lymphadenopathy is thus vital, and one differentiating criterion is hardness (elasticity) of the lymph node. The purpose of this review is to highlight a promising new ultrasound technique, known as elastography, which measures the characteristics of tissue compliance. The principles underlying elastography are that tissue compression produces strain (displacement) within the tissue - which is lower in harder tissues than in softer tissues - and that malignant tissues are generally harder than normal surrounding tissue. Therefore, elastography might yield clinical information useful in diagnosing cervical metastasis and improving prognosis in oral cancer. It has long been used for cancers of the breast, pancreas, and thyroid, and its use in cervical lymphadenopathy is now being explored, which could lead to great advancements in the diagnosis and prognosis of oral cancer.

Review of salivary papers published in the British Journal of Oral & Maxillofacial Surgery during 2009-2010

The management of salivary gland disease forms an appreciable part of the work undertaken by our specialty. Fast-track and one-stop clinics for head and neck lumps allow for early diagnosis of salivary gland tumours in most units, and for the sharing of cases between our ear, nose and throat (ENT) colleagues. The emphasis on benign salivary gland disease is very much on outcome after operation, and there have been improvements in surgical technique, particularly in relation to minimal dissection of salivary adenomas and sialendoscopy. This article continues a series of reviews, which aim to provide readers with a quick overview and update of recent publications in the British Journal of Oral and Maxillofacial Surgery (BJOMS) within a particular subspecialty.

To evaluate the efficacy of ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings

AIM

To evaluate the efficacy of Ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings.

MATERIAL AND METHODS

The study was conducted on forty-five patients with maxillofacial swellings. The clinical diagnosis, radiographic diagnosis and ultrasonographic diagnosis were made which was compared to the histopathological diagnosis. The maxillofacial swellings included cystic lesions, benign swellings, malignant swellings, lymphadenopathies and abscesses and space infections.

RESULTS

The diagnostic accuracy and contingency coefficient was evaluated considering histopathology as gold standard. The diagnostic accuracy of ultrasound was found to be 92.30% in the diagnosis of cystic lesions, 87.5% in benign tumors, 81.8% in malignant tumors, 100% in lymphadenopathies and 90% in space infections and abscesses. The contingency coefficient of 0.934 was obtained when ultrasonography was compared to the histopathology, which was highly significant. Similar significant results were obtained comparing ultrasonography with clinical diagnosis (0.895) and radiographic diagnosis (0.889).

CONCLUSION

Ultrasonography provides accurate imaging of the head and neck region and provides information about the nature of the lesion, its extent, and relationship with the surrounding structures. As the conventional and digital radiography enable the diagnosis of the presence of the disease, but do not give any indication of its nature. So, together with clinical and histopathological examinations, real time ultrasound imaging works out as a valuable adjunct in the diagnosis of orofacial swellings.