Use of ultrasound to assess healing of a mandibular distraction wound.
OBJECTIVE
A standardized, noninvasive technique to assess healing of the mandibular distraction wound is not available. Current methods include clinical examination, plain radiography, and computed tomography. These imaging techniques are expensive and obligate the patient to serial radiation exposure. In addition, anatomic overlap and metal artifacts may obscure the distraction gap. In contrast, ultrasound has been shown to be a noninvasive, efficient, and inexpensive way to evaluate bone healing. The purpose of this study was to test the feasibility of ultrasound to evaluate an experimental mandibular distraction osteogenesis wound.


METHODS
Distraction devices were placed via a submandibular incision into 24 minipigs. The protocol consisted of 0-day latency and distraction rates of 1, 2, or 4 mm/d for a 12-mm gap. The wounds were assessed in vivo after 0, 8, 16, and 24 days of neutral fixation. Ex vivo radiographs were used to estimate bone fill using a semiquantitative score. A semiquantitative ultrasound score was assigned, and the beam penetration depth was measured in millimeters.


RESULTS
In all groups, clinical stability of the distraction wound increased with the duration of fixation. Plain radiographs, taken during neutral fixation, showed that the desired distraction gap was achieved and maintained. The ultrasound score increased with fixation time, whereas beam penetration depth decreased as expected. Ex vivo radiographs showed increasing bone fill score with time and paralleled the ultrasound score.


CONCLUSIONS
The results of this feasibility study indicate that ultrasound is potentially useful for the assessment of bone formation in distraction osteogenesis wounds.
Thurmüller
Petra
P
Massachusetts General Hospital, Harvard School of Dental Medicine and Harvard Medical School, Boston 02114, USA.
Troulis
Maria
M
O'Neill
Mary Jane
MJ
Kaban
Leonard B
LB
D000818:Animals; D015519:Bone Density; D002146:Bony Callus / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D017102:Fracture Healing / Q000502:physiology*; D008334:Mandible / Q000000981:diagnostic imaging* / Q000601:surgery*; D010012:Osteogenesis / Q000502:physiology; D019857:Osteogenesis, Distraction; D011859:Radiography; D018709:Statistics, Nonparametric; D013552:Swine; D013556:Swine, Miniature; D014463:Ultrasonography