COMPUTED tOMOGRAPHY IN CONCOMITANT GUNSHOT INJURY OF FACIAL SKELETON
Pavlova O.Yu., Serova N.S., Skobeleva Yu.O., Tereshchuk S.V., Shamanaeva L.S.
|
Purpose. Demonstration of computed tomography (CT) possibilities in a patient with combined damage to the facial and brain parts of the skull due to a gunshot wound. Materials and methods. A male patient, 36 years old, was admitted to the hospital in May 2016 after an accident. The diagnosis was combined gunshot injury, penetrating shot wounds of the skull, brain, facial skeleton with damage to the orbits, upper and lower jaws. Upon admission to the hospital, primary surgical treatment of facial wounds and tracheostomy were performed, reposition of the lower jaw fragments with metallic osteosinthesis, enucleation of the right globe. In May 2018 the patient was hospitalized at the maxillofacial surgery clinic №4 at the Sechenov University in order to conduct reconstructive surgical treatment of the facial skeleton. At the Russian-Japanese imaging center, Clinical University Hospital №1, the patient underwent multispiral computed tomography (MSCT) to assess the damage to bone and soft tissue structures of the face and determine the tactics of surgical treatment. MSCT was performed on a Toshiba Aquilion ONE 640-slice computer tomograph (Japan), with a slice thickness of 0.5 mm, in a spiral mode, with capture of the facial and brain parts of the skull, in the mode of bone and soft tissue reconstruction. The study was supplemented by multi-planar and three-dimensional reconstructions. Results. According to the results of MSCT, multiple post-traumatic defects and deformations of the facial skeleton were revealed. In the area of the facial skeleton, both orbits, the left eyeball and the brain, multiple foreign bodies were determined. Using MSCT data, virtual planning was carried out to determine the volume of reconstructive treatment and the choice of autografts. The first step was surgical repair of the upper jaw with an autograft from the scapula. The second stage was the reconstruction of the lower jaw with an autograft from the fibula. As a result of surgical treatment, the anatomical and topographic relationship of the bone structures of the facial skeleton was restored. The patient's condition at discharge was satisfactory. In the future, it is planned to carry out reconstructive operations in the area of the facial skeleton in order to fill the deficit of face soft tissues and restore the aesthetic appearance of the patient. Conclusion. This clinical observation demonstrates the importance of high-quality and timely diagnosis of patients with gunshot injuries of the facial skeleton both at the stage of the initial examination and the preoperative stage, and during monitoring in postoperative stages. Performing MSCT in this category of patients helps to obtain complete information about the condition of the bone and soft tissue structures of the facial skeleton, brain, reveal all the associated injuries, as well as plan the course and volume of surgery. |
I.M. Sechenov First Moscow State Medical University (Sechenov University).
Moscow, Russia..
Moscow, Russia.
Krasnodar, Russia. |
Keywords: gunshot wound, trauma, MSCT, 3D-reconstruction.
Corresponding author: Skobeleva Yu.O., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Pavlova O.Yu., Serova N.S., Skobeleva Yu.O., Tereshchuk S.V., Shamanaeva L.S. Computed tomography in concomitant gunshot injury of facial skeleton. REJR 2020; 10(2):223-237.DOI:10.21569/2222-7415-2020-10-2-223-237.
.
Received: 15.04.20 Accepted: 07.07.20
Exploring the possibilities of Ultrasonic Shear Wave Elastography (SWE) in controlling the formation of bone calluses at different stages of its development.
Material and methods. A study of 51 patients (29 men, 22 women from 17 to 65 years) with fractures of long tubular bones of the upper and lower limbs was conducted. Ultrasound tests were performed on the SuperSonic Aixplorer (France) device with an assessment of tissue stiffness in the kPa and the use of multifrequency probes 2-15 MHz. In the area of the fracture scanned bone corn, surrounding soft tissues and vessels, excluded interposition. The formation of bone calluses was studied at different stages of its development, from 0-7 days to 6 months.
Results. According to the SWE, the most intensive increase in bone calluses is in the first 1.5 months after the fracture, followed by the build-up of bone calluses. For each stage of bone callos formation determined sensitivity, specificity of the method of SWE.
Discussion. The use of the SWE method to control the formation of bone calluses is possible from the first days after bone fracture. The stiffness of bone calluses at SWE is determined in the kPa. Ultrasound also allows you to study the condition of bone fragments, surrounding tissues and vessels. Conducting ultrasound with the use of SWE, dopplerography allows in dynamics to trace the formation of bone calluses in all three stages of its development.
Conclusion. SWE wave allows to determine the stiffness of the bone calluses in the dynamics, starting from the first days after the fracture and to its complete formation. SWE implements a new approach to assess the stiffness of bone calluses, which allows to get accurate quantitative results in real time. The sensitivity and specificity of the SWE in determining the stiffness of bone calluses is highest in the first – connective tissue stage of its formation (94% and 90% respectively).