Facial Plast Surg 2021; 37(05): 571-575
DOI: 10.1055/s-0041-1724123
Original Research

Low-Intensity Pulsed Ultrasound Therapy: A Nonsurgical Treatment Modality for Mandible Fracture Nonunion?

Adam R. Abel
1   Division of Oral and Maxillofacial Surgery, Department of Surgery, NewYork-Presbyterian Hospital–Weill Cornell Medical Center, New York, New York
,
Gwendolyn S. Reeve
1   Division of Oral and Maxillofacial Surgery, Department of Surgery, NewYork-Presbyterian Hospital–Weill Cornell Medical Center, New York, New York
› Author Affiliations
Funding None.

Abstract

Standard treatment of mandibular nonunion includes debridement and application of maxillomandibular or rigid internal fixation techniques, with adjunctive bone grafting when necessary. Frequently described in the orthopaedic literature, low-intensity pulsed ultrasound therapy (LIPUS) is a noninvasive treatment modality used to accelerate healing of fresh fractures and established nonunions. The purpose of this study was to conduct a systematic review to determine the extent of LIPUS study in the treatment of mandibular nonunions to identify whether LIPUS represents an effective nonsurgical alternative or adjunct for nonunion management. A literature review was conducted to investigate published reports on the utilization of LIPUS in treating mandible fracture nonunions. The search yielded two randomized controlled trials demonstrating favorable healing parameters in fresh human mandible fractures treated with LIPUS, two randomized controlled trials demonstrating osteogenic differentiation in human mandibular fracture cellular components, and one study reporting improved healing at rabbit mandibular osteotomy sites. No articles published reports studying LIPUS in facial fracture nonunion were identified. This report reviews published literature on mandibular nonunions, and the evidence of LIPUS use in long bone nonunions. There are no known studies presenting LIPUS treatment of mandible fracture nonunions. However, on the basis of published orthopaedic data, LIPUS therapy could be considered as an adjunct or alternative to traditional surgical management of select mandible fracture nonunions.



Publication History

Article published online:
25 February 2021

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  • References

  • 1 Haug RH, Schwimmer A. Fibrous union of the mandible: a review of 27 patients. J Oral Maxillofac Surg 1994; 52 (08) 832-839
  • 2 Mathog RH, Toma V, Clayman L, Wolf S. Nonunion of the mandible: an analysis of contributing factors. J Oral Maxillofac Surg 2000; 58 (07) 746-752 , discussion 752–753
  • 3 Mathog RH, Boies Jr LR. Nonunion of the mandible. Laryngoscope 1976; 86 (07) 908-920
  • 4 Marsell R, Einhorn TA. The biology of fracture healing. Injury 2011; 42 (06) 551-555
  • 5 Ostrander BT, Wang HD, Cusano A, Manson PN, Nam AJ, Dorafshar AH. Contemporary management of mandibular fracture nonunion-a retrospective review and treatment algorithm. J Oral Maxillofac Surg 2018; 76 (07) 1479-1493
  • 6 Bochlogyros PN. Non-union of fractures of the mandible. J Maxillofac Surg 1985; 13 (04) 189-193
  • 7 Patel K, Kumar S, Kathiriya N. et al. An evaluation of the effect of therapeutic ultrasound on healing of mandibular fracture. Craniomaxillofac Trauma Reconstr 2015; 8 (04) 299-306
  • 8 Gopalan A, Panneerselvam E, Doss GT, Ponvel K, Raja Vb K. Evaluation of efficacy of low intensity pulsed ultrasound in facilitating mandibular fracture healing-a blinded randomized controlled clinical trial. J Oral Maxillofac Surg 2020; 78 (06) 997.e1-997.e7
  • 9 Imai Y, Hasegawa T, Takeda D. et al. The osteogenic activity of human mandibular fracture haematoma-derived cells is stimulated by low-intensity pulsed ultrasound in vitro. Int J Oral Maxillofac Surg 2014; 43 (03) 367-372
  • 10 Huang W, Hasegawa T, Imai Y, Takeda D, Akashi M, Komori T. Low-intensity pulsed ultrasound enhances bone morphogenetic protein expression of human mandibular fracture haematoma-derived cells. Int J Oral Maxillofac Surg 2015; 44 (07) 929-935
  • 11 Erdogan O, Esen E, Ustün Y. et al. Effects of low-intensity pulsed ultrasound on healing of mandibular fractures: an experimental study in rabbits. J Oral Maxillofac Surg 2006; 64 (02) 180-188
  • 12 Corradi C, Cozzolino A. The action of ultrasound on the evolution of an experimental fracture in rabbits. Minerva Orthopedica e Traumatologica 1952; 44
  • 13 Xavier C, Duarte L. Stimulation of bone repair by ultrasound. Rev Brasil Orthopedics 1983; 18: 73-80
  • 14 Pilla AA, Mont MA, Nasser PR. et al. Non-invasive low-intensity pulsed ultrasound accelerates bone healing in the rabbit. J Orthop Trauma 1990; 4 (03) 246-253
  • 15 Wang SJ, Lewallen DG, Bolander ME, Chao EY, Ilstrup DM, Greenleaf JF. Low intensity ultrasound treatment increases strength in a rat femoral fracture model. J Orthop Res 1994; 12 (01) 40-47
  • 16 Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg Am 1994; 76 (01) 26-34
  • 17 Kristiansen TK, Ryaby JP, McCabe J, Frey JJ, Roe LR. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am 1997; 79 (07) 961-973
  • 18 Leung KS, Lee WS, Tsui HF, Liu PP, Cheung WH. Complex tibial fracture outcomes following treatment with low-intensity pulsed ultrasound. Ultrasound Med Biol 2004; 30 (03) 389-395
  • 19 Watanabe Y, Matsushita T, Bhandari M, Zdero R, Schemitsch EH. Ultrasound for fracture healing: current evidence. J Orthop Trauma 2010; 24 (Suppl. 01) S56-S61
  • 20 Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH. Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma 2001; 51 (04) 693-702 , discussion 702–703
  • 21 Gebauer D, Mayr E, Orthner E, Ryaby JP. Low-intensity pulsed ultrasound: effects on nonunions. Ultrasound Med Biol 2005; 31 (10) 1391-1402
  • 22 Leighton R, Watson JT, Giannoudis P, Papakostidis C, Harrison A, Steen RG. Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis. Injury 2017; 48 (07) 1339-1347
  • 23 Rubin C, Bolander M, Ryaby JP, Hadjiargyrou M. The use of low-intensity ultrasound to accelerate the healing of fractures. J Bone Joint Surg Am 2001; 83 (02) 259-270
  • 24 Watanabe Y, Arai Y, Takenaka N, Kobayashi M, Matsushita T. Three key factors affecting treatment results of low-intensity pulsed ultrasound for delayed unions and nonunions: instability, gap size, and atrophic nonunion. J Orthop Sci 2013; 18 (05) 803-810
  • 25 Ryaby J, Bachner E, Bendo J. et al. Low intensity pulsed ultrasound increases calcium incorporation in both differentiating cartilage and bone cell cultures. Trans Orthop Res Soc 1989; 14: 15
  • 26 Chapman IV, MacNally NA, Tucker S. Ultrasound-induced changes in rates of influx and efflux of potassium ions in rat thymocytes in vitro. Ultrasound Med Biol 1980; 6 (01) 47-58
  • 27 Ryaby J, Mathew J, Pilla A. et al. Low-intensity pulsed ultrasound modulates adenylate cyclase activity and transforming growth factor beta synthesis. Electromagn Med 1991; 26: 95-100
  • 28 Kokubu T, Matsui N, Fujioka H, Tsunoda M, Mizuno K. Low intensity pulsed ultrasound exposure increases prostaglandin E2 production via the induction of cyclooxygenase-2 mRNA in mouse osteoblasts. Biochem Biophys Res Commun 1999; 256 (02) 284-287
  • 29 Ito M, Azuma Y, Ohta T, Komoriya K. Effects of ultrasound and 1,25-dihydroxyvitamin D3 on growth factor secretion in co-cultures of osteoblasts and endothelial cells. Ultrasound Med Biol 2000; 26 (01) 161-166
  • 30 Wu C, Lewallen D, Bolander M. et al. Exposure to low intensity ultrasound stimulates aggrecan gene expression by culture chondrocytes. Trans Orthop Res Soc 1996; 21: 622