Ultrasonography in Oral and Maxillofacial Infections: A Scoping Review
DOI:
https://doi.org/10.15517/djvzpy03Keywords:
Ultrasonography; Maxillofacial infections; Odontogenic infection; Point-of-care ultrasound; Diagnosis; Drainage.Abstract
Maxillofacial infections are complex clinical conditions that can progress rapidly and extend into deep fascial spaces. Although computed tomography remains the reference imaging modality, ultrasonography has emerged as a promising alternative due to its accessibility, low cost, and lack of ionizing radiation. The aim of this review was to analyze and synthesize the available scientific evidence on the diagnostic and therapeutic role of ultrasonography in maxillofacial infections. A scoping review was conducted following the PRISMA-ScR guidelines and the methodological frameworks of Arksey and O’Malley and the Joanna Briggs Institute. A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between 2000 and May 9, 2026. The PubMed search strategy was: ("Ultrasonography"[Mesh]) AND ((("Focal Infection, Dental"[Mesh]) OR (maxillofacial infection)) OR (facial space infection)). Primary studies evaluating the diagnostic and/or therapeutic use of ultrasonography in maxillofacial infections were included. Eighteen studies involving a total of 787 participants were included. Most studies assessed odontogenic infections and superficial facial space infections. Ultrasonography was useful for differentiating cellulitis from abscesses, assessing lesion extent, and guiding minimally invasive drainage procedures. However, limitations were reported in the assessment of deep fascial spaces due to interference from bone and air. The use of Point-of-Care Ultrasound (POCUS) demonstrated effectiveness in hospital and emergency care settings. Ultrasonography appears to be a valuable complementary tool in the management of maxillofacial infections, particularly for superficial infections and minimally invasive procedures. However, methodological heterogeneity and operator dependency limit definitive conclusions about its diagnostic and therapeutic accuracy.
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Milic T., Raidoo P., Gebauer D. Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review. Br J Oral Maxillofac Surg. 2021; 59 (6): 633-42. DOI: https://doi.org/10.1016/j.bjoms.2020.09.020
Dammling C., Abramowicz S., Kinard B. Current Concepts in Prophylactic Antibiotics in Oral and Maxillofacial Surgery. Oral Maxillofac Surg Clin North Am. 2022; 34 (1): 157-67. DOI: https://doi.org/10.1016/j.coms.2021.08.015
Chen F., Fang L., Feng K., Xu J. Respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors. J Infect Dev Ctries. 2023; 17 (7): 979-85. DOI: https://doi.org/10.3855/jidc.16810
Xu X., Cui C., Ma Q., Sun X. Multi-disciplinary treatment of oral and maxillofacial-space infection during pregnancy: A case report. Asian J Surg. 2024; 47 (10): 4511. DOI: https://doi.org/10.1016/j.asjsur.2024.07.228
Cutilli T., Cargini P., Placidi D., Corbacelli A. Necrotizing fasciitis of the maxillofacial region caused by dental infection. A case report and review. Minerva Stomatol. 2007; 56 (9): 469-76.
Pepato A.O., Yamaji M.A., Sverzut C.E., Trivellato A.E. Lower third molar infection with purulent discharge through the external auditory meatus. Case report and review of literature. Int J Oral Maxillofac Surg. 2012; 41 (3): 380-3. DOI: https://doi.org/10.1016/j.ijom.2011.09.011
Rajendra Santosh A.B., Ogle O.E., Williams D., Woodbine E.F. Epidemiology of Oral and Maxillofacial Infections. Dent Clin North Am. 2017; 61 (2): 217-33. DOI: https://doi.org/10.1016/j.cden.2016.11.003
Zhou J., Wan T., Miao R., Tang W., Liu L., Long J., et al. Oral and maxillofacial emergencies: A retrospective study of 5220 cases in West China. Dent Traumatol. 2023; 39 (2): 140-6. DOI: https://doi.org/10.1111/edt.12798
Mardini S., Gohel A. Imaging of Odontogenic Infections. Radiol Clin North Am. 2018; 56 (1): 31-44. DOI: https://doi.org/10.1016/j.rcl.2017.08.003
Rautaporras N., Uittamo J., Furuholm J., Marinescu Gava M., Snäll J. Deep odontogenic infections - Computed tomography imaging-based spreading routes and risk for airway obstruction. J Stomatol Oral Maxillofac Surg. 2023; 124 (4): 101424. DOI: https://doi.org/10.1016/j.jormas.2023.101424
Christensen B.J., Park E.P., Nelson S., King B.J. Are Emergency Medicine Physicians Able to Determine the Need for Computed Tomography and Specialist Consultation in Odontogenic Maxillofacial Infections? J Oral Maxillofac Surg. 2018; 76 (12): 2559-63. DOI: https://doi.org/10.1016/j.joms.2018.07.015
Frid H., Bilder A., Hija A., Emodi O. Diagnostic Accuracy and Clinical Impact of Handheld Point-of-Care Ultrasound in Pediatric Odontogenic Infections: A Prospective Cohort Study. Children (Basel). 2025; 12 (10). DOI: https://doi.org/10.3390/children12101392
Patil S., Alkahtani A., Bhandi S., Mashyakhy M., Alvarez M., Alroomy R., et al. Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review. Diagnostics (Basel). 2021; 11 (7). DOI: https://doi.org/10.3390/diagnostics11071208
Langer S.G., Carter S.J., Haynor D.R., Maravella K.R., Mattes D., Strandness E.D., Jr., et al. Image acquisition: ultrasound, computed tomography, and magnetic resonance imaging. World J Surg. 2001; 25 (11): 1428-37. DOI: https://doi.org/10.1007/s00268-001-0128-y
Abbasi M., Bayat M., Beshkar M., Momen-Heravi F. Ultrasound-guided simultaneous irrigation and drainage of facial abscess. J Craniofac Surg. 2012; 23 (2): 558-9. DOI: https://doi.org/10.1097/SCS.0b013e31824cd63a
Bassiony M., Yang J., Abdel-Monem T.M., Elmogy S., Elnagdy M. Exploration of ultrasonography in assessment of fascial space spread of odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107 (6): 861-9. DOI: https://doi.org/10.1016/j.tripleo.2009.02.016
Ghali S., Katti G., Shahbaz S., Chitroda P.K., V.A., Divakar D.D., et al. Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging. World J Clin Cases. 2021; 9 (3): 573-80. DOI: https://doi.org/10.12998/wjcc.v9.i3.573
Costa S.M., Ribeiro B.C., de-Jesus A.O., Libanio GR, Lanes-Silveira R, Amaral MB. Ultrasound protocol in odontogenic infections: a new proposal. Med Oral Patol Oral Cir Bucal. 2023; 28 (1): e56-e64. DOI: https://doi.org/10.4317/medoral.25583
Musu D., Rossi-Fedele G., Campisi G., Cotti E. Ultrasonography in the diagnosis of bone lesions of the jaws: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 122 (1): e19-29. DOI: https://doi.org/10.1016/j.oooo.2016.03.022
Taub D., Yampolsky A., Diecidue R., Gold L. Controversies in the Management of Oral and Maxillofacial Infections. Oral Maxillofac Surg Clin North Am. 2017; 29 (4): 465-73. DOI: https://doi.org/10.1016/j.coms.2017.06.004
Tricco A.C., Lillie E., Zarin W., O'Brien K.K., Colquhoun H., Levac D., et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018; 169 (7): 467-73. DOI: https://doi.org/10.7326/M18-0850
Arksey H., O'malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005; 8 (1): 19-32. DOI: https://doi.org/10.1080/1364557032000119616
Peters M.D.J., Marnie C., Tricco A.C., Pollock D., Munn Z., Alexander L., et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18 (10): 2119-26. DOI: https://doi.org/10.11124/JBIES-20-00167
Srinivas K., Sumanth K.N., Chopra S.S. Ultrasonographic evaluation of inflammatory swellings of buccal space. Indian J Dent Res. 2009; 20 (4): 458-62. DOI: https://doi.org/10.4103/0970-9290.59454
Mukhi P.U., Mahindra U.R. The use of ultrasonography in diagnosis and management of superficial fascial space infections. Indian J Dent Res. 2012; 23 (3): 313-9. DOI: https://doi.org/10.4103/0970-9290.102211
Shah N., Patel S., Rupawala T., Makwana S., Mansuri S., Bhimani K. Evaluation of Efficacy of Ultrasonography as an Additional Diagnostic Tool for Deciding Management Protocol of Odontogenic Superficial Fascial Space Infections: A Prospective Clinical Study. J Maxillofac Oral Surg. 2022; 21 (4): 1148-54. DOI: https://doi.org/10.1007/s12663-021-01560-x
Saifi A.M., Anjum O., Byra P., Kumar A., Subhalakshmi S., Bharani K.S.N.S. Ultrasonography as a Diagnostic Tool for Superficial Space Infections: A Prospective Study. Journal of Maxillofacial and Oral Surgery. 2024. DOI: https://doi.org/10.1007/s12663-024-02134-3
Gross I., Nassar M., Guzner N., Granot I., Pines N., Cahan L.O.S., et al. Point-of-care ultrasound for the evaluation of dental abscesses in the pediatric emergency department. Cjem. 2026; 28 (4): 357-61. DOI: https://doi.org/10.1007/s43678-026-01101-w
Poweski L., Drum M., Reader A., Nusstein J., Beck M., Chaudhry J. Role of ultrasonography in differentiating facial swellings of odontogenic origin. J Endod. 2014; 40 (4): 495-8. DOI: https://doi.org/10.1016/j.joen.2014.01.002
Pallagatti S., Sheikh S., Puri N., Mittal A., Singh B. To evaluate the efficacy of ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings. Eur J Radiol. 2012; 81 (8): 1821-7. DOI: https://doi.org/10.1016/j.ejrad.2011.04.065
Adamu Y.M., Hassan M.O., Abba M., Amole O., Garba I., Dare A. Efficacy of Ultrasonography in the Diagnosis of Dento-Maxillofacial Swellings among an Urban Population in Nigeria. Nigerian Journal of Basic and Clinical Sciences. 2022; 19 (1): 66-70. DOI: https://doi.org/10.4103/njbcs.njbcs_5_21
Mallorie C.N., Jones S.D., Drage N.A., Shepherd J. The reliability of high resolution ultrasound in the identification of pus collections in head and neck swellings. Int J Oral Maxillofac Surg. 2012; 41 (2): 252-5. DOI: https://doi.org/10.1016/j.ijom.2011.10.012
Al-Belasy F.A. Ultrasound-guided drainage of submasseteric space abscesses. Journal of Oral and Maxillofacial Surgery. 2005; 63 (1): 36-41. DOI: https://doi.org/10.1016/j.joms.2004.05.218
Lindeboom J.A., Kuijper E.J., Bruijnesteijn van Coppenraet E.S., Lindeboom R., Prins J.M. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial. Clin Infect Dis. 2007; 44 (8): 1057-64. DOI: https://doi.org/10.1086/512675
Yusa H., Yoshida H., Ueno E., Onizawa K., Yanagawa T. Ultrasound-guided surgical drainage of face and neck abscesses. Int J Oral Maxillofac Surg. 2002; 31 (3): 327-9. DOI: https://doi.org/10.1054/ijom.2002.0233
Abbiramy G.K., Raghavendra K., Soman S., Gopinathan P.A. Management of fascial space infections using ultrasonography as a surgical guide for drainage - A case series. Natl J Maxillofac Surg. 2023; 14 (3): 485-91. DOI: https://doi.org/10.4103/njms.njms_1_22
Ryba F.M., George K. Point-of-care ultrasound for oral and maxillofacial surgeons. Br J Oral Maxillofac Surg. 2017; 55 (6): 600-3. DOI: https://doi.org/10.1016/j.bjoms.2017.03.015
Lewis D.L., Butts C.J., Moreno-Walton L. Facing the danger zone: the use of ultrasound to distinguish cellulitis from abscess in facial infections. Case Rep Emerg Med. 2014; 2014: 935283. DOI: https://doi.org/10.1155/2014/935283
Tung-Chen Y. Executive summary of the consensus document on point-of-care ultrasound implementation: recommendations from the Clinical Ultrasound Working Groups of SEMI, SEDAR, SEGG, SEMERGEN, SEMES, SEMFYC, and SEMG. Rev Clin Esp (Barc). 2024; 224 (10): 670-8. DOI: https://doi.org/10.1016/j.rceng.2024.10.001
Shanti R.M., Aziz S.R. Should we wait for development of an abscess before we perform incision and drainage? Oral Maxillofac Surg Clin North Am. 2011; 23 (4): 513-8, v. DOI: https://doi.org/10.1016/j.coms.2011.07.004
Adeyemo W.L., Akadiri OA. A systematic review of the diagnostic role of ultrasonography in maxillofacial fractures. Int J Oral Maxillofac Surg. 2011; 40 (7): 655-61. DOI: https://doi.org/10.1016/j.ijom.2011.02.001
Oates C.P., Wilson A.W., Ward-Booth R.P., Williams E.D. Combined use of Doppler and conventional ultrasound for the diagnosis of vascular and other lesions in the head and neck. Int J Oral Maxillofac Surg. 1990; 19 (4): 235-9. DOI: https://doi.org/10.1016/S0901-5027(05)80400-X
Perisanidis C., Saranteas T., Kostopanagiotou G. Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery. Dentomaxillofac Radiol. 2013; 42 (2): 29945724. DOI: https://doi.org/10.1259/dmfr/29945724
Liang J., Jiang L., Li M., Liu L., Li H. Should preoperative computed tomography be routine examination for cervicofacial space infections? BMC Infect Dis. 2022; 22 (1): 566. DOI: https://doi.org/10.1186/s12879-022-07545-6
Rama Mohan K., Koteswara Rao N., Leela Krishna G., Santosh Kumar V., Ranganath N., Vijaya Lakshmi U. Role of ultrasonography in oral and maxillofacial surgery: a review of literature. J Maxillofac Oral Surg. 2015; 14 (2): 162-70. DOI: https://doi.org/10.1007/s12663-014-0616-x
Weiss R., 2nd, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel). 2019; 7 (2). DOI: https://doi.org/10.3390/dj7020052
Kaasalainen T., Ekholm M., Siiskonen T., Kortesniemi M. Dental cone beam CT: An updated review. Phys Med. 2021; 88: 193-217. DOI: https://doi.org/10.1016/j.ejmp.2021.07.007
Fontenele R.C., Gaêta-Araujo H., Jacobs R. Cone beam computed tomography in dentistry: Clinical recommendations and indication-specific features. J Dent. 2025; 159: 105781. DOI: https://doi.org/10.1016/j.jdent.2025.105781
Abdalla-Aslan R., Gaitini D., Shilo D., Emodi O., Beck-Razi N., Rachmiel A., et al. Intraoral and transcutaneous point-of-care-ultrasound: an adjunct bedside tool for oral and maxillofacial clinicians. Quintessence Int. 2022; 53 (4): 352-61.
Alonso Lorenzo J.C. [Ultrasound in primary care: the Sisyphus boulder]. Aten Primaria. 2012; 44 (10): 584-5. DOI: https://doi.org/10.1016/j.aprim.2012.06.011
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