de for the detection of metastatic nodes.

Triplex sonographic evaluation of enlarged nodes is also based on assessment of the internal architecture as well as size determination of the node, and abnormalities in the node may be reflected by increased parenchymal echogenicity or loss of hilar echogenicity in malignant disease.\[[@ref6]\] In addition, the recent development of Doppler sonography technology has shed light on the diagnostic significance of changes in nodal blood flow in differentiating metastatic from non-metastatic nodes. Studies have shown that sonography used for staging head and neck tumors is more sensitive than clinical examination and even CT scan for detection of cervical LNs involvement.\[[@ref6]\]

The purpose of this study is to demonstrate triplex ultrasonographic characterization of cervical lymph nodes could, with acceptable degree of certainty, differentiate malignant from benign lymph nodes, in order to prevent invasive diagnostic procedures.

MATERIALS AND METHODS {#sec1-2}
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A total of 50 patients, who were referred to the Department of Cranio Maxillofacial Plastic and Reconstructive Surgery at College of Dental Sciences, Davangere, Karnataka from August 2008 to August 2010, of both sexes, with carcinoma of different regions of the oral cavity, confirmed with incision biopsy and had clinically palpable cervical lymph nodes (suspected of metastasis), were included in this study.

Written and verbal consent were obtained by the subjects prior to the start of study in accordance with the declaration of Helsinki (World Medical Association). All cervical regions of these patients were scanned by three experienced radiologists separately, with PHILIPS Envisor-C (Shenzhen Lontek Electronic Technology Co., Limited, China). Broad band (3-12MHz), grayscale at 3-12 MHz and power Doppler at 5 MHz along with linear array transducer of 7-12 MHz frequencies and all the findings were properly registered. All patients were in supine position and their neck hyper extended. The r