Changes

==Introduction==

==Introduction==

===Imaging and Diagnosis ===

====Imaging and Diagnosis ====

[[File:Maxillofacial trauma CT.jpg|200px|right|thumb|CT image of a feline skull showing maxillary fracture]]

[[File:Maxillofacial trauma CT.jpg|200px|right|thumb|CT image of a feline skull showing maxillary fracture]]

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.  '  

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 ====

The treatment goals are: realignment to normal occlusion, minimal invasiveness, minimal morbidity, early return to self-feeding, and pain control. When dealing with facial fractures, the repair has to be stable but not necessarily rigid. The use of intramedullary pins, plates, and screws is cautioned against as it can easily result in tooth root damage. Pins, plates, and screws have further disadvantages: they are expensive and require specialized equipment and training. The upper jaw and the nasal cavity consist of thin bone plates that are very difficult to fix rigidly. Intraosseous wire fixation is limited but surgical techniques using special mini-plates have proven useful and enable good realignment of fractures.  

The treatment goals are:  

*Realignment to normal occlusion

*Minimal invasiveness

*Minimal morbidity

*Early return to self-feeding

*Pain control

 

When dealing with facial fractures, the repair has to be stable but not necessarily rigid. The use of intramedullary pins, plates, and screws is cautioned against as it can easily result in tooth root damage. Pins, plates, and screws have further disadvantages: they are expensive and require specialized equipment and training. The upper jaw and the nasal cavity consist of thin bone plates that are very difficult to fix rigidly. Intraosseous wire fixation is limited but surgical techniques using special mini-plates have proven useful and enable good realignment of fractures.  

==Specific Injuries==

==Specific Injuries==

===Maxillary and Temporomandibular Joint Injury===

====Maxillary and Temporomandibular Joint Injury====

Maxillary fractures are often more subtle to diagnose compared with [[Mandibular Fractures - Cat & Dog|mandibular fractures]] and may provide reasonable healing with conservative management only (pain management and soft food).  

Maxillary fractures are often more subtle to diagnose compared with [[Mandibular Fractures - Cat & Dog|mandibular fractures]] and may provide reasonable healing with conservative management only (pain management and soft food).  

Signs of maxillary trauma can include:  

Signs of maxillary trauma can include:  

* malocclusion of particular teeth or an entire arcade  

* Malocclusion of particular teeth or an entire arcade  

* traumatic oronasal communication

* Traumatic oronasal communication

* [[epistaxis]]

* [[Epistaxis]]

* swelling of the maxillary or nasal region

* Swelling of the maxillary or nasal region

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.  

</gallery></center>

</gallery></center>

===Midline Palatal Separation===

====Midline Palatal Separation====

Midline palatal separation is seen primarily in cats that have fallen from a height or been involved in a road traffic accident (RTA).

Midline palatal separation is seen primarily in cats that have fallen from a height or been involved in a road traffic accident (RTA).

</gallery></center>

</gallery></center>

===Palatine fractures===

====Palatine Fractures====

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.  

</gallery></center>

</gallery></center>

===Incisive Bone Fractures===

====Incisive Bone Fractures====

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.  

</gallery></center>

</gallery></center>

===Zygomatic Arch Fractures ===

====Zygomatic Arch Fractures ====

These are often associated with trauma to the eye and orbit. The fracture can result in displacement of the eye caudally or ventrally if the lateral support is lost or can result in exophthalmos if the bone fragments are displaced medially.  

These are often associated with trauma to the eye and orbit. The fracture can result in displacement of the eye caudally or ventrally if the lateral support is lost or can result in exophthalmos if the bone fragments are displaced medially.  

</gallery></center>

</gallery></center>

===Temporomandibular Joint Fractures ===

====Temporomandibular Joint Fractures ====

These are usually seen in combination with other maxillofacial injuries. Depending on the degree of displacement, the fracture may or may not result in a [[Dental Malocclusion|malocclusion]]. The fracture may involve the condylar process (of the mandible) and/or the mandibular fossa of the temporal bone of the maxilla.  

These are usually seen in combination with other maxillofacial injuries. Depending on the degree of displacement, the fracture may or may not result in a [[Dental Malocclusion|malocclusion]]. The fracture may involve the condylar process (of the mandible) and/or the mandibular fossa of the temporal bone of the maxilla.  

 

[[Category:Traumatic Dental Conditions]]

[[Category:Traumatic Dental Conditions]]

[[Category:Waltham reviewing]]

[[Category:Waltham reviewing]]