Carotid tree changes of Maxillofacial Missile injuries by Doppler sonographay - an Iraqi study

Abstract

Background: Injuries of the carotid artery caused by penetrating wounds of the neck are nearly 10 times as common as those caused by non penetrating trauma (1), over 10% of all penetrating neck wounds result in significant carotid artery(2) ,and more than 90% of such injuries are secondary to gunshot wounds (3). Injuries to the extra cranial carotid arteries from penetrating trauma is more likely to cause a dissection through intimae disruption and subsequent formation of a false channel and thrombus (4).
Patients: Patients were selected from Maxillofacial department in the Specialized Surgeries Hospital in Baghdad . thirty patients were examined , twenty nine were male ( mean 96,66% ) ,only one female was examined ( 3,34% ) . We prepared a specially designed case sheet including , life saving procedures , type of missile , clinical examination include site of missile injuries according to Saletta JD et al 1976 (5) who classified the neck Into three zones , investigation X- ray ,C T scan. .The ultrasonographic scanning of the carotid arteries was performed, the Doppler machine was -SIEMENS – sonoline ELEGRA . Using a highfrequency linear array imaging probe or transducer 7,5- 9 ( MHz) with a Hewlett packard scanner. Methods : The ultrasonographic scanning of the carotid arteries was performed with the patient in the supine position , the examination takes 30 to 60 minutes (6,7) . Using a highfrequency= linear array imaging probe (7.5- 9 MHz) .
Results : Patients age ranging from 15 – 57 years and the mean was 36 years ,most cases were from age range 20-29 years ( 40%) .Eighteen patients ( 60%) were injured with bullets , twelve were injured with shell fragments ( 40 % ) , twelve ( 40%) were hand gun bullets and six ( 20%) were rifle bullets. Intimae media thicknesses of common carotid arteries were measured .Mean of IMT right was 0.7 mm and left side was 0.71 mm . While IMT of right external carotid artery was 0.71 mm , IMT of left external carotid artery was 0.75 mm . IMT of right internal carotid artery was 0.8 mm ,IMT of left internal carotid artery was 0.78 mm .Results reveled that mean of IMT of Ext. carotid artery at injured side was more thicker ( 0.79 mm) than non injured side and the mean of IMT of common carotid artery was also thicker at injured side 0.8 mm . Conclusion: Ultrasound scanning is noninvasive, and usually painless . , there are no known harmful effects on humans , carotid Ultrasound has to be a risk free procedure . Further Ultrasound scanning gives a clear picture of soft tissues that do not show up well on X- ray images . Mean of IMT of Ext. carotid artery at injured side was more thicker ( 0.79 mm) than non injured side and the mean of IMT of common carotid artery was also thicker at injured side 0.8 mm .