Changes

===Imaging and Diagnosis ===

===Imaging and Diagnosis ===

Lateral and DV skull radiographs together with [[Intra-Oral Radiography - Small Animal|intra-oral dental radiographs]] facilitate the diagnosis of maxillofacial injuries. Lateral and DV skull radiographs alone result in too much bony superimposition of structures. Dental radiographs are also higher definition images showing subtle changes.  

Lateral and DV skull radiographs together with [[Intra-Oral Radiography - Small Animal|intra-oral dental radiographs]] facilitate the diagnosis of maxillofacial injuries. Lateral and DV skull radiographs alone result in too much bony superimposition of structures. Dental radiographs are also higher definition images showing subtle changes.  

CT scans demonstrated 2.0 times more maxillofacial injuries in cats compared with conventional radiographs. The average number of maxillofacial injuries per animal by radiographs and CT-scan was 3.8 and 7.7 in cats, respectively. CT allows for accurate assessment, diagnosis and treatment planning of maxillofacial trauma in cats however is not always available at the time of injury or may not be possible due to financial constraints.  '''Fig1'''  

CT scans demonstrated 2.0 times more maxillofacial injuries in cats compared with conventional radiographs. The average number of maxillofacial injuries per animal by radiographs and CT-scan was 3.8 and 7.7 in cats, respectively. CT allows for accurate assessment, diagnosis and treatment planning of maxillofacial trauma in cats however is not always available at the time of injury or may not be possible due to financial constraints.  '  

===Treatment ===

===Treatment ===

Signs of maxillary trauma can include:  

Signs of maxillary trauma can include:  

* malocclusion of particular teeth or an entire arcade '''(fig2)'''

* malocclusion of particular teeth or an entire arcade  

* traumatic oronasal communication

* traumatic oronasal communication

* [[epistaxis]]

* [[epistaxis]]

Patients suffering documented maxillary injuries should also be evaluated for changes in ocular position and movement as this is indicative of traumatic injury involving the extra-ocular muscles or insertion locations on the orbital rim.  

Patients suffering documented maxillary injuries should also be evaluated for changes in ocular position and movement as this is indicative of traumatic injury involving the extra-ocular muscles or insertion locations on the orbital rim.  

===Midline Palatal Separation===

===Midline Palatal Separation===

Treatment consisting of suturing the mucosa is usually adequate for relatively stable bone fractures. Debride wound edges and place [[Suture Patterns|simple interrupted sutures]]. Rarely do these need advanced flap techniques to close the separation. Use monofilament absorbable [[Suture Materials|suture material]] (not PDS as this is too stiff).

Treatment consisting of suturing the mucosa is usually adequate for relatively stable bone fractures. Debride wound edges and place [[Suture Patterns|simple interrupted sutures]]. Rarely do these need advanced flap techniques to close the separation. Use monofilament absorbable [[Suture Materials|suture material]] (not PDS as this is too stiff).

===Palatine fractures===

===Palatine fractures===

  '''fig 5'''

  '''fig 5'''

Unstable fragments from maxillary and palatine shelf fractures result in a malocclusion due to a shifting of the maxillary arcade. Osteosynthesis using cerclage wire and/or a transfixation pin or reconstruction of the dental arch using locking bone plate and screw systems is recommended. Intra-oral splints made from acrylic can be used to stabilize fractures if the displacement is not too severe.  

Unstable fragments from maxillary and palatine shelf fractures result in a malocclusion due to a shifting of the maxillary arcade. Osteosynthesis using cerclage wire and/or a transfixation pin or reconstruction of the dental arch using locking bone plate and screw systems is recommended. Intra-oral splints made from acrylic can be used to stabilize fractures if the displacement is not too severe.  

===Incisive Bone Fractures===

===Incisive Bone Fractures===

  '''fig6'''

  '''fig6'''

These fractures are usually minimally displaced and can be repaired using cerclage wire and acrylic splint quite successfully.  

These fractures are usually minimally displaced and can be repaired using cerclage wire and acrylic splint quite successfully.  

===Zygomatic Arch Fractures ===

===Zygomatic Arch Fractures ===

Conservative management of the fracture is usually recommended. If internal fixation is necessary, extreme caution should be exercised to avoid damage to the [[Cranial Nerves - Anatomy & Physiology#Facial nerve (VII)|facial nerve]] or maxillary artery (in caudal fractures).  

Conservative management of the fracture is usually recommended. If internal fixation is necessary, extreme caution should be exercised to avoid damage to the [[Cranial Nerves - Anatomy & Physiology#Facial nerve (VII)|facial nerve]] or maxillary artery (in caudal fractures).  

===Temporomandibular Joint Fractures ===

===Temporomandibular Joint Fractures ===

If the articular surface of the joint is involved, then a condylectomy is recommended. If not, maxillomandibular fixation is usually adequate. In some cases a muzzle may suffice.  

If the articular surface of the joint is involved, then a condylectomy is recommended. If not, maxillomandibular fixation is usually adequate. In some cases a muzzle may suffice.  

Restoration of the alignment of the maxillary and mandibular canine teeth and application of maxillomandibular fixation in a partial open mouth position is reasonably well accepted by most patients. Use of repair techniques such as this provides the benefits of a less invasive repair technique, no disruption of the fracture hematoma, and reduced risk of damaging the blood supply to nearby teeth.  '''Fig10'''

Restoration of the alignment of the maxillary and mandibular canine teeth and application of maxillomandibular fixation in a partial open mouth position is reasonably well accepted by most patients. Use of repair techniques such as this provides the benefits of a less invasive repair technique, no disruption of the fracture hematoma, and reduced risk of damaging the blood supply to nearby teeth.  '''Fig10'''

==Further Reading ==

==Further Reading ==