Application of a bilateral temporal fascia free graft in a dog with multifragmented frontal sinus and nasal bone fracture.

OBJECTIVE: To describe the use of temporal fascia free grafts to treat dorsal open comminuted frontal sinus and nasal fractures. ANIMAL: One Belgian shepherd dog. STUDY DESIGN: Case report METHODS: A 5-year-old spayed female Belgian shepherd was admitted with severe facial deformation due to trauma. A deep, 3 cm wide wound was present between the nose and the frontal sinus. No abnormalities were detected on neurological examination. On computed tomographic examination, comminuted open fractures of the frontal and nasal bones were associated with a severe depression of the dorsal wall and presence of bone fragments in the sinus cavities. Bone fragments were apposed with polydioxanone monofilament suture. Bilateral temporal fascia grafts were placed over the bone fragments. RESULTS: The integrity of the frontal and nasal cavities, and the facial profile of the dog were restored. No short-term or long-term complications were observed after 4 months follow up. CONCLUSION: The innovative combination of suture apposition of bone fragments and a temporal fascia free graft resulted in very satisfying long-term outcomes in a dog with open sinus and nasal bone fractures.

Treatment of calvarial defects by resorbable and non-resorbable sonic activated polymer pins and mouldable titanium mesh in two dogs: a case report.

BACKGROUND: To date, calvarial defects in dogs have traditionally been addressed with different types of implants including bone allograft, polymethylmethacrylate and titanium mesh secured with conventional metallic fixation methods. This report describes the use of an absorbable and non absorbable novel polymer fixation method, Bonewelding® technology, in combination with titanium mesh for the repair of calvarial defects in two dogs. The clinical outcomes and comparative complication using resorbable and non-resorbable thermoplastic pins were compared. CASE PRESENTATION: This report of two cases documents the repair of a traumatic calvarial fracture in an adult male Greyhound and a cranioplasty following frontal bone tumor resection in an adult female Cavalier King Charles Spaniel with the use of a commercially available titanium mesh secured with an innovative thermoplastic polymer screw system (Bonewelding®). The treatment combination aimed to restore cranial structure, sinus integrity and cosmetic appearance. A mouldable titanium mesh was cut to fit the bone defect of the frontal bone and secured with either resorbable or non-resorbable polymer pins using Bonewelding® technology. Gentamycin-impregnated collagen sponge was used intraoperatively to assist with sealing of the frontal sinuses. Calvarial fracture and post-operative implant positioning were advised using computed tomography. A satisfactory restoration of skull integrity and cosmetic result was achieved, and long term clinical outcome was deemed clinically adequate with good patient quality of life. Postoperative complications including rostral mesh uplift with minor associated clinical signs were encountered when resorbable pins were used. No postoperative complications were experienced in non-resorbable pins at 7 months follow-up, by contrast mesh uplift was noted 3 weeks post-procedure in the case treated using absorbable pins. CONCLUSIONS: The report demonstrates the innovative use of sonic-activated polymer pins (Bonewelding® technology) alongside titanium mesh is a suitable alternative technique for skull defect repair in dogs. The use of Bonewelding® may offer advantages in reduction of surgical time. Further, ultrasonic pin application may be less invasive than alternative metallic fixation and potentially reduces bone trauma. Polymer systems may offer enhanced mesh-bone integration when compared to traditional metallic implants. The use of polymer pins demonstrates initial potential as a fixation method in cranioplasty. Initial findings in a single case comparison indicate a possible advantage in the use of non-absorbable over the absorbable systems to circumvent complications associated with variable polymer degradation, further long term studies with higher patient numbers are required before reliable conclusions can be made.

Transmylohyoid orotracheal intubation in surgical management of canine maxillofacial fractures: an alternative to pharyngotomy endotracheal intubation.

OBJECTIVE: To describe the surgical technique of transmylohyoid orotracheal intubation in surgical management of maxillofacial fractures in dogs. STUDY DESIGN: Case series. ANIMALS: Dogs (n = 4) with maxillofacial fractures. METHODS: Transmylohyoid orotracheal intubation was used for airway management of dogs undergoing surgical repair of maxillofacial trauma. A stoma was surgically created by an incision through the skin, subcutaneous tissue, and mylohyoideus muscle immediately medial to the lingual cortex of the mandible at the level of the mandibular 1st molar tooth, so that an endotracheal tube could exit the oral cavity between the mandibular bodies bypassing the dentition. RESULTS: Transmylohyoid orotracheal intubation allowed excellent surgical visibility of the oral cavity and intraoperative control of occlusion during surgery. No complications were encountered during the procedure and the stoma healed without complication. CONCLUSIONS: Transmylohyoid orotracheal intubation is a safe, simple, and effective technique for bypassing the rostral oral cavity and dentition during surgical management of maxillofacial fractures.

Avian Skull Orthopedics.

Because the avian skull is the reflection of the wide biodiversity of birds, many anatomic, morphologic, and functional variations are encountered. The main objectives of this article are to review the surgical considerations associated with the functional anatomy of the avian jaw apparatus and its variation among species, and to describe the general medical and surgical management of head traumatic and developmental disorders in birds.

Feline head trauma: a CT analysis of skull fractures and their management in 75 cats.

OBJECTIVES: The aim of this study was to describe and evaluate the configurations and management of feline skull fractures and concurrent injuries following head trauma. METHODS: Medical records and CT images were reviewed for cats with skull fractures confirmed by CT that were managed conservatively or with surgery. Details of signalment, presentation, skull fracture configuration, management, re-examination, and complications or mortality were recorded and analysed. RESULTS: Seventy-five cats (53 males, 22 females) with a mean age of 4.8 ± 3 years met the inclusion criteria. Eighty-nine percent of cats had fractures in multiple bones of the skull, with the mandible, upper jaw (maxilla, incisive and nasal bones) and craniofacial regions most commonly affected. Temporomandibular joint injury occurred in 56% of cats. Road traffic accidents (RTAs) were the most common cause of skull fractures, occurring in 89% of cats, and caused fractures of multiple regions of the skull. RTAs were also associated with high levels of concurrent injuries, particularly ophthalmic, neurological and thoracic injuries. A more limited distribution of injuries was seen in non-RTA cats. Equal numbers of cats were managed conservatively or surgically (47%). Mortality rate was 8% and complications were reported in 22% of cats. Increasing age at presentation and presence of internal upper jaw fractures were risk factors for development of complications. No risk factors were identified for mortality. CONCLUSIONS AND RELEVANCE: RTAs were the most common cause of feline skull fractures and resulted in fractures in multiple regions of the skull and concurrent injuries occurred frequently. Problems with dental occlusion were uncommon post-treatment. An increased risk of implant loosening and malocclusion was seen with palatine and pterygoid bone fractures and hard palate injuries. This study provides useful additional information regarding feline skull fractures, concurrent injuries and management techniques following head trauma.

Management of equine skull fractures using fixation with polydioxanone sutures.

Ten horses presented with severe distortion of the facial contour, crepitus on palpation and mild to moderate epistaxis. Individual horses also showed ocular damage, ptosis, severe dyspnoea and movement of the facial bones concurrent with respiration. The fracture fragments were exposed using a large curvilinear incision and elevated using a retractor, periosteal elevator, chisel or Steinmann pin. The fracture fragments were unstable following reduction and fixation was necessary. Stabilisation was achieved with polydioxanone sutures placed through holes drilled in opposing sides of the fracture lines. Polydioxanone sutures provided good stability and had better handling properties than wire. There was good apposition of fracture edges and minimal complications. Use of polydioxanone sutures can also avoid the expense and complexity of plate fixation in selected cases, and should be considered as an alternative to fixation with stainless steel wire in any facial fracture that adjoins stable bone.

Interpreting radiographs 6: Radiology of the equine head (Part 2).

The value of radiology as part of an examination of the equine head is emphasised and the radiological appearances of more commonly occurring conditions are described. Even the normal anatomy of this complex site is subject to great variation and the aspiring radiologist should, therefore, have a good knowledge of the possible normal variations. A flexible approach must be used rather than a limitation to one or two ritual projections. The use of contrast media, wherever it might be useful, is advocated so that the maximum amount of information may be obtained from each examination. Finally, emphasis is laid on the fallibility of radiology when used in isolation and its use to complement other investigative procedures, such as endoscopy, is encouraged.

Cosmetic repair of a facial deformity by use of a silicone implant in a horse.

A heat-vulcanized silicone implant was used for cosmetic repair of a facial deformity in a horse. The deformity had resulted from fracture of the frontal bone into the frontal sinus 6 months earlier. Normal facial contour was restored by suturing the sculpted implant to the periosteum over the defect. Results 1 year after surgery were excellent.

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.

Skull trauma and mandibular fractures.

This article discusses the treatment of skull and mandibular fractures in small animals as well as fixation techniques, including interdental fixation, external skeletal fixation, intraoral splints, wiring, and pinning. Information is provided on the treatment of loose and damaged teeth in the fractured area. Management of temporomandibular joint luxation also is addressed.

Traumatic tympanic bulla fracture.

A Pekingese dog was presented for evaluation of head trauma with ventral head and neck swelling, puncture wounds, palpable mandibular fractures, and loss of menace, severe miosis, and loss of palpebral reflex of the right eye. Computed tomography confirmed multiple mandibular and zygomatic fractures, a right ear canal avulsion, and a complete right tympanic bulla fracture with ventral displacement. The tympanic bulla fracture was managed conservatively. Topical lubrication and antibiotic ointment was prescribed for the right eye. A subtotal hemimandibulectomy was performed to address the mandibular fractures. A temporary oesophagostomy feeding tube was placed. No short-term complications developed as a result of the fractured bulla and avulsed ear canal being left in situ, and no complications were reported 18 months after the injury. To the authors' knowledge this is the first report of a traumatic tympanic bulla fracture in the dog.

Head trauma in the cat: 1. assessment and management of craniofacial injury.

PRACTICAL RELEVANCE: Feline trauma is commonly seen in general practice and frequently involves damage to the head. CLINICAL CHALLENGES: While craniofacial injuries following trauma vary widely in severity, affected cats can often be severely compromised in terms of their neurological, respiratory and cardiovascular status, and their management can be challenging in both the short and long term. They need prompt stabilisation and careful monitoring in the initial period to maximise prospects of a successful outcome. Many cats with severe facial trauma will require surgery to stabilise skull fractures or address injuries to the eyes, with its inherent issues surrounding pain management, ensuring adequate nutrition and the necessity for ongoing hospitalisation. DIAGNOSTICS: Cats with head trauma benefit from imaging of the injured areas as well as thoracic radiography. Imaging the skull can be challenging and is best performed under general anaesthesia. In unstable patients this can be delayed to prevent any associated morbidity. EVIDENCE BASE: The clinical evidence base relating to injury to the feline head is limited, despite its relative frequency in general practice. This review focuses on the initial approach to craniofacial (in particular, ocular and jaw) trauma, and outlines simple techniques for management of soft tissue and bone injuries. Much of the information is based on the authors' clinical experience, as there is a paucity of well-described clinical case material.

Head trauma.

The equine head is especially prone to trauma from kicks, collisions, entrapments, and falls. The specialized structures of the equine head are important in both function and appearance. When injury causes either loss of function or cosmesis, timely treatment is paramount. This article discusses the occurrence and therapy of trauma to the equine head, including fractures of the mandible and premaxilla, facial bone, hyoid apparatus, and skull base.

Standing surgery and procedures of the head.

Although most surgical procedures of the head are technically easier to perform with the horse under general anesthesia, other factors will influence whether a surgical procedure is performed with the horse standing or recumbent under the influence of general anesthesia. The accessibility of the head lends itself to many standing surgical procedures if the proper combination of analgesia and physical and chemical restraint is used. Traumatic injuries of the head (lacerations, facial bone fractures, and oral fractures) may involve vital structures, and a thorough examination is indicated. Failure to treat a traumatic injury may result in facial deformity, bony sequestra, paranasal sinusitis, salivary-cutaneous fistula, cutaneous fistulas into a nasal passage or paranasal sinus, nasal septal deformities, and ocular dysfunction. Proper management of these injuries typically results in a cosmetic outcome because of the head's abundant blood supply. Other surgical procedures that can be performed in the standing horse include centesis and trephination of the paranasal sinuses, certain dental procedures, alar fold stabilization, and extirpation of epidermal inclusion cysts of the nasal diverticulum.