Changes

==Introduction==

==Introduction==

'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular fractures]]''' are commonly seen in dogs and cats. With cats they often part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease, metabolic disease and neoplasia'''.

'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease, metabolic disease and neoplasia'''.

==Signalment==

==Signalment==

===Symphyseal Fractures===

===Symphyseal Fractures===

Symphyseal fractures are repaired using '''circumferential wire'''. An skin incision should be made in the ventral mandible at the level of the mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliars'''. The wire is then cut short and places flush with the skin. The skin incision closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.  

Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible at the level of the mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and places flush with the skin. The skin incision closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.  

===Mandibular Body Fractures===

===Mandibular Body Fractures===

   

   

'''Interarcade canine acrylic bonding (ICAB)''':

'''Interarcade canine acrylic bonding (ICAB)''':

This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. t is a fairly simple, cheap and effective method.  

This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method.  

'''Tape muzzle''':

'''Tape muzzle''':

A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. It cannot be used in cats, brachycephalic dogs and not compliant patients.  

A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. It cannot be used in cats, brachycephalic dogs and non-compliant patients.  

'''Interdental wire and acrylic bonding (IWAB)''':

'''Interdental wire and acrylic bonding (IWAB)''':

This method cannot be used in cats but is a effective and cheap technique for use in the dog. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.  

This method cannot be used in cats but is an effective and cheap technique for use in the dog. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.  

'''Interfragmentary wiring''':

'''Interfragmentary wiring''':

'''Bone plates''':

'''Bone plates''':

Bone plates cane be placed at the junction of the body and ramus of the mandible, at the ventral border of the

Bone plates cane be placed at the junction of the body and ramus of the mandible, at the ventral border of the mandibular body and the mid-buccal surface of the mandible.

mandibular body and the mid-buccal surface of the mandible.

'''Hemimandibulectomy''':

'''Hemimandibulectomy''':

==Prognosis==

==Prognosis==

The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.  

The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.  

{{Learning

{{Learning

|flashcards = [[Equine Orthopaedics and Rheumatology Q&A 03]]<br>[[Small Animal Orthopaedics Q&A 03]]

|flashcards = [[Small Animal Orthopaedics Q&A 03]]

}}

}}

=References=

==References==

Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{review}}

[[Category:Oral Diseases - Horse]]

[[Category:Oral Diseases - Dog]]

[[Category:Musculoskeletal Diseases - Horse]]

[[Category:Musculoskeletal Diseases - Dog]]

[[Category:Expert Review - Horse]]

[[Category:Expert Review - Snall Animal]]

[[Category: To Do - Siobhan Brade]]

[[Category:Oral Diseases - Cat]]

[[Category:To Do - Manson review]]

[[Category:Musculoskeletal Diseases - Cat]]