Assessment of tumorous mandibular involvement by transcutaneous ultrasound and flexible endosonography.
Tumorous involvement of the mandible affects the prognosis and choice of treatment. To evaluate the usefulness of transcutaneous ultrasound and recently-developed flexible endosonography and their ability to display bone invasion in the lower jaw, we studied 33 non-selected patients with extensive, histologically-verified oral and oropharyngeal carcinomas. Both sonographic examinations were performed prospectively in all patients prior to surgery, without knowledge to the sonographer of the results of other imaging methods. Histological findings served as gold standards and offered 14 mandibular involvements. Flexible endosonography is characterized by high accuracy data in assessment of mandibular involvement occurring in tumors of the floor of the mouth and of the tonsil. On the other hand acceptable results by transcutaneous ultrasound could only be obtained in assessing bone invasion of oral tumors. However, osseous destruction in patients with oropharyngeal tumors were not detectable as the involved medial surface of the mandibular ramus was inaccessible to the extraorally placed transducer. Both sonographic methods, especially endosonography, enabled the examiner to differentiate cortical bone as opposed to spongiosa involvement in many cases, but failed in assessment of tumorous periosteal involvement. Pitfalls in detection and differentiation of bone invasion with false positive and false negative findings are discussed with regard to mandibular anatomy, for both intra- and extraoral examination.
Department of Otorhinolaryngology, University of Heidelberg, Germany.
W J
WJ
Heppt
W J
WJ
Issing
D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology; D002277:Carcinoma / Q000473:pathology*; D003937:Diagnosis, Differential; D004867:Equipment Design; D006801:Humans; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology; D008339:Mandibular Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D009060:Mouth Floor; D009062:Mouth Neoplasms / Q000473:pathology*; D009361:Neoplasm Invasiveness; D010521:Periosteum / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D014067:Tonsillar Neoplasms / Q000473:pathology; D014463:Ultrasonography / Q000295:instrumentation