Use of an osteoconductive compound as an aid in the management of a maxillary fracture in a boa constrictor.

A boa constrictor was presented with a short oblique compound fracture of the rostral third of the right maxilla. The fracture was reduced and biomaterial was placed around the fracture. A computed tomography scan at 1.5 mo post-surgery showed that the fracture had healed with slight displacement of the bone fragments.

Bilateral iatrogenic [corrected] maxillary fractures after dental treatment in two aged horses.

This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fractures during or after routine dental treatment are rare, but can occur, especially in older horses. Appropriate sedation and, if necessary, regional nerve blocks might reduce the risk of iatrogenic fractures of the maxilla. General anesthesia must be considered for tooth extraction in horses that are difficult to restrain.

Location and distribution of craniomaxillofacial fractures in 45 cats presented for the treatment of head trauma.

OBJECTIVES: The aim of this retrospective study was to describe the location and distribution of craniomaxillofacial (CMF) fractures in 45 cats presented to a veterinary referral centre between 2012 and 2017. METHODS: Cats with a history of head trauma, one or more CMF fractures and a pretreatment CT scan of the CMF region were included in this study. For the purpose of the study, the CMF skeleton was divided into 15 functional anatomical regions and the fracture sites were allocated to one of these functional regions. Statistical analysis was performed using R. RESULTS: Skull fractures were evident in 80.0% of cats, and mandibular fractures in 86.7% of cats in this study. The median number of anatomical functional regions affected was eight and there was evidence of moderate or strong correlation between fractures of different regions of the mid-face. Where fractures were recorded in the nasopharynx and orbit they were bilateral in 93.5% and 89.7%, respectively. Twenty-six (57.8%) of the cats had fractures affecting one or both temporomandibular joints, which included fractures of the mandibular fossa, condylar neck and condyle. Twenty-nine cats (64.4%) had tooth fractures and seven cats (15.6%) had significant eye injuries. CONCLUSIONS AND RELEVANCE: Cats presenting with a single symphyseal separation or parasymphyseal fracture are very likely to have further fractures at other locations. Fractures in the nasopharynx, orbit, nose, upper jaw, intermaxillary suture and zygomatic arch regions (the 'mid-face') are likely to occur together. The pattern of distribution of mandibular fractures is not as predictable as that for maxillary fractures. CT imaging is required to achieve a complete diagnosis of the location and distribution of skull fractures in cats after head trauma.

Complications of equine oral surgery.

The vast majority of equine oral procedures are dental-related and, unless great care is taken, almost all such procedures have the potential to cause marked short- or long-term damage to other oral structures. This review of the more common complications of oral surgery begins at the rostral oral cavity with procedures of the incisors, and then moves caudally to deal with complications related to procedures of wolf teeth and cheek teeth, including salivary duct disruption and dental sinusitis. Finally, complications associated with maxillary and mandibular fractures are discussed.

Oral fractures in dogs of Brazil--a retrospective study.

A retrospective study was performed in 100 dogs with 121 mandibular and 21 maxillary fractures. Dog fight (43.0%) and automobile (12.0%) trauma were the most common etiologies for fracture. The cause of fracture was unknown in 23.0% of the cases, while pathologic fractures occurred in 13.0% of cases. Young dogs (< 1-year-old) and dogs > 8-years of age were most affected. Mandibular fractures occurred in 90 dogs (90.0%), with two dogs (2.2%) having concurrent maxillary fractures. Maxillary fractures only were diagnosed in 10 dogs (10.0%). The molar region (47.1%) was the most commonly affected location for mandibular fracture, followed by fractures of the symphysis and parasymphysis (30.6%), premolar region (17.4%), angular process (4.1%) and vertical ramus (0.8%). In fractures of the mandibular region, the mandibular first molar tooth was often (85.9%) involved while the canine teeth were involved in 67.5% of symphyseal and parasymphyseal fractures. The most common fracture of the maxilla was the maxillary bone (52.4%), followed by the incisive (33.3%), palatine (9.5%), and nasal (4.8%) bones.

Fractures of the rostral portion of the mandible and maxilla in horses: 89 cases (1979-1997).

OBJECTIVE: To compare fracture locations, repair methods, complications, and outcomes of horses with fractures of the rostral portions of the mandible and maxilla. DESIGN: Retrospective study. ANIMALS: 89 horses with fractures of the rostral portions of the mandible and maxilla. PROCEDURE: Medical records and radiographs were reviewed. Fractures were categorized by fracture location and stability. Postoperative complications and long-term outcome were determined by clinical examination and telephone interviews with horse owners. RESULTS: 4 fracture types were recognized. Fractures involving just the alveolar plate (33%) and those involving the alveolar plate and the body of the bone (32%) were most common and were often repaired by interdental wiring. Unilateral fractures of the mandible (11%) were managed without surgery if stable. Unstable fractures were repaired with wires, a U-shaped bar (U-bar), or a bone plate. Bilateral fractures (24%) were often repaired with orthopedic wires in foals or with a U-bar, acrylic splint, wires, or bone plate in adult horses. In 2 horses, bilateral fractures were managed conservatively. Short-term complications developed in 24 of 89 (27%) horses. Soft tissue infections and wire loosening or failure were the most common short-term and long-term complications. Wire replacement was not required in any horses after release from hospital. Persistent draining tracts were most often associated with bone sequestration. Long-term functional and cosmetic outcomes were favorable for all fracture types and repair methods. CLINICAL IMPLICATIONS: Although complications in horses with fractures of the mandible and maxilla are common, long-term prognoses for functional and cosmetic outcome are favorable.

Transient, traumatically induced, central diabetes insipidus in a dog.

A 9-year-old mixed-breed dog was evaluated for dental malocclusion secondary to mandibular fractures that had been repaired after the dog had been hit by a car. The dog had hypernatremia, high plasma osmolality, low urine osmolality, and hyposthenuria with adequate fluid administration. Skull radiography revealed a fracture line at approximately the level of the pituitary fossa. Administration of exogenous vasopressin resulted in an increase in urine specific gravity and urine osmolality, a decrease in serum osmolality, and a normalization of serum sodium concentrations. Follow-up evaluation revealed a reduction in the frequency of exogenous treatment with vasopressin over the ensuing months, indicating transient, traumatically induced, central diabetes insipidus.

Fractures of the mandible and maxilla.

External fixation is an effective method for stabilization of many mandibular fractures. Thorough physical examination and patient stabilization should be instituted before attending to the fractures and associated soft tissue trauma. Normal occlusion rather than perfect reduction is the goal of oral fracture repair. Loose teeth or teeth in the fracture should be removed, as should any avascular bone fragments. Soft tissue wounds should be treated as for any contaminated wound. Mucosal wounds are allowed to heal by second intention. Although prophylactic perioperative antibiotics are indicated, they are usually not needed postoperatively. The three basic types of external fixators described include the Kirschner-Ehmer splint, pins or screws and acrylic, and the biphase splint. All three types are relatively easy to apply, and the principles of their application are similar. A minimum of two pins or screws are placed percutaneously in each fragment, avoiding the mandibular canal. The Kirschner-Ehmer splint is more easily adjustable than the biphase splint or the pin-acrylic splint, which use acrylic connecting bars. The advantages of fixators that use acrylic bars are that the pins or screws need not all be in the same plane and that they are more lightweight than the Kirschner-Ehmer splint. The disadvantages of the biphase splint are its increased expense and its use being limited to larger dogs. External fixators are well tolerated by the animals, and postoperative care is minimal. Mandibular fractures are usually healed in 3 to 5 weeks, and the fixators can be removed with the animal under sedation.

Treatment of fractures of the mandible and maxilla by mini titanium plate fixation systems in dogs and cats.

Mini titanium plates were used to repair certain fractures of the maxilla and mandible in dogs and cats, under general anaesthesia. The location of the fractures treated were: corpus mandible, one dog; corpus mandible and symphysis, two dogs; caudal mandible, two dogs; rostral mandible, one dog; maxilla, one dog; nasal bone, one dog; corpus mandible and symphysis, one cat; caudal mandible, one cat; and maxilla, one cat. The healing periods varied from 6 to 9 weeks. In seven cases, implants were removed after a period of 3.5 to 18 months. In four cases the implants were left in place. The follow up period was between 8 and 36 months. In ten cases the procedure was successful, however in one case the outcome was not satisfactory due to a broken plate. There were no instances of dental malocclusion, nonunion, malunion, osteomyelitis or soft tissue infection. Eating, playing with toys, a fast transition to solid food and a quick return to normal jaw movements were observed. In our hands, the mini titanium plate fixation system was a safe and effective method for repairing certain maxillary and mandibular fractures in dogs and cats.

Use of maxillary and mandibular splints for restoration of normal occlusion following jaw trauma in a cat: a case report.

A compression fracture of the maxilla in a young cat was treated by splinting the maxillary canine teeth. Wire-reinforced composite resin was used to keep these teeth from tipping palatally. This technique stabilized the fracture with anatomic reduction and minimal invasion of the tissues. A mandibular symphyseal separation was also stabilized with a cerclage wire and composite resin bonded wire fixation of the mandibular canine teeth. Two years later, occlusion was normal.

Oral and maxillofacial reconstruction in a cat using wire and acrylic.

A 15-month-old DSH cat was presented with facial deformity secondary to multiple oral and maxillofacial fractures after being struck by an automobile. Multiple wires and dental acrylics were used for fracture repair.

[Mandibular and maxillary fractures in dogs and cats]. / Fracturen van de mandibula en maxilla bij hond en kat.

Fractures of the mandible and maxilla are often caused by car accidents or by falling from a height. Frequently the fractures are open, especially when the fracture is located rostrally. During diagnostic work-up, special attention should be given to concomitant injury of the brain, and to cervical and thoracic injuries. The principles of treatment for jaw fractures are identical to those for complicated long bone fractures. Adaptations of techniques are necessary because of the need for undisturbed food intake, the presence of dental elements in the fragments, the poor soft tissue coverage especially in the rostral part of the mandible, and the typical mechanical load of the bones. The dental roots should be avoided when possible. Pharyngostomy prior to fracture treatment allows optimal assessment of the occlusion during surgery. In general, the treatment should permit non-supported food intake by the patient after surgery.

[Luxation of a canine tooth with fracture of the alveolar wall of the maxilla in a dog]. / Luxatie van een hoektand met fractuur van de alveolaire wand van het os maxillare bij een hond.

The method of treatment used in a case of alveolar fracture of the maxilla is reported in the present paper. Using a splint, the canine tooth was fixed at the level of the enamel-cement border of the teeth. The method employed in applying compression at the site of the fracture is reported.

Surgical repair of a severely comminuted maxillary fracture in a dog with a titanium locking plate system.

A four-year old male Labrador Retriever was admitted with head trauma after being hit by a car. The dog had sustained multiple nasal, maxillary, and frontal bone fractures that resulted in separation of the maxilla from the base of the skull. A severely comminuted left zygomatic arch fracture was also present. These fractures were all repaired using a point contact, locking titanium plate system, in a single procedure that resulted in excellent postoperative occlusion and immediate function. Healing was uneventful. Full function and excellent cosmetic appearance were evident 13 months after surgery. This case illustrates the ease of repair and the success of treatment of severely comminuted maxillofacial fractures by conforming to basic biomechanical principles taken directly from the human experience and successfully applied to the dog; these included multiple plate application along the buttresses and trusses of the facial skeleton. The plate fixation was applied to bridge the multiple fractures along the most appropriate lines of stress. The small size of the plates, and the ability to easily contour them to adapt to the bone surface in three-dimensions, allowed their placement in the most appropriate positions to achieve sufficient rigidity and lead to uncomplicated healing without any postoperative complications.

Prevalence and nature of dentoalveolar injuries among patients with maxillofacial fractures.

OBJECTIVE: Although not previously reported, experience suggests that dentoalveolar injury is -common among patients with maxillofacial fractures. The objective of this study was to evaluate and describe the prevalence and nature of dentoalveolar injuries in patients identified with maxillofacial fractures. METHODS: Medical records of 43 dogs and cats diagnosed with maxillofacial fractures between 2005 and 2012 were reviewed to identify patients with concurrent dentoalveolar injury. Medical records of patients with dentoalveolar injury were abstracted for the following information: signalment (including sex, age and skull type), mechanism of maxillofacial trauma, location and number of maxillofacial fractures, dentoalveolar injury type and location and the number of dentoalveolar injury per patient. Statistical evaluation was performed to determine associations between signalment, mechanism of trauma, location and number of maxillofacial fractures and the prevalence and nature of concurrent dentoalveolar injury. RESULTS: Dentoalveolar injuries are common among patients with maxillofacial trauma. Age and mechanism of trauma are significant predictors of the presence of dentoalveolar injuries in patients with maxillofacial trauma. CONCLUSIONS AND CLINICAL RELEVANCE: The findings of this study serve to encourage veterinarians to fully assess the oral cavity in patients with maxillofacial fractures as dentoalveolar injuries are common and can be predicted by age and mechanism of trauma.

[Computed tomography in cats with craniofacial trauma with regard to maxillary and orbital fractures]. / Computertomographische Untersuchung des Schädels von Katzen mit kraniofazialem Trauma im Hinblick auf Maxilla- und Orbitafrakturen.

OBJECTIVE: Computed tomographic examination of the skull of cats with craniofacial trauma. Analysis of diagnostic findings with regard to the occurrence of isolated and combined maxillary and orbital fractures. MATERIAL AND METHODS: Prospective study (August 2006 - June 2010): Computed tomography (CT) of the skull of cats with craniofacial trauma. RESULTS: Thirty-eight cats met the inclusion criteria. Breeds were 36 Domestic Shorthair cats, one Maine Coon and one Somali cat. Age at admission ranged from 11 to 187 months. The ratio of the numbers of males to females was 22:16 (1.4). Computed tomographic examination revealed a maxillary fracture in 27 (71%) animals. Sixteen (42%) cats had multiple maxillary fractures (≥2). Twenty-eight animals (74%) displayed orbital fractures. Combined maxillary and orbital fractures occurred in 26 (68%) patients. The odds ratio of this combined occurrence was 87 (p<0.001). Sixteen (57%) of 28 cats with orbital fractures showed multiple orbital fractures (≥2). The incidence of bilateral orbital fractures was 67% (25 patients). The medial orbital wall was the most commonly fractured orbital wall (66%), and the orbital floor the second most common (61%). CONCLUSION: Computed tomographic examination of the skull of cats with craniofacial trauma showed that maxillary and orbital fractures are more common than previously described. Combined maxillary and orbital fractures occurred in more than half of the patients. In cats, orbital fractures mainly affect the medial orbital wall and the orbital floor. CLINICAL RELEVANCE: Cats with craniofacial trauma often have maxillary and orbital fractures. The additional information taken from the computed tomographic examination could lead to an optimised therapeutical concept.