RU2701906C1 - Method for analysis of haemodynamics and state of vessels of maxillofacial region in patients with dento-facial anomalies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry, and aims at analyzing the state of the dentoalveolar system (DAS) and haemodynamics of head and neck vessels in patients with an occlusion pathology. Method involves conducting a teleradiography (TRG) of a head in a lateral projection, analyzing the obtained image in the Dolphin Imaging program to assess the anatomical features of the structure and relationships of the bone and soft tissue elements. Preliminary diagnosis is stated. To assess functional state of vessels of head and neck, ultrasonic Doppler sonography of head and neck vessels (USDS) is performed. Systolic and diastolic blood flow velocities and arteries Purselo index are determined, arteries diameter and stroke are additionally determined. Based on data of USDS, haemodynamics and the state of jaws of the maxillofacial region are analyzed. Before prescribing the treatment, a final diagnosis is made. Treatment is prescribed taking into account TRG and USDS data. At the end of the treatment, repeated teleradiography and ultrasonic Doppler sonography are performed, and changes in the functional state of the maxillofacial vessels are evaluated in the patients with the occlusion pathology in the course of the clinical outcome.

EFFECT: invention enables determining the anomaly of the dento-facial system and assessing the state of the vessels in the given and adjacent regions, provides a more complete picture of the pathological process, enables assessing the functional state of the dento-facial system in dynamics.

1 cl, 3 dwg, 1 tbl, 1 ex

Description

The invention relates to medicine, namely to dentistry and is intended for analysis of the state of the dentofacial system (ZHS) and hemodynamics of the vessels of the head and neck in patients with malocclusion. In case of maxillofacial anomalies (AML) hemodynamic disturbance is observed in the arteries of the face and is more common in young patients [Yilmaz S., Kiliec A.R., Keles A. // Am. Jjournal Orthod. .Dentofacial Orthhop. 2000. Vol. 117, No. 2. P. 156-163.]. According to various estimates, the prevalence of VLA is up to 95% [Profit U.R. Modern Orthodontics / Per. from English under the editorship of tsp - correspondent RAMS prof. L.S. Persina. - M .: MED press-inform, 2006. - 560 p.]. Disorders of blood flow correlate with occlusion pathologies, with long-term VLA.

An understanding by the orthodontic doctor of the state of the vessels of the maxillofacial region (HFM) and the hemodynamics in them in patients is necessary for choosing the rational tactics of treating anomalies of the dentofacial system and preventing the development of complications.

A widely known method of visualization and analysis of the parameters of the maxillofacial region using the method of tele-roentgenography (TRG) followed by decoding the resulting image, however, it allows you to evaluate only the anatomical features of the structure and relationships of bone and soft tissue elements, not taking into account the state of the vessels, their morphology and blood circulation in them.

There is also a method of ultrasound dopplerography (Doppler ultrasound) that allows you to assess the functional state of the vessels of the head and neck, but does not allow to detect the presence of dentofacial anomaly.

As a prototype, the chosen method of visualization of MHL using TRG.

Common with the proposed method is the non-invasiveness of the study (lack of penetration of parts of the equipment through the natural external barriers of the body, such as skin or mucous membranes), the ability to assess the relationship of soft tissue and bone structures.

The disadvantages of the prototype:

1. Superficial assessment of soft tissues. The lack of vascular imaging and, as a consequence, the impossibility of detecting violations of the vascular wall and malformations (any deviation from normal development, resulting in gross changes in the structure and function of the organ or tissue).

2. It does not allow to measure the linear velocity of blood flow, resistance and peripheral resistance of the vascular wall.

A method is proposed for analyzing the morphofunctional state of the dentofacial system and hemodynamics of the vessels of the head and neck in patients with occlusion pathology.

The method is as follows:

1. Conducting a tele-radiography of the head in lateral projection in a standard way.

2. Analysis of the obtained image in Dolphin Imaging in a standard way.

3. Ultrasound Dopplerography (Doppler ultrasound) of the vessels of the head and neck [Vorobev V.A., Pototskaya S.V., Plotnikova I.V. Changes in blood flow in the external carotid artery and its branches, depending on malocclusion and orthodontic treatment // Far Eastern Medical Journal. - 2008. - No 1. - S. 96-98].

Tasks solved by the proposed method:

1. Development of a method for the simultaneous assessment of the morphology and function of the SES using the methods of TRG and USDG.

2. Elimination of the disadvantages of the prototype.

3. Improving the quality of diagnosis of VLA.

Features of the proposed method for assessing the morphofunctional state of ZHS using teleretgenography and a computer analysis system Dolphin Imaging and ultrasound dopplerography of the vessels of the maxillofacial region:

1. Does not cause psychological discomfort to the patient during the study.

2. Non-invasiveness (lack of penetration of parts of the equipment through the body's natural external barriers, such as skin or mucous membranes).

3. Does not require special preparation for the study.

4. Allows you to determine the degree of development of vascular pathology of the dentofacial area.

5. The method is characterized in that:

1. Allows you to determine the anomaly of the dentofacial system and assess the condition of blood vessels in this and adjacent areas.

2. Gives a more complete picture of the pathological process.

3. Allows you to evaluate the functional state of the dentofacial system.

The technical result of the method is:

- Improving the quality of diagnosis of dentofacial anomalies.

The invention is illustrated by photographs, where in FIG. 1. - the face of the patient M., 19 years old (a - face, 6 - smile, in - profile)., In FIG. 2 - patient M., 19 years old. Decoding TRG in the lateral projection in the program Dolphin Imaging (USA),

in FIG. 3 - patient M., 19 years old. USDG of the superficial temporal artery.

Clinical example:

Patient M., 19 years old (Fig. 1), went to the clinic with complaints of incorrect tooth position, a violation of the aesthetics of the face. Correlation of dentition according to Engle's III class. Analysis of TWG in the lateral projection in the Dolphin Imaging program (Fig. 2.) showed an increase in the SNB angle, the deviation of the ANB angle is greater than the permissible values, the Wits number is -7.

Preliminary diagnosis: mesial occlusion, gnatic form.

Cephalometric analysis confirms the need to reduce the size of the lower jaw by osteotomy in the region of the corners of the lower jaw on the left and right. The presence of this dento-maxillofacial anomaly suggests changes in the vessels of the HMO and hemodynamics in them. To confirm, ultrasound dopplerography (triplex scanning) of the vessels of the head and neck on the right and left was performed. Both sides were examined: the common carotid artery (CCA), the bifurcation (separation) region of the CCA into the external carotid artery (ICA) and internal carotid artery (ICA), branches of the HCA (facial, temporal, posterior ear arteries), vertebral artery.

The results are presented in table 1. An increase in the maximum systolic velocity in the facial and posterior ear arteries was revealed. Diastolic blood flow is higher than normal in the NSA, superficial temporal and posterior ear arteries. There is an asymmetry, a change in blood flow is more pronounced on the right. The Purselo index (an indicator of peripheral blood flow resistance) is higher than the average norm (0.7) in the NSA, facial, superficial temporal and posterior ear arteries. Hemodynamically insignificant changes in the linear course of the vertebral arteries on both sides were also found.

Note: d is the diameter; Vs - systolic blood flow velocity; Vd - diastolic blood flow velocity.

The final diagnosis: mesial occlusion (gnatic form), echographic signs of hemodynamically significant disorders in the basin of the NSA, as well as its small branches: facial, superficial temporal, posterior ear arteries.

The presence of identified abnormalities in hemodynamics suggests a violation of the blood supply to periodontal tissues and, as a consequence, the development of dystrophic processes in them, which can lead to the appearance of: gum recession (exposure of the root of the tooth), gingivitis, periodontitis, periodontal disease.

Treatment plan

Based on the findings of TRG, complex treatment was prescribed by the joint use of orthodontic and surgical methods of treatment:

1. The preoperative orthodontic stage of treatment with a brace system by Ormco (USA) on the upper and lower jaw for 6 months. Considering the data of ultrasonic ultrasound examination, treatment was corrected by using small orthodontic forces (round CuNiTi arcs of small diameter) and prescribing a drug to improve the rheological properties of blood to improve blood supply to periodontal tissues.

2. Making a splint (plastic template) for the correct positioning of the lower jaw during surgery.

3. Surgical stage - osteotomy in the region of the corners of the lower jaw on the right and left.

4. Conducting physiotherapy using electrophoresis, phonophoresis in the region of the corners of the lower jaw.

5. Postoperative orthodontic stage - continued treatment with the braces for 12 months.

6. Retention stage - fixing the result by wearing orthodontic retention devices for 3 years.

7. Recommended repeated ultrasound after orthodontic treatment and after 6 months.

After the complex treatment in patient M., according to TRG and cephalometry in the Dolphin Imaging program, the parameters of the dentofacial system were close to normal. According to Doppler ultrasound, the hemodynamic parameters in the vessels of the head and neck 6 months after the postoperative orthodontic stage also approached the norm, which indicates an improvement in blood supply and a decrease in the risk of dystrophic processes in the periodontal tissues and the need for the proposed method for the analysis of hemodynamics in the vessels of the upper limbs during diagnosis and treatment of patients with AML.

Claims (1)

A method for analyzing the condition of the maxillofacial region in patients with occlusion pathologies, including conducting a tele-radiography (TRG) of the head in lateral projection, analyzing the received image in the Dolphin Imaging program, performing ultrasound dopplerography of the vessels of the head and neck (USG) to assess the functional state of the vessels of the head and neck , determine the systolic and diastolic blood flow velocities and the Purselo index of arteries, on the basis of ultrasound data, analyze the hemodynamics and condition of the vessels of the maxillofacial region, prescribe treatment taking into account the data of TRG and USDG, characterized in that they analyze the received image in the Dolphin Imaging program to assess the anatomical features of the structure and relationships of bone and soft tissue elements, after that they make a preliminary diagnosis, USDG is performed for occlusion pathology, and the diameter and course of the arteries are determined before the treatment is assigned the final diagnosis, at the end of the treatment, repeated tele-radiography and ultrasound dopplerography are performed and changes in the functional state of the vessel are evaluated in the maxillofacial area in patients with occlusion pathology in the dynamics on which judging on the results of the treatment.

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