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Analysis of the blood supply to the post-fracture edentulous mandible: study by colour Doppler sonography

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Abstract

Purpose

This study assessed the arterial blood supply to the mandible of edentulous patients treated for mandibular fractures using colour Doppler ultrasound.

Methods

The blood supply of edentulous patients surgically treated for mandibular fractures (group A) and edentulous fracture-free individuals (group B) was assessed. Only the fractured sides were evaluated in the first group (N = 17), whereas each side was evaluated in the second group (N = 20). The arterial flow of six sites was assessed. The systolic-peak maximum velocity (SPV), final diastolic velocity (FDV), resistive index (RI), pulsatility index (PI), acceleration and flow direction of each artery were obtained. Additionally, the presence of local vascular obstructive factors was evaluated. The differences between groups were analysed using the Kruskal-Wallis test, which was complemented by the Mann-Whitney test, for correlations between the degree of alveolar atrophy and the study factors (p < 0.050).

Results

There was a significant decrease in the flow of certain arteries, especially the submental (SPV, p = 0.007, PI, p = 0.022, and acceleration, p = 0.015), in the fracture group. The facial artery in both groups showed lower values related to local obstructive factors (SPV, p = 0.001, FDV, p = 0.040, and PI, p = 0.030). The submental artery flow was higher (SPV, p = 0.006, and FDV, p = 0.009) in non-atrophic individuals.

Conclusions

There was a decreased flow mainly in the submental artery, but there were no cases of major vascular injury in edentulous patients treated for mandibular fractures.

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References

  1. Sidal T, Curtis DA (2006) Fractures of the mandible in the aging population. Spec Care Dentist 26(4):145–149 [Medline: 16927736]

    Article  PubMed  Google Scholar 

  2. Nasser M, Fedorowicz Z, Ebadifar A. Management of the fractured edentulous atrophic mandible. Cochrane Database Syst Rev. 2007 (1):CD006087. [Medline: 17253578]

  3. Madsen MJ, Haug RH, Christensen BS, Aldridge E (2009) Management of atrophic mandible fractures. Oral Maxillofac Surg Clin North Am 21(2):175–183 [Medline: 19348982]

    Article  PubMed  Google Scholar 

  4. Franciosi E, Mazzaro E, Larranaga J, Rios A, Picco P, Figari M (2014) Treatment of edentulous mandibular fractures with rigid internal fixation: case series and literature review. Craniomaxillofac Trauma Reconstr 7(1):35–42 [Medline: 24624255]

    Article  PubMed  PubMed Central  Google Scholar 

  5. Santos GS, de Assis Costa MD, de Oliveira Costa C, Souza FA, Júnior IR, de Melo WM (2013) Failure of miniplate osteosynthesis for the management of atrophic mandibular fracture. J Craniofac Surg 24(4):e415–e418 [Medline: 23851887]

    Article  PubMed  Google Scholar 

  6. Zide MF, Ducic Y (2003) Fibula free microvascular reconstruction of the severely comminuted atrophic mandible fracture – case report. J Craniomaxillofac Surg 31(5):296–298 [Medline: 14563330]

    Article  PubMed  Google Scholar 

  7. McCarthy I (2006) The physiology of bone blood flow: a review. J Bone Joint Surg Am 88 Suppl 3:4–9 [Medline: 17079361]

    PubMed  Google Scholar 

  8. Bell WH, Kennedy JW (1976) Biological basis for vertical ramus osteotomies –a study of bone healing and revascularization in adult rhesus monkeys. J Oral Surg 34(3):215–224 [Medline: 815526]

    CAS  PubMed  Google Scholar 

  9. Curé JK (2001) Imaging of vascular lesions of the head and neck. Facial Plast Surg Clin North Am 9(4):525–549 [Medline: 17590940]

    PubMed  Google Scholar 

  10. Williamson TH, Harris A (1996) Color Doppler ultrasound imaging of the eye and orbit. Surv Ophthalmol 40(4):255–267 [Medline: 8658337]

    Article  CAS  PubMed  Google Scholar 

  11. Zhao Y, Ariji Y, Gotoh M, Kurita K, Natsume N, Ma X, Ariji E (2002) Color Doppler sonography of the facial artery in the anterior face. Oral Surg Oral Med Oral Pathol 93(2):195–201 [Medline: 11862211]

    Article  Google Scholar 

  12. Ethunandan M, Birch AA, Evans BT, Goddard JR (2000) Doppler sonography for the assessment of central mandibular blood flow. Br J Oral Maxillofac Surg 38(4):294–298 [Medline: 10922154]

    Article  CAS  PubMed  Google Scholar 

  13. Ariji Y, Kimura Y, Gotoh M, Sakuma S, Zhao Y, Ariji E (2001) Blood flow in and around the masseter muscle: normal and pathologic features demonstrated by color Doppler sonography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91(4):472–482 [Medline: 11312466]

    Article  CAS  PubMed  Google Scholar 

  14. Eisemann B, Johnson LR, Coll JR (2005) Ultrasound measurement of mandibular arterial blood supply. Techniques for defining ischemia in the pathogenesis of alveolar ridge atrophy and tooth loss in the elderly. J Oral Maxillofac Surg 63(1):28–35 [Medline: 15635554]

    Article  Google Scholar 

  15. Eyrich GKH, Grätz KW, Sailer HF (1997) Surgical treatment of fractures of the edentulous mandible. J Oral Maxillofac Surg 55(10):1081–1087 [Medline: 9331230]

    Article  CAS  PubMed  Google Scholar 

  16. Luhr HG, Reidick T, Merten HA (1996) Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaultion of 84 consecutive cases. J Oral Maxillofac Surg 54(3):250–254 [Medline: 8600229]

    Article  CAS  PubMed  Google Scholar 

  17. Jacobovicz J, Tolazzi AR, Timi JR (2007) Doppler ultrasound evaluation of facial transverse and infraorbital arteries: Influence of smoking and aging process. Aesthet Plast Surg 31(5):526–531 [Medline: 17659420]

    Article  Google Scholar 

  18. Ariji Y, Yuasa H, Ariji E (1998) High frequency color Doppler sonography of the submandibular gland: relationship between salivar secretion and blood flow. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86(4):476–481 [Medline: 9798236]

    Article  CAS  PubMed  Google Scholar 

  19. Argollo N, Lessa I, Ribeiro S (2006) Cranial Doppler resistance index measurement in preterm newborns with cerebral white matter lesion. J Pediatr (Rio J) 82(3):221–226 [Medline: 16773177]

    Google Scholar 

  20. Grant EG, Benson CB, Moneta GL et al (2003) Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis--Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 19(4):190–198 [Medline: 14730262]

    Article  PubMed  Google Scholar 

  21. Downey DB (2005) The retroperitoneum and great vessels. In: Rumack CM, Wilson SR, Charboneau JW (eds) Diagnostic ultrasound, 3rd edn. Mosby, St Louis, pp 443–487

    Google Scholar 

  22. Storum KA, Bell WH, Nagura H (1988) Microangiographic and histologic evaluation of revascularization and healing after genioplasty by osteotomy of the inferior border of the mandible. J Oral Maxillofac Surg 46(3):210–216 [Medline: 3162522]

    Article  CAS  PubMed  Google Scholar 

  23. Lustig JP, London D, Dor BL, Yanko R (2003) Ultrasound indentification and quantitative measurement of blood supply to the anterior part of the mandible. Oral Surg Oral Med Oral Pathol 96(5):625–629 [Medline: 14600700]

    Article  Google Scholar 

  24. Baladi MG, Tucunduva MJ, Tucunduva Neto R, Cortes AR, Aoki EM, Arita ES, Freitas CF. Effectiveness of ultrasonography in detecting intraosseous vascularization: an in-vitro study. Clin Lab Res Den. 2014;20(3):160–5. doi: 10.11606/issn.2357-8041.clrd.2014.80783

  25. Pogrel MA, Dodson T, Tom W (1987) Arteriographic assessment of patency of the inferior alveolar artery and its relevance to alveolar atrophy. J Oral Maxillofac Surg 45(9):767–770 [Medline: 3305837]

    Article  CAS  PubMed  Google Scholar 

  26. McGregor AD, MacDonald DG (1989) Age changes in the human inferior alveolar artery – a histological study. Br J Oral Maxillofac Surg 27(5):371–374 [Medline: 2804039]

    Article  CAS  PubMed  Google Scholar 

  27. Lu C, Miclau T, Hu D, Marcucio RS (2007) Ischemia leads to delayed union during fracture healing: a mouse model. J Orthop Res 25(1):51–61 [Medline: 17019699]

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wolford LM (2000) The sagittal split ramus osteotomy as the preferred treatment for mandibular prognathism. J Oral Maxillofac Surg 58(3):310–312 [Medline: 10716114]

    Article  CAS  PubMed  Google Scholar 

  29. Wannfors K, Gazelius B (1991) Blood flow in jaw bones affected by chronic osteomyelitis. Br J Oral Maxillofac Surg 29(3):147–153 [Medline: 1873281]

    Article  CAS  PubMed  Google Scholar 

  30. Niranjan NS (1988) An anatomical study of the facial artery. Ann Plast Surg 21(1):14–22 [Medline: 3421650]

    Article  CAS  PubMed  Google Scholar 

  31. Wolf J, Mattila K, Hietanen J, Vartiovaara J (1989) A radiological study of degenerative changes in the external carotid region and carotid bifurcation. Br J Oral Maxillofac Surg 27(5):362–370 [Medline: 2804038]

    Article  CAS  PubMed  Google Scholar 

  32. Granström G, Nilsson P, Röckert HO, Ortendal T (1984) Studies on protracted tissue reactions and repair after circulatory and skeletal damage to the rat mandible. Int J Oral Surg 13(2):151–159 [Medline: 6430817]

    Article  PubMed  Google Scholar 

  33. Yang HM, Won SY, Kim HJ, Hu KS (2015) Neurovascular structures of the mandibular angle and condyle: a comprehensive anatomical review. Surg Radiol Anat 37(9):1109–1118 [Medline: 25956586]

    Article  PubMed  Google Scholar 

  34. Bodo M, Settle T, Royal J, Lombardini E, Sawyer E, Rothwell SW (2013) Multimodal noninvasive monitoring of soft tissue wound healing. J Clin Monit Comput 27(6):677–688 [Medline: 23832619]

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Prof. Dr. Israel Chilvarquer for his help in classification of alveolar atrophy degree.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo–USP, Brazil, Av. Prof. Lineu Prestes, 2227-Cidade Universitária, 02036-021, São Paulo, SP, Brazil

    Júlio Cezar M. A. Mancini & João Gualberto C. Luz

  2. Department of Diagnostic Imaging, University Hospital, University of São Paulo, São Paulo, Brazil

    Márcio Ricardo Taveira Garcia & Ilka Regina Souza de Oliveira

  3. Department of Oral and Maxillofacial Surgery, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil

    Ronaldo Rodrigues de Freitas

Authors
  1. Júlio Cezar M. A. Mancini
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  2. Márcio Ricardo Taveira Garcia
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  3. Ilka Regina Souza de Oliveira
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  4. Ronaldo Rodrigues de Freitas
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  5. João Gualberto C. Luz
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Correspondence to João Gualberto C. Luz.

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The authors declare that they have no conflict of interest.

No external funding, apart from the support of the authors’ institution, was available for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mancini, J.C.M.A., Garcia, M.R.T., de Oliveira, I.R.S. et al. Analysis of the blood supply to the post-fracture edentulous mandible: study by colour Doppler sonography. Oral Maxillofac Surg 20, 417–424 (2016). https://doi.org/10.1007/s10006-016-0583-0

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  • DOI: https://doi.org/10.1007/s10006-016-0583-0

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