Applications of intraoral and extraoral ultrasonography in oral pathology: an observational study

OBJECTIVES Ultrasonography is a non-inva sive and cost-effective diagnostic tool, widely used in medicine but still underutilized in dentistry. This study aims to present a case series on the use of intraoral and extraoral ultrasonography in the diagnosis and management of various oral pathologies, high lighting its potential and limita tions in dental clinical practice. MATERIALS AND METHODS Twenty-nine consecutive patients (19 females, 10 males; mean age 52 years, range 8-78 years) were examined from 2019 to 2024 at the Oral Pathology, Oral Medicine, and Dental Diagnostic Clinic of the University Hospital of Padua. Ultra sonographic examinations were conducted using linear probes (3 12 MHz) with intraoral and/or ex traoral approaches, depending on lesion location. Color Doppler pro tocol was consistently applied for enhanced result characterization. The devices used were GE Logiq CLINICAL SIGNIFICANCE Q7 Expert and Siemens Acuson NX3 Series. Patient characteris tics were anonymously collected in a database. Clinical diagnostic hypotheses, ultrasonographic di agnoses, and histological diagno ses (when available) were subse quently compared. RESULTS The primary pathologies investigat ed included vascular lesions (8 cas es, 6 confirmed), benign soft tissue lesions (5 cases, all confirmed), glandular lesions (2 cases, both confirmed), and abscess formation (1 case, confirmed). In 9 cases, no predominant diagnostic hypothesis was formulated prior to the ultraso nographic examination. Of the 29 patients examined, 25 underwent surgical treatment, of which 13 had biopsies performed. In all 13 cases, the biopsy confirmed both the clini cal hypothesis and the ultrasono graphic diagnosis. Six patients with vascular lesions were treated with laser photocoagulation. The most frequently examined sites were: tongue (13 cases), lips (5 cases), cheeks (5 cases), mandibular region (3 cases), oral mucosa (2 cases), and mental region/floor of mouth (2 cases). CONCLUSIONS Ultrasonography proved to be a valuable diagnostic tool for vari ous oral pathologies, offering ad vantages in terms of speed, cost-effectiveness, and non-inva siveness. It was particularly useful in differentiating high-flow from low-flow vascular lesions, distin guishing between solid and cystic lesions, and guiding interventional procedures such as biopsies or drainage. The concordance be tween clinical, ultrasonographic, and histological diagnoses was high, although the limited case se ries precludes in-depth statistical analysis. Ultrasonography demon strated its efficacy in the differential diagnosis between phlegmon, cellu litis, and abscess, reducing the need for CT scans and exposure to ioniz ing radiation. Ultrasonography can effectively complement clinical examina tion and other imaging modali ties in the diagnosis and man agement of oral pathologies. Its use may be particularly advan tageous in situations where ex posure to ionizing radiation is contraindicated, such as in pe diatrics or pregnancy. Close col laboration between clinicians and radiologists is essential to optimize the use of this modali ty, given its operator-dependent nature. Future studies with larg er case series could confirm the positive trend observed and ex pand the applications of ultraso nography in dentistry, including temporomandibular joint diag nostics.