REPARATIVE OSTEOGENESIS STUDY IN PATIENTS WITH FRACTURES OF FACIAL SKELETON WITH COMPREHENSIVE ULTRASONOGRAPHY

Pankevych V. V., Kucher A. R., Zakharkiv A. M., Kaminsky M. V., Nazarevych M. R.

DENTISTRY

Scentific article

This study discusses the capabilities of comprehensive ultrasonography to optimize the diagnostic process in patients with fractures of the facial skeleton. As is well known, the main criteria for consolidation of fractures is the clinical condition of the damaged area and radiological characteristics of reparative regeneration of bone tissue. However, due to the inability of visualizing noncalcified bone regenerate, radiological signs of the process of fracture consolidation are significantly delayed compared with clinical. Another drawback of X-ray imaging is that in its execution often arise projection magnification and image deformation, which significantly complicates determining the true value of the fracture. Despite the proven diagnostic value of comprehensive ultrasonography in traumatology, this method is not used in the study of the processes of consolidation in patients with fractures of the facial skeleton. The purpose of our study was to determine the diagnostic value of comprehensive ultrasonography in the study of dynamics of reparative osteogenesis in patients with fractures of this location. Materials and methods. We examined 30 patients aged 18 to 47 years old with facial skeleton fractures, after conservative or surgical treatment — depending on indications. The survey was carried out on 3rd day, through 2 weeks after injury and after removal of the splinting constructions (on 21st day). Ultrasonographic examination was performed on the machine Logic E, using linear sensor with a frequency of 7.5-12MHz. Complex research include B-mode scanning — to assess the structure of periosteal tissues, surface of the bone, the periosteum and regenerate and angiography-mode scanning (PDM-mode) – to assess blood flow in the area of damage. Results. During the first days after injury we observed on ultrasonograms step-like interruption of hyperechoic line, by height of which we measured the degree of displacement of bone fragments. We also visualized additional metal constructions and their locations in patients after surgery with osteosynthesis. The blood flow in the fracture cleft was not recorded in the PDM-mode, although there was an obvious increase in the volume of blood flow in periosteum tissues (up to 13 cm/sec), as evidenced by an increase of skin temperature, its redness and edema. Through 2 weeks after injury we detected on comprehensive ultrasonography typical dynamics offilling diastase by granulation tissue with proliferation of blood vessels and the formation of fibrous intergrowth following with its ossification. In the PDM-mode we revealed a significant strengthening of local microcirculatory blood flow in the regenerative area — up to 42cm/sec. From 3rd to 4th week since the injury in a cleft fracture appeared hypoechoic zone with hyperechoic structures, indicating the final formation of primary callus. The rate of blood flow in the skin over the fracture site and regenerative area decreased, appeared zone of acoustic silence, registered signal with mainly arterial blood filling. After 3-4 months, depending on the level of injury, callus formed, which manifested with the following features: cortical plate visualized as a continuous hyperechoic signal with distal acoustic shadow, soft tissue had normal echostructure, in the place of callus registered one feeding vessel. Thus, the use of comprehensive ultrasonography allows to control and predict the course of formation of bone regenerate already from the first days after fractures of facial skeleton and carry out, if necessary, correction treatment.

reparative osteogenesis, fractures of the facial skeleton, comprehensive ultrasonography, vascularization, blood flow, color Doppler mapping, power Doppler mapping (PDM)

• 1. Боярина Н. И. Эхографическое исследование дистракционного регенерата при компрессионно-дистракционном остеосинтезе нижней челюсти: автореф. дис. на соискание учен. степени канд. мед. наук / Н. И. Боярина. — М., 2006. — 18 с.
• 2. Варес Я. Е. Застосування ультрасонографії в діагностиці травматичних пошкоджень кісток лицевого скелета / Я. Е. Варес, А. Р. Кучер, Т. А. Філіпська, А. В. Філіпський // Новини стоматології. — 2008. — № 2. — С. 99-102.
• 3. Камінская М. О. Лікувальна тактика при уповільненій консолідації переломів кісток у дітей / М. О. Камінская // Збірник наукових праць співробітників НМАПО імені П. Л. Шупика. — 2013. — Вип. 22, т. 3. — С. 199-204.
• 4. Лелюк В. Г. Ультразвуковая ангиология. 2-е изд., доп. и переизданное / В. Г. Лелюк, С. Э. Лелюк. — М.: Реальное Время, 2003. — С. 115-130.
• 5. Лобанов Г. В. Ультразвуковая диагностика при политравме (клинический случай) / Г. В. Лобанов, Д. В. Кузьменко, С. А. Бессмертный // Лікарю, що практикує. — 2015. — № 3. — С. 94-97.
• 6. МакНелли Ю. Ультразвуковые исследования костно-мышечной системы: Практическое руководство; пер. с англ. Хитровой А. Н. / под. ред. Г. И. Назаренко, И. Б. Героевой. — М.: Видар-М, 2007. — 400 с.
• 7. Надточий А. Г. Эхографический контроль формирования дистракционных регенератов при компресионно-дистракционном остеосинтезе / А. Г. Надточий, А. Г. Шамсудинов, Н. В. Букатина, Н. И. Боярина // Ультразвуковая диагностика. — 2000. — № 4. — С. 58-65.
• 8. Ультрасонография в артрологии: практическое руководство / [Р. Я. Абдуллаев, Г. В. Дзяк, А. Н. Хвисюк и др.]. − Х.: Новое слово, 2010. — 192 с.
• 9. Ультрасонографія як один із провідних методів обстеження пацієнтів з переломами виличної кістки та дуги / Я. Е. Варес, А. Р. Кучер, Т. А. Філіпська [та ін.] // Актуальні питання ультразвукової діапевтики. Сучасні технології в ультразвуковій діагностиці патологій внутрішніх органів, судин та м’яких тканин: матер. Укр. конгресу радіологів та науково-практ. конф. — Судак, 2009. — С. 89.
• 10. Щуров В. А. Высокочастотная ультразвуковая допплерография в диагностике состояния костного регенерата / В. А. Щуров, Н. И. Буторина, И. В. Щуров // Гений ортопедии. — 2007. — № 4. — С. 25-27.
• 11. Щуров В. А. Оценка кровоснабжения костного регенерата методом высокочастотной ультразвуковой допплерографии / В. А. Щуров, С. О. Мурадасинов, И. В. Щуров // Травматология и ортопедия России. — 2008. — № 3. — С. 39-41.
• 12. Adeyemo W. L. A systematic review of the diagnostic role of ultrasonography in maxillofacial fractures / W. L. Adeyemo, O. A. Akadrii // Int J. Oral. Maxillofac. Surg. — 2011. — V. 40. — Р. 655-661.
• 13. Chun K. A. Postoperative ultrasonography of the musculoskeletal system / K. A. Chun, K. H. Cho // Ultrasonography. — 2015. — V. 25. — P. 36-40.
• 14. Daniels J. M. Basics of musculoskeletal ultrasound / J. M. Daniels, W. W. Dexter. — NewYork: Springer Science + Business Media, 2013. — Р. 134.
• 15. Filipsky A. V. Possibilities of ultrasonography application in diagnostics of bone pathology of maxillofacial area / A. V. Filipsky, Ya. E. Vares, T. A. Filipska // 1 Congress of Biomedicine in Oro-Maxillofacial Area: Abstracts. — Kosice, 2009. — P. 126-128.
• 16. Hayashi T. Application of ultrsonography in Dentistry-Review / T. Hayashi // Japanese Dental Sciences. — 2012. – V. 28. № 1. — Р. 5-15.
• 17. Koijam Sashicumar Singh A comparative study on the diagnostic utility of ultrasonography with conventional radiography and computed tomography scan in detection of zygomatic arch and mandibular fractures / Koijam Sashicumar Singh, S. Jajachandran // Contemp Clin Dent. — 2014. – V. 5, № 2. — Р. 166-169.
• 18. Marshburn H. Thomas Goal-directed ultrasound in the detection of long bone fractures / H. Thomas Marshburn, Eric Legome, Ashot Sargsyanetal // J. Trauma. — 2004. — V. 57. — P. 329-332.
• 19. Oeppen Rachel S. An update on the use of ultrasound imaging in oral and maxillofacial surgery / Rachel S. Oeppen, Daren Gibson, Peter A. Brennan // Brit. J. Oral. Maxillofac. Surg. — 2010. — V. 48, № 6. — Р. 412-418.
• 20. Pillen S. Skeletal muscle ultrasonography: Visual versus quantitative evaluation / S. Pillen, M. van Keimpema, R. A. Nievelstein [et al.] // Ultrasound Med. Biol. — 2006. — V. 32, № 9. — P. 1315-1321.
• 21. Vinod Vijay Chandar Utility of ultrasonography as adjunct to diagnosis in certain orofacial lesions over the clinical and radiological evaluation: A comparativ estudy / Vinod Vijay Chandar, M. Venkateswarlu // J. Indian Academ Oral Med Radiol. — 2009. — V. 21, № 1. — Р. 45-50.
• 22. Williamson D. Ultrasound imaging of foream fractures in children / D. Williamson // Ann. Emergency Medicine. — 2000. — V. 35, № 5. — P. 6. (Abstr. 8-th International Conference on Emergency Medicine «Emergency Medicine in the Third millennium» Boston, Mass., May 4-7, 2000).

«Bulletin of problems biology and medicine» Issue 1 part 1 (126), 2016 year, 364-370 pages, index UDK 617.52 – 001.5 – 003.9 – 073.48