الفهرس 
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Abstract
The maxillofacial region is a common anatomic site for the development of infections, cysts, and tumors of odontogenic or non-odontogenic origin. There are many reasons for requesting imaging information about a maxillofacial swelling as; determination of the nature of a condition, evaluate the extent of a lesion and monitor the progression or regression of a lesion over time. CT) and MRI are recent imaging tools that often used to clarify maxillofacial lesions nature, extent, boundaries, and effect on surroundings, but they are still expensive examinations and have their limitations. The US is one of these recent tools that overcome the disadvantages of CT and MRI.
The US is used for the diagnosis of maxillofacial swellings because it is a quick method, widely available, relatively inexpensive, painless, gives rapidly acquired images and can be repeated as often as necessary without risk to the patient. The ultrasonographic features were able to at least categorize the swelling type.
Little researches were done to evaluate the efficacy of US examination in diagnosing the maxillofacial swellings, so this study was aiming to evaluate the efficacy of US examination by assessing different features that appeared in the ultrasonographic examination of the maxillofacial swellings in correlation to clinical examination and other radiological methods findings considering histopathology as a gold standard.
50 patients with clinically obvious swellings in the maxillofacial region were randomly selected. Patient’s swellings were categorized into: inflammatory/space infection and abscess, cystic, lymph node, benign and malignant neoplastic swellings after the final/histopathological diagnosis that was considered the gold standard of this prospective study.
Thediagnostic accuracy of the US,the clinical and the other radiological methods examinations were compared to histopathology to determine the diagnostic method efficacy in diagnosing maxillofacial swellings.
A high significant association (p-value < 0.001) and contingency coefficient of 0.88 and 0.81 between ultrasonographic&histopathological diagnosis and between ultrasonographic& clinical diagnosis were found respectively, with a diagnostic accuracy of 89% for ultrasonographic guided diagnosis (USGD) and 66% for clinical examination when compared to histopathology.
There wasa significant clinical correlation in terms of reported pain, tenderness and lymph nodes involvement to ultrasonographic features appeared from examined maxillofacial swellings. The ultrasonographic diagnosis accuracy reached 100% inlymph node and malignant swelling groups followed by 98% in inflammatory and cystic swellings.The sensitivity of ultrasonographic diagnosis was 100% in cystic, lymph node and malignant swellings followed by 91% in inflammatory swellings and 86% in benign swellings.
The majority of inflammatory swellings were characterized by; irregular shapes, hypoechoic echogenicity, heterogeneous US architecture of the lesion and posterior enhancement. The cystic swellings were characterized by; very clear boundaries, homogenous lesion architecture, enhanced posterior echoes and without neither vascularity nor necrosis. Most examined lymph nodes swellings were characterized by ill-defined boundaries, homogenous lesion architecture, cystic tissue characteristics, posterior enhancement and with central necrosis & calcifications. Benign swellings were characterized by;heterogenous US architecture of lesion, mixed tissue characteristics, without vascularity, without necrosis, and without calcifications. The malignant neoplastic swellings were characterized by; irregular shapes, heterogenous US architecture of lesion, without vascularity and without calcifications.
Conclusion & Recommendations
The use of ultrasonographic features with Doppler function in addition to the clinical aspects, greatly aid in reaching an accurate final diagnosis for maxillofacial swellings.It significantly improves the evaluation of patients with various types of maxillofacial swellings.
If US features of a maxillofacial lesion were of irregular shapes, hypoechoic and of heterogenous lesion architecture; are suggesting to inflammatory/infection lesion. Features of very clear boundaries, homogenous lesion architecture and enhanced posterior enhancement; these are suggestions of the cystic lesion. Lymph node features can be ill boundaries, homogenous lesion architecture and with centric necrosis. If US features were of heterogenous lesion architecture and with mixed tissue characteristics and enhanced posterior echoes; they are suggesting to the benign lesion. While, irregular shapes, with heterogenous lesion architecture and with eccentric necrosis; are suggesting to malignant neoplasm.
So, the ultrasound is a recommended imaging tool in diagnosing maxillofacial swellings as it has relatively high sensitivity, specificity, and accuracy when compared to the histopathology and it greatly aids in extracting an accurate diagnosis of a maxillofacial swelling.Also, it is highly recommended to be used to supplement the clinical examination in patients with maxillofacial swellings to arrive at a final diagnosis.