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Evaluation of distracted mandibular bone using computed tomography scan and ultrasonography: technical note

¹Oral and Maxillofacial Surgery Department, Dental School, Ain Shams University, Cairo, Egypt; ²Radiology Department, Medical School, Ain Shams University, Cairo, Egypt; ³Oral and Maxillofacial Surgery Department, Dental School, King Abdulaziz University, Jeddah, Saudi Arabia

*Correspondence to: Ibrahim El-Hakim, 6 El-Gendy Street, Hadayek Helwan, Cairo 11433, Egypt; E-mail: imelhakim{at}hotmail.com

Received 31 December 2007; revised 23 April 2008; accepted 29 April 2008

Objectives: Distraction osteogenesis is considered an important reconstruction armamentarium in the management of mandibular deformities and deficiency disorders. The duration of the consolidation period is still a debatable issue among the clinicians. Evaluation of the newly formed bone is the cornerstone for terminating the consolidation period safely. The aim of this study is to find a more conservative protocol for the evaluation of callus distraction by monitoring bone healing using two different examination tools: ultrasonography and dental CT.

Methods: Four adult patients (three women and one man) underwent mandibular distraction (using two intraoral and two extraoral devices). The latency period was 5–7 days and the distraction was at a rate of 2 mm per day, with 12–14 weeks of consolidation. All patients were evaluated during activation, 3 months, 6 months and 1 year post-distraction. Evaluation included clinical examination, plain radiographs, CT and ultrasonography examinations.

Results: Ultrasonographic examination of the healing callus revealed four different phases of maturation. These phases were similar to the degree of tissue calcification as measured by CT. Tissue density across the distraction wound at the time of distractor removal (12–14 weeks) was equal to or less than one-third of normal bone density.

Conclusions: Clinical monitoring of mandibular distraction wounds can be successfully achieved through frequent use of ultrasonographic examinations. Standardization of ultrasonography based on CT findings will expand the reliability of ultrasound in monitoring callus maturation. An algorithm for evaluation of distraction wound healing is suggested.

Keywords: computed tomography scan, ultrasonography, distraction osteogenesis, dentofacial deformaties