CURRENT LITERATURE

Role of Ultrasonography in Differentiating Facial Swellings of Odontogenic Origin

Lisa Poweski, DDS, MS , Melissa Drum, DDS, MS , Al Reader, DDS, MS, John Nusstein, DDS, MS , Mike Beck, DDS, MA , Jahanzeb Chaudhry, DDS, MDSc

In the April 2014 issue of the Journal of Endodontics Poweski et al undertook to determine “if ultrasound were more accurate than a blind incision for drainage procedure in locating purulence…”. They compared clinical examination plus ultrasonography versus clinical examination alone in differentiating cellulitis from abscesses in patients with facial swelling of odontogenic origin. They concluded that “The addition of ultrasonography to a clinical examination did not significantly increase the number of correct diagnoses.”

Their published abstract appears below:

Abstract

Introduction

Differentiating an acute, odontogenic facial swelling clinically as cellulitis or an abscess has not been thoroughly investigated in endodontics. It has been suggested in the medical and dental literature that the use of ultrasound may aid in differentiating cellulitis from an abscess. Therefore, if ultrasound were more accurate than a blind incision for drainage procedure in locating purulence, perhaps the outcome of the incision for drainage procedure would be beneficial in the resolution of odontogenic infections. The purpose of this prospective study was to compare clinical examination plus ultrasonography versus clinical examination alone in differentiating cellulitis from abscesses in patients with facial swelling of odontogenic origin.

Methods

Eighty-two emergency patients participated in this study. Each patient was examined and diagnosed by clinical examination and clinical examination plus ultrasonography. An incision for drainage procedure was performed, and a definitive diagnosis was recorded as cellulitis (no purulence) or an abscess (presence of purulence).

Results

With the incision for drainage procedure, cellulitis occurred 37% of the time and abscesses 63%. With clinical examination alone, a correct diagnosis was made 68% of the time. With clinical examination plus ultrasonography, a correct diagnosis was made 70% of the time. There was no statistically significant difference between the 2 examination methods.

Conclusions

The addition of ultrasonography to a clinical examination did not significantly increase the number of correct diagnoses.

Dr. Barry H. Korzen

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