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ECPB 2016, 74(2): 71–76
https://doi.org/10.25040/ecpb2016.02.071
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Possibilities of Ultrasonography in Establishing the Causes of Inflammation of the Parotid-masseteric Areas

KUCHER A., ZHIZNOMIRSKA O., SLABA O., MINKO L., FILIPSKYI AND., FILIPSKYI ANT.
Abstract

Inflammatory processes in the structure of human diseases occupy a leading position. Maxillofacial area (MFA) is no exception, so inflammatory diseases are diagnosed in the 25–30% of all dental pathologies. About 90 % of patients are treated in outpatient treatment in the dental clinic complaining of various odontogenic and nonodontogenic inflammation of MFA. Among which, according to different authors, 30–40% accounted for inflammation of the parotid-masseteric area (PMA). This anatomical region includes a variety of structures : the parotid salivary gland and regional lymph nodes and vessels, which often react to the impact of endogenous and exogenous factors manifestation of inflammatory diseases. Among the latter, the most common are inflammatory changes in lymph nodes and inflammation of the parotid gland.

The analysis of ultrasonographic studies of 125 patients aged from 18 to 85 years for the period from 2013 to 2015, which were directed on the cause of PMA inflammation. All patients included in the study group had clinical signs of PMA inflammation with variable degree of severity. Subsequently, patients were divided into groups: the first group consisted of 56 patients with inflammatory changes in lymph nodes; the second group included 38 patients with sialoadenitis; the third group – 9 patients with sialodohitis; the fourth group comprises 2 patients with venous dysplasia PMA; fifth group – 2 patients with inflammation of the masticatory muscles. Ultrasound investigation (USG) was performed on the Logiq E machine (USA) in B mode using additional samples (compression and Valsalva).

Among all inflammatory diseases, the most common inflammatory changes are in lymph nodes – from reactive hyperplasia lymph nodes to different types of the lymphadenitis. This is because the lymph nodes of each PMA are the collector of the lymph from the half of the face: temporal and parietal areas, supralateral areas of the neck, outer ear, conjunctiva, the mucous membrane of the mouth, and the teeth of the upper jaw. Thus, the vast majority of the lymph nodes located deep in the parotid gland. This can explain that these inflammatory changes in lymph nodes could be falsely interpreted as inflammation of the parotid gland. Differential diagnosis must be established, because treatment tactic (conservative or surgical) depends on the stage of the lymphadenitis; in case of sialoadenitis – always-conservative treatment. Among the patients, who were included in the study, inflammatory changes in lymph nodes were found in 56 cases (52.3 %). Sialoadenitis (mumps) are on the second place in frequency after inflammatory changes in lymph nodes – 38 (35.5 %) patients. In 9 cases (8.4 %) were found widening of the excretory duct of one of the parotid glands with concomitant inflammation of the parotid gland in 6 cases. In 2 cases (1.9 %) arteriovenous dysplasia was found, which was accompanied by persistent swelling, and patients turned in connection with painful symptoms. USG method was conducted differential diagnosis with mumps; in one case revealed a thrombus of modified dysplastic veins. In 2 patients (1.9 %) with suspected acute mumps inflammation in the masseter muscles was discovered, which was interpreted as inflammatory infiltrate.

Using of ultrasound significantly improves the accuracy of diagnosis of inflammatory diseases of parotid-masseteric areas. USG study can pinpoint individual topographic anatomical pathological process, which is important when planning a conservative (therapeutic) treatment or surgery. All of the above suggests that the method USG is an essential component of all diagnostic algorithm in the examined patients with inflammatory diseases of parotid-masticatory areas.

Keywords: inflammation, lymphadenitis, parotid-masseteric area, salivary glands, sialoadenitis, ultrasonography

Full text: PDF (Ukr) 1.23M

References
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