Transoral Ultrasound in the Diagnosis of Obstructive Salivary Gland Pathologies

Clinical audit of ultrasonography for detecting sialoliths in the submandibular gland in paediatric patients: A comparison to computed tomography and magnetic resonance imaging

Objectives

To compare the performance of ultrasonography with magnetic resonance imaging (MRI) and computed tomography (CT) for detecting submandibular sialoliths.

Methods

Thirteen patients with suspected submandibular sialoliths who underwent ultrasonography and CT or MRI were included. Sialoliths were diagnosed using CT (11 cases) or MRI (two cases). The submandibular duct was classified into distal and proximal ducts based on the point around the mylohyoid muscle. Sialoliths located in the proximal duct were difficult to differentiate from those located within the submandibular gland (SMG). Therefore, the location of the sialoliths was classified as follows: within the SMG/proximal duct and within the distal duct. The ultrasound results were compared with CT/MRI results.

Results

Of the 13 patients included, two had sialoliths in both the SMG/proximal duct and the distal duct, three had sialoliths in the SMG/proximal duct, and five had sialoliths in the distal duct on CT or MRI. In this small cohort, all five sialoliths in the SMG/proximal duct were detected by ultrasoonography; however, of the seven cases with sialoliths located in the distal duct, only three could be detected by ultrasonography.

Conclusions

The incidence of sialoliths in the distal duct was higher than that in the SMG/proximal duct. Ultrasonography showed a good performance compared with CT/MRI in the SMG/proximal duct but not in the distal duct.

Ultrasound in the diagnosis and differential diagnosis of enoral and plunging ranula: a detailed and comparative analysis

Purpose

To develop sonographic criteria for ranula that to allow rapid and precise diagnosis, differentiation between enoral (ER) and plunging ranula (PR), and differential diagnosis from other competing pathologies in this region.

Methods

Patients who presented with or were referred with ranula between 2002 and 2022 were assessed in a retrospective study. After clinical investigation, ultrasound examinations were performed in all cases. Several sonographic parameters describing the echotexture, shape and size of ranulas, their relationship to important surrounding anatomical landmarks and the characteristic spreading pattern of ERs and PRs were elaborated and evaluated.

Results

207 ranulas were included (82.12% ERs and 17.87% PRs). The ranulas were all in close anatomical relationship to the sublingual gland (SLG) and mylohyoid muscle (MM). The echo texture was hypoechoic to anechoic in 97.6% of the lesions. In comparison with ERs, PRs were larger and irregular in shape significantly more often (P = 0.0001). There were significant differences between ERs and PRs in their exact location relative to the SLG (superficial, deep, anterior, each P = 0.0001; posterior, P = 0.03) and level of the MM (above, below, above and below, P = 0.0001 each). The exact extent and plunging pattern were depicted in all PRs, but naturally in none of the ERs.

Conclusions

The ultrasound criteria developed in this study, confirming previously published results, indicate that ultrasound is an excellent diagnostic tool for diagnosing ranula and differentiating between ERs and PRs.

Simultaneous Application of Ultrasound and Sialendoscopy and its Value in the Management of Sialolithiasis

OBJECTIVE

Ultrasound (US) and sialendoscopy (SE) are routinely used in patients presenting with sialolithiasis in the submandibular (SMG) and parotid gland (PG). The objective was to assess the value of the simultaneous application of US and SE in the management of sialolithiasis.

STUDY DESIGN

Retrospective study.

SETTING

Tertiary referral center for salivary gland diseases.

PARTICIPANTS

Patients in whom US and SE as single investigation tools were neither conclusive nor useful in the management of sialolithiasis were investigated using both methods simultaneously (simUS + SE).

MAIN OUTCOME MEASURES

Establishment of the final diagnosis and/or contribution to the planning/performing of treatment in sialolithiasis.

RESULTS

74 patients were examined by simUS + SE (58.1 % SMG and 41.9 % PG). In all patients (unclear) hyperechoic reflexes were assessed and/or localized by SE-controlled US navigation. 68.9 % of the patients were investigated for diagnostic or differential-diagnostic reasons including distinguishing extraductal from intraductal calcifications and/or to exclude residual stones after therapy. In 52.7 % simUS + SE was used to plan and/or perform further treatment, in 20.3 % to enable performing a combined approach (all PG) and in 29.7 % to evaluate and plan the most adequate therapy (mainly intraductal vs. extracorporeal shock wave lithotripsy, 68.2 % of these SMG). In two cases SE-controlled and US-guided stone extraction was performed.

CONCLUSION

SimUS + SE is an innovative approach which proved to be very useful in managing sialolithiasis. It added valuable information regarding the establishment of a diagnosis or differential diagnosis, planning and performing the most adequate treatment, intraoperative control of therapy and postoperative follow-up.

The applicability of ultrasound in the diagnosis of inflammatory and obstructive diseases of the major salivary glands: a scoping review

OBJECTIVES

The purpose of the present scoping review was to determine the contribution of ultrasound images in the diagnosis of inflammatory and obstructive diseases of the major salivary glands (MSGs).

METHODS

A search of studies of ultrasonographic assessments of human samples was performed in several electronic databases and grey literature up to July 2021. The extracted data were the examined MSG; the diagnostic value of ultrasound (sensibility, specificity, positive- and negative predictive value, accuracy); features of lesions, including number, echogenicity, echotexture, form, margins, size, posterior acoustic aspect, and location; and related clinical information, such as swelling, palpation, sensible to pain, salivation, lymph nodes, recurrence, duration, and causes.

RESULTS

After verifying the eligibility criteria, 90 articles focused on detecting inflammatory, and obstructive diseases of the MSG were gathered, with variable study designs and size samples. A wide variety of pathologies were assessed, including sialolitiasis (n = 45), acute sialadenitis (n = 30), chronic sialadenitis (n = 25), granulamatous diseases (n = 15), Kuttner's tumor (n = 11), juvenile recurrent parotitis (n = 9), abscess (n = 7), post-radiotherapy sialadenitis (n = 6), sialadenosis (n = 9), abscess (n = 7), IgG4-related disease sialadenitis (n = 5), HIV-sialadenitis (n = 4), obstructive sialadenitis (n = 3), iodinated contrast-induced sialadenitis (n = 2), and pneumoparotitis (n = 1). Most studies were case reports or series of cases. Few studies exhibited data about the accuracy of ultrasound in detecting MSG diseases.

CONCLUSIONS

The present scoping review concluded that ultrasound aspects of different MSG pathologies are similar but contribute to their differential diagnosis and can be considered as a valuable initial method for assessing the MSG of adults and children.

Acoustic-Field Beamforming-Based Generalized Coherence Factor for Handheld Ultrasound

Handheld ultrasound devices have been widely used for diagnostic applications. The use of the acoustic-field beamforming (AFB) method has been proposed for handheld ultrasound to reduce electricity consumption and avoid battery and unwanted heat issues. However, the image quality, such as the contrast ratio and contrast-to-noise-ratio, are poorer with this technique than with the conventional delay-and-sum method. To address the problems associated with the worse image quality in AFB imaging, in this paper we propose the use of an AFB-based generalized coherence factor (GCF) technique, in which the GCF weighting developed for adaptive beamforming is extended to AFB. Simulation data, experimental results, and in vivo testing verified the efficacy of our proposed AFB-based GCF technique.

Ultrasound in Inflammatory and Obstructive Salivary Gland Diseases: Own Experiences and a Review of the Literature

Background: Ultrasound is established as a diagnostic tool in salivary glands for obstructive diseases such as sialolithiasis and tumors. Concerning inflammatory diseases and in non-sialolithiasis-caused obstruction, much fewer data are available. In recent years, technical development has allowed a better assessment of the gland parenchyma, and knowledge about intraductal pathologies has increased considerably, which has provided new insights and a new interpretation of ultrasound findings. Objectives: To provide a comprehensive review of the literature that includes our own experiences and to point out the state of the art in ultrasound in the diagnostics of inflammatory and obstructive salivary gland diseases, taking adequate techniques and recent technical developments into consideration. Data sources and study eligibility criteria: A systematic literature search was performed in Pubmed using various specific key words. Results: According to the literature results, including our own experiences, ultrasound is of value in up to >90% of cases presenting with inflammatory and/or obstructive diseases. Technical developments (e.g., elastography) and the application of modified ultrasound techniques (e.g., transoral ultrasound) have contributed to these results. Today, ultrasound is considered a first-line diagnostic tool in these diseases. However, in some inflammatory diseases, the final diagnosis can be made only after inclusion of the anamnesis, clinical symptoms, serologic blood tests, or histopathologic investigation. Conclusions: Ultrasound can be considered as a first-line diagnostic tool in obstructive and inflammatory salivary gland diseases. In obstructive diseases, it may be sufficient for diagnostics in >90% of cases. In inflammatory diseases, ultrasound is at least an excellent screening method and can be used to establish the diagnosis in cases of an early suspicion. In all diseases ultrasound can contribute to better management and can be used for monitoring during follow-up.

[Sonography of the head and neck area - Part 1: Endosonography]

Sonography of the head and neck area plays a major role in both outpatient and inpatient ear, nose and throat medicine. Transcervical ultrasound is an important imaging method, especially in lymph node and tumor diagnostics. Its advantage is the ubiquitous availability and the excellent combinability with endoscopy and palpation. Despite decades of experience with sonography in the head and neck area, in contrast to the transcutaneous application, the transoral or endosonographic approach has so far not been widely used. Here it is often not due to the technical capabilities of the examiner, but rather to the unusual approach within the scope of the investigation. In this context, endosonography may be used primarily in tumor diagnostics in order to establish a complete sonographic examination from in- and outside.

Non-invasive evaluation of labial gingival and alveolar crest thickness in the maxillary anterior teeth region by 15-MHz B-mode ultrasonography

Background

Knowledge of gingival thickness (GT) and alveolar crest thickness (ACT) is essential when performing surgical and non-surgical procedures in the maxillary anterior teeth region. This study aimed at evaluating the GT and ACT in the maxillary anterior teeth region using 15-MHz B-mode Ultrasonic (US).

Methods

A total of 300 teeth from 50 healthy participants, comprising 25 women and 25 men, aged between 18 and 35 years were analyzed. We measured labial periodontal tissue structures of maxillary anterior teeth, including GT and ACT, at 3 mm apical to the gingival margin (GT3) and the crestal level, respectively. The GT and ACT measurements were correlated.

Results

The mean labial GT3 of the maxillary central incisors, lateral incisors, and canines were 1.24 ± 0.03 mm, 1.21 ± 0.03 mm and 1.11 ± 0.03 mm, respectively. Canine GT3 was significantly thin than those in the central and lateral incisors (P < 0.05). With regards to labial ACT, we recorded 0.79 ± 0.03 mm, 0.76 ± 0.02 mm and 0.73 ± 0.02 mm for maxillary central incisors, lateral incisors and canines, respectively. There were no significant differences in ACT of maxillary anterior teeth (P > 0.05). GT3 of men was greater than that of women (P < 0.05). In addition, GT and ACT were positively correlated (r = 0.32, P < 0.01).

Conclusion

15-MHz B-mode US is an effective tool for measuring labial GT and ACT of anterior teeth. There are sex-associated differences in GT3 and the correlation between the GT3 and ACT of anterior teeth is moderately positive.

Contrast-Enhanced Ultrasound Guided Transoral Core Needle Biopsy: A Novel, Safe and Well-Tolerated Procedure for Obtaining High-Quality Tissue in Patients with Oral Cancer

The aim of the prospective study described here was to compare the tolerability, safety and diagnostic value of contrast-enhanced ultrasound-guided transoral core needle biopsy (CEUS-CNB) with that of conventional US-guided transoral CNB (US-CNB) and standard incisional biopsy in patients with oral masses. Between June 2017 and November 2019, consecutive patients with oral masses referred for biopsy were randomly assigned to undergo incisional biopsy, US-CNB or CEUS-CNB. Procedure time, intra‑operative blood loss volume, diagnostic performance and pain level before and after the procedure assessed by visual analogue score (VAS) were recorded and compared among the three procedures. Finally, 238 patients with pathology confirmation were analyzed: 80 patients underwent incisional biopsy, 78 patients US-CNB and 80 patients CEUS-CNB. In this study, no significant difference was found in biopsy time between CEUS-CNB, US-CNB and incisional biopsy (75 ± 11 s vs. 73.6 ± 12 s vs. 77 ± 13 s, p = 0.24). CEUS-CNB achieved the highest sensitivity (CEUS-CNB: 100%, US-CNB: 88.5%, incisional biopsy: 84.3%), negative predictive value (CEUS-CNB: 100%, US-CNB: 81.3%, incisional biopsy: 78.4%) and accuracy (CEUS-CNB: 100%, US-CNB: 92.3%, incisional biopsy: 90%). The VAS score for incision biopsy was higher (p = 0.01) and the amount of bleeding was larger (p < 0.001), yet there was no significant difference between CEUS-CNB and US-CNB. Our results indicate CEUS-guided transoral CNB is an efficient, safe and well-tolerated procedure, with biopsy time comparable to and diagnostic performance better than those of conventional US-guided transoral CNB and incisional biopsy.

Neutrophil Extracellular Traps Promote the Development and Growth of Human Salivary Stones

Salivary gland stones, or sialoliths, are the most common cause of the obstruction of salivary glands. The mechanism behind the formation of sialoliths has been elusive. Symptomatic sialolithiasis has a prevalence of 0.45% in the general population, is characterized by recurrent painful periprandial swelling of the affected gland, and often results in sialadenitis with the need for surgical intervention. Here, we show by the use of immunohistochemistry, immunofluorescence, computed tomography (CT) scans and reconstructions, special dye techniques, bacterial genotyping, and enzyme activity analyses that neutrophil extracellular traps (NETs) initiate the formation and growth of sialoliths in humans. The deposition of neutrophil granulocyte extracellular DNA around small crystals results in the dense aggregation of the latter, and the subsequent mineralization creates alternating layers of dense mineral, which are predominantly calcium salt deposits and DNA. The further agglomeration and appositional growth of these structures promotes the development of macroscopic sialoliths that finally occlude the efferent ducts of the salivary glands, causing clinical symptoms and salivary gland dysfunction. These findings provide an entirely novel insight into the mechanism of sialolithogenesis, in which an immune system-mediated response essentially participates in the physicochemical process of concrement formation and growth.

Evaluation of preoperative Ultrasonography in the Differentiation between Superficial and Deep Parotid Gland Tumors

Imaging of the intraparotid course of the facial nerve remains a challenge and is not an established routine procedure. The aim of this study was to evaluate ultrasound in localizing a parotid tumor in relation to the facial nerve. The ultrasound findings and operative reports of all patients treated for parotid gland tumors were studied retrospectively. Eight hundred sixty-eight parotid lesions formed our study sample. The unit of measurement was the minimal distance between the parotideomasseteric fascia and the superficial capsule of the tumor, measured in millimeters by means of ultrasound. The mean value for this parameter was 1.3 mm for superficial and 4.6 mm for deep lobe tumors (p < 0.001). When the cutoff value was set at 2.6 mm, the sensitivity and specificity of ultrasound were 89.6 and 88.4%, respectively. Our study revealed that ultrasound can help in the pre-operative differentiation between tumors of the superficial and deep lobes of the parotid gland.