Ultrasonography as a Diagnostic Tool for Superficial Space Infections: A Prospective Study

Incision and drainage for dental infections performed blindly can result in more harm if it fails to locate and evacuate the abscess cavity completely. The use of ultrasonography (USG) in such situations may be beneficial. Therefore, the present study was designed to evaluate the efficacy of ultrasonography as a diagnostic tool for superficial space infections.

A prospective study was conducted on 40 patients of either gender, aged 18–60 years who presented with infection of facial spaces of odontogenic origin. Clinical and radiographic examinations of all patients were performed followed by an ultrasonography examination. USG echogenicity of tissues was used to stage the disease (pre-abscess, abscess, cellulitis). Smaller abscesses were drained by aspirating pus with an 18 gauge needle with the help of real-time ultrasound. Larger abscesses were drained by surgical incision and drainage under the static image guidance of ultrasound. Clinical and ultrasonography findings were recorded and data tabulated.

72.5% of patients were with single space involvement, whereas 27.5% had multiple spaces involvement. With clinical and radiographic examination alone, a correct diagnosis was made in only 16 out of 40 cases with a positive predictive value of 46.4% and a negative predictive value of 25%. USG and USG-guided intraoperative aspiration showed a sensitivity and specificity of 100% for diagnosing cases of facial space infection of odontogenic origin. Staphylococci (40.9%) were the predominant species, followed by Pseudomonas (31.8%), Klebsiella (13.6%) and Enterococcus (13.6%).

Ultrasonography (USG) is a valuable diagnostic tool for superficial space infections. It is much superior in defining the exact location of an abscess and guides the surgical approach by locating the abscess cavities. It avoids traditional open surgical incision and drainage in incorrectly diagnosed abscess cases and can be used to follow the course of the disease and its response to nonsurgical treatment.