Oral Radiology

, Volume 35, Issue 2, pp 101–126 | Cite as

Sonographic diagnosis in the head and neck region: from an educational lecture presented at the 56th General Assembly and Annual Scientific Congress of the Japanese Society for Oral and Maxillofacial Radiology

  • Mayumi ShimizuEmail author
  • Warangkana Weerawanich
Review Article


Sonography is a simple, inexpensive, and non-invasive diagnostic modality. Although tissues behind bony structures and deep tissues are not delineated, sonography can depict superficial soft tissues very clearly. In the head and neck region, however, it has not yet been used widely, as the anatomical structures are complicated, and considerable experience is needed both to perform an examination and to make a diagnosis. To perform examinations efficiently, operators must be familiar with the sonographic system in use, and take images at standard planes. To make a correct diagnosis, operators require knowledge of the sonographic anatomy on standard planes, representative sonographic signs and artifacts, and common diseases and their typical sonographic findings. In this paper, we have explained the sonographic anatomy on standard planes, and the sonographic findings of common diseases in the oral and maxillofacial region.


Sonography Diagnosis Head and neck 


Compliance with ethical standards

Conflict of interest

Mayumi Shimizu and Warangkana Weerawanich declare that they have no conflict of interest.

Human and animal right statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was not needed for the study. The manuscript does not contain identifying information of patients.


  1. 1.
    Costache A, Dumitru M, Anghel I, Cergan R, Anghel AG, Sarafoleanu C. Ultrasonographic anatomy of head and neck – a pictorial for the ENT specialist. Med Ultrason. 2015;17(1):104–8. Scholar
  2. 2.
    Gervasio A, D’Orta G, Mujahed I, Biasio A. Sonographic anatomy of the neck: the suprahyoid region. J Ultrasound. 2011;14(3):130–5. (Epub 2011 Jun 29).CrossRefGoogle Scholar
  3. 3.
    Baker JA, Soo MS, Rosen EL. Artifacts and pitfalls in sonographic imaging of the breast. AJR Am J Roentgenol. 2001;176(5):1261–6.CrossRefGoogle Scholar
  4. 4.
    Kiesler K, Gugatschka M, Friedrich G. Incidence and clinical relevance of herniation of the mylohyoid muscle with penetration of the sublingual gland. Eur Arch Otorhinolaryngol. 2007;264(9):1071–4 (Epub 2007 May 4).CrossRefGoogle Scholar
  5. 5.
    Jain P, Jain R, Morton RP, Ahmad Z. Plunging ranulas: high-resolution ultrasound for diagnosis and surgical management. Eur Radiol. 2010;20(6):1442–9. (Epub 2009 Nov 27).CrossRefGoogle Scholar
  6. 6.
    Jain P, Jain R. Types of sublingual gland herniation observed during sonography of plunging ranulas. J Ultrasound Med. 2014;33(8):1491–7. Scholar
  7. 7.
    Shimizu M, Ussmüller J, Hartwein J, Donath K, Kinukawa N. Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(2):226–33.CrossRefGoogle Scholar
  8. 8.
    Shimizu M, Ussmüller J, Hartwein J, Donath K. A comparative study of sonographic and histopathologic findings of tumorous lesions in the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(6):723–37.CrossRefGoogle Scholar
  9. 9.
    Shimizu M. Sonographic differential diagnosis of the parotid gland tumors with the cases at Hamburg University [Internet]. Dept. Oral & Maxillofacial Radiology Fac. Dentistry, Kyushu University. 2003.
  10. 10.
    Zhang L, Zhang ZY. Evaluation of the ultrasonographic features of salivary gland tumours. Chin J Dent Res. 2010;13(2):133–7.CrossRefGoogle Scholar
  11. 11.
    Sriskandan N, Hannah A, Howlett DC. A study to evaluate the accuracy of ultrasound in the diagnosis of parotid lumps and to review the sonographic features of parotid lesions—results in 220 patients. Clin Radiol. 2010;65(5):366–72. (Epub 2010 Feb 25).CrossRefGoogle Scholar
  12. 12.
    Ariji Y, Kimura Y, Hayashi N, Onitsuka T, Yonetsu K, Hayashi K, et al. Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. AJNR Am J Neuroradiol. 1998;19(2):303–7.Google Scholar
  13. 13.
    Sato N, Kawabe R, Fujita K, Omura S. Differential diagnosis of cervical lymphadenopathy with intranodal color Doppler flow signals in patients with oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(4):482–8.CrossRefGoogle Scholar
  14. 14.
    Chikui T, Yonetsu K, Nakamura T. Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis. AJNR Am J Neuroradiol. 2000;21(3):561–7.Google Scholar
  15. 15.
    Yonetsu K, Sumi M, Izumi M, Ohki M, Eida S, Nakamura T. Contribution of doppler sonography blood flow information to the diagnosis of metastatic cervical nodes in patients with head and neck cancer: assessment in relation to anatomic levels of the neck. AJNR Am J Neuroradiol. 2001;22(1):163–9.Google Scholar
  16. 16.
    Chikui T, Yuasa K, Maemura S, Kanda S. Change of angiostructure and hemodynamics in lymph node metastases in rabbits. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(3):350–7.CrossRefGoogle Scholar
  17. 17.
    Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol. 2005;184(5):1691–9.CrossRefGoogle Scholar
  18. 18.
    Chang DB, Yuan A, Yu CJ, Luh KT, Kuo SH, Yang PC. Differentiation of benign and malignant cervical lymph nodes with color Doppler sonography. AJR Am J Roentgenol. 1994;162(4):965–8.CrossRefGoogle Scholar
  19. 19.
    Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR Am J Roentgenol. 1997;168(5):1311–6.CrossRefGoogle Scholar
  20. 20.
    Scholbach T, Scholbach J, Krombach GA, Gagel B, Maneschi P, Di Martino E. New method of dynamic color doppler signal quantification in metastatic lymph nodes compared to direct polarographic measurements of tissue oxygenation. Int J Cancer. 2005;114(6):957–62.CrossRefGoogle Scholar
  21. 21.
    Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Hiraoka M, et al. Cervical lymph node metastases: diagnosis at sonoelastography—initial experience. Radiology. 2007;243(1):258–67 (Epub 2007 Feb 9).CrossRefGoogle Scholar
  22. 22.
    Bhatia KS, Cho CC, Tong CS, Lee YY, Yuen EH, Ahuja AT. Shear wave elastography of focal salivary gland lesions: preliminary experience in a routine head and neck US clinic. Eur Radiol. 2012;22(5):957–65. (Epub 2011 Dec 27).CrossRefGoogle Scholar
  23. 23.
    Desmots F, Fakhry N, Mancini J, Reyre A, Vidal V, Jacquier A, et al. Shear wave elastography in head and neck lymph node assessment: image quality and diagnostic impact compared with B-mode and Doppler ultrasonography. Ultrasound Med Biol. 2016;42(2):387–98. (Epub 2015 Nov).CrossRefGoogle Scholar
  24. 24.
    Shingaki M, Nikkuni Y, Katsura K, Ikeda N, Maruyama S, Takagi R, et al. Clinical significance of intraoral strain elastography for diagnosing early-stage tongue carcinoma: a preliminary study. Oral Radiol. 2017;33(3):204–11. Scholar
  25. 25.
    Sumi M, Ohki M, Nakamura T. Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR Am J Roentgenol. 2001;176(4):1019–24.CrossRefGoogle Scholar
  26. 26.
    Chaukar D, Dandekar M, Kane S, Arya S, Purandare N, Rangarajan V, et al. Relative value of ultrasound, computed tomography and positron emission tomography imaging in the clinically node-negative neck in oral cancer. Asia Pac J Clin Oncol. 2016;12(2):e332–8. (Epub 2014 Aug 17).CrossRefGoogle Scholar
  27. 27.
    Heusch P, Sproll C, Buchbender C, Rieser E, Terjung J, Antke C, et al. Diagnostic accuracy of ultrasound, 18F-FDG-PET/CT, and fused 18F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC. Clin Oral Investig. 2014;18(3):969–78. (Epub 2013 Jul 27).CrossRefGoogle Scholar
  28. 28.
    Yuasa K, Kawazu T, Nagata T, Kanda S, Ohishi M, Shirasuna K. Computed tomography and ultrasonography of metastatic cervical lymph nodes in oral squamous cell carcinoma. Dentomaxillofac Radiol. 2000;29(4):238–44.CrossRefGoogle Scholar
  29. 29.
    Shi C, Li S, Shi T, Liu B, Ding C, Qin H. Correlation between thyroid nodule calcification morphology on ultrasound and thyroid carcinoma. J Int Med Res. 2012;40(1):350–7.CrossRefGoogle Scholar
  30. 30.
    Yoo YH, Kim JA, Son EJ, Youk JH, Kwak JY, Kim EK, et al. Sonographic findings predictive of central lymph node metastasis in patients with papillary thyroid carcinoma: influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography. J Ultrasound Med. 2013;32(12):2145–51. Scholar
  31. 31.
    Natori T, Koga M, Anegawa E, Nakashima Y, Tetsuka M, Yoh J, et al. Usefulness of intra-oral ultrasonography to predict neck metastasis in patients with tongue carcinoma. Oral Dis. 2008;14(7):591–9. Scholar
  32. 32.
    Ariji Y, Goto M, Fukano H, Sugita Y, Izumi M, Ariji E. Role of intraoral color Doppler sonography in predicting delayed cervical lymph node metastasis in patients with early-stage tongue cancer: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(2):246–53. (Epub 2014 Nov 11).CrossRefGoogle Scholar
  33. 33.
    Mattalitti SFO, Kawazu T, Kawano S, Ikari T, Wada H, Yoshiura K. Estimation of prognosis of tongue cancer using tumor depth and margin shape obtained from ultrasonography. Oral Radiol. 2017;33(2):101–7. Scholar
  34. 34.
    Choi EC, Moon WJ, Lim YC. Case report. Tuberculous cervical lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma. Br J Radiol. 2009;82(982):e208–11. Scholar
  35. 35.
    Herd MK, Woods M, Anand R, Habib A, Brennan PA. Lymphoma presenting in the neck: current concepts in diagnosis. Br J Oral Maxillofac Surg. 2012;50(4):309–13. (Epub 2011 May 5).CrossRefGoogle Scholar
  36. 36.
    Shimizu M, Tokumori K, Saitoh M, Miwa K, Yoshiura K, Kanda S. Sonographic analysis of rat submandibular glands in experimentally-induced sialadenitis. Dentomaxillofac Radiol. 2000;29(2):90–6.CrossRefGoogle Scholar
  37. 37.
    Gritzmann N, Rettenbacher T, Hollerweger A, Macheiner P, Hübner E. Sonography of the salivary glands. Eur Radiol. 2003;13(5):964–75 (Epub 2002 Sep 5).Google Scholar
  38. 38.
    Bialek EJ, Jakubowski W, Zajkowski P, Szopinski KT, Osmolski A. US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls. Radiographics. 2006;26(3):745–63.CrossRefGoogle Scholar
  39. 39.
    Takashima S, Morimoto S, Tomiyama N, Takeuchi N, Ikezoe J, Kozuka T. Sjogren syndrome: comparison of sialography and ultrasonography. J Clin Ultrasound. 1992;20(2):99–109.CrossRefGoogle Scholar
  40. 40.
    Ariji Y, Ohki M, Eguchi K, Izumi M, Ariji E, Mizokami A, et al. Texture analysis of sonographic features of the parotid gland in Sjögren’s syndrome. AJR Am J Roentgenol. 1996;166(4):935–41.CrossRefGoogle Scholar
  41. 41.
    Yoshiura K, Yuasa K, Tabata O, Araki K, Yonetsu K, Nakayama E, et al. Reliability of ultrasonography and sialography in the diagnosis of Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(3):400–7.CrossRefGoogle Scholar
  42. 42.
    Shimizu M, Okamura K, Yoshiura K, Ohyama Y, Nakamura S, Kinukawa N. Sonographic diagnostic criteria for screening Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(1):85–93 (Epub 2006 Apr 17).CrossRefGoogle Scholar
  43. 43.
    Salaffi F, Carotti M, Iagnocco A, Luccioli F, Ramonda R, Sabatini E, et al. Ultrasonography of salivary glands in primary Sjögren’s syndrome: a comparison with contrast sialography and scintigraphy. Rheumatology. 2008;47(8):1244–9. (Epub 2008 Jun 19).CrossRefGoogle Scholar
  44. 44.
    Takagi Y, Kimura Y, Nakamura H, Sasaki M, Eguchi K, Nakamura T. Salivary gland ultrasonography: can it be an alternative to sialography as an imaging modality for Sjogren’s syndrome? Ann Rheum Dis. 2010;69(7):1321–4. (Epub 2010 May 24).CrossRefGoogle Scholar
  45. 45.
    Shimizu M, Okamura K, Kise Y, Takeshita Y, Furuhashi H, Weerawanich W, et al. Effectiveness of imaging modalities for screening IgG4-related dacryoadenitis and sialadenitis (Mikulicz’s disease) and for differentiating it from Sjögren’s syndrome (SS), with an emphasis on sonography. Arthritis Res Ther. 2015;17(1):223. Scholar
  46. 46.
    Shimizu M, Okamura K, Yoshiura K, Ohyama Y, Nakamura S. Sonographic diagnosis of Sjögren syndrome: evaluation of parotid gland vascularity as a diagnostic tool. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(4):587–94. (Epub 2008 Mar 10).CrossRefGoogle Scholar
  47. 47.
    Shimizu M, Ussmüller J, Donath K, Yoshiura K, Ban S, Kanda S, et al. Sonographic analysis of recurrent parotitis in children: a comparative study with sialographic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(5):606–15.CrossRefGoogle Scholar
  48. 48.
    Shimizu M, Moriyama M, Okamura K, Kawazu T, Chikui T, Goto TK, et al. Sonographic diagnosis for Mikulicz disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(1):105–13. (Epub 2009 May 17).CrossRefGoogle Scholar
  49. 49.
    Asai S, Okami K, Nakamura N, Shiraishi S, Sugimoto R, Anar D, et al. Localized or diffuse lesions of the submandibular glands in immunoglobulin g4-related disease in association with differential organ involvement. J Ultrasound Med. 2013;32(5):731–6. Scholar
  50. 50.
    O’Connor R, McGurk M. The plunging ranula: diagnostic difficulties and a less invasive approach to treatment. Int J Oral Maxillofac Surg. 2013;42(11):1469–74. (Epub 2013 May 29).CrossRefGoogle Scholar
  51. 51.
    Goto TK, Yoshiura K, Nakayama E, Yuasa K, Tabata O, Nakano T, et al. The combined use of US and MR imaging for the diagnosis of masses in the parotid region. Acta Radiol. 2001;42(1):88–95.CrossRefGoogle Scholar
  52. 52.
    Knopf A, Mansour N, Chaker A, Bas M, Stock K. Multimodal ultrasonographic characterisation of parotid gland lesions—a pilot study. Eur J Radiol. 2012;81(11):3300–5. (Epub 2012 Jan 24).CrossRefGoogle Scholar
  53. 53.
    Tsushima Y, Matsumoto M, Endo K, Aihara T, Nakajima T. Characteristic bright signal of parotid pleomorphic adenomas on T2-weighted MR images with pathological correlation. Clin Radiol. 1994;49(7):485–9.CrossRefGoogle Scholar
  54. 54.
    Angang D, Jia L, Xia G, Ping X, Jiang L. Gray scale and doppler ultrasonography features of the carcinoma ex pleomorphic adenoma. Dentomaxillofac Radiol. 2018;47(4):20170268. (Epub 2018 Feb 13).CrossRefGoogle Scholar
  55. 55.
    Keng CY, Lan HHC, Chen CCC, Gueng MK, Su YG, Lee SK. Soft tissue hemangiomas: high-resolution grayscale and color doppler ultrasonographic features in 43 patients. J Med Ultrasound. 2008;16(3):223–30.CrossRefGoogle Scholar
  56. 56.
    Glasier CM, Seibert JJ, Williamson SL, Seibert RW, Corbitt SL, Rodgers AB, et al. High resolution ultrasound characterization of soft tissue masses in children. Pediatr Radiol. 1987;17(3):233–7.CrossRefGoogle Scholar
  57. 57.
    Kim HK, Kim SM, Lee SH, Racadio JM, Shin MJ. Subcutaneous epidermal inclusion cysts: ultrasound (US) and MR imaging findings. Skeletal Radiol. 2011;40(11):1415–9. (Epub 2010 Dec 7).CrossRefGoogle Scholar
  58. 58.
    Clarke R, Suresh P, Thomas R, Freeman S. Twinkle artefact in the ultrasound diagnosis of superficial epidermoid cysts. Ultrasound. 2016;24(3):147–53. (Epub 2016 Nov 22).CrossRefGoogle Scholar
  59. 59.
    Kutuya N, Kurosaki Y. Sonographic assessment of thyroglossal duct cysts in children. J Ultrasound Med. 2008;27(8):1211–9.CrossRefGoogle Scholar
  60. 60.
    Choi HI, Choi YH, Cheon JE, Kim WS, Kim IO. Ultrasonographic features differentiating thyroglossal duct cysts from dermoid cysts. Ultrasonography. 2018;37(7):71–7. (Epub 2017 May 24).CrossRefGoogle Scholar
  61. 61.
    Adhikari S, Blaivas M. Sonography first for subcutaneous abscess and cellulitis evaluation. J Ultrasound Med. 2012;31(10):1509–12.CrossRefGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial RadiologyKyushu University HospitalFukuokaJapan
  2. 2.Department of Oral and Maxillofacial Radiology, Faculty of Dental ScienceKyushu UniversityFukuokaJapan
  3. 3.Department of Oral and Maxillofacial Radiology, Faculty of DentistryMahidol UniversityBangkokThailand

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