Maxillofacial Trauma - Revision history

Bara at 14:05, 2 November 2014

2014-11-02T14:05:21Z

Bara at 10:53, 30 October 2014

2014-10-30T10:53:13Z

Ggaitskell at 09:08, 22 October 2014

2014-10-22T09:08:22Z

Ggaitskell: /* Further Reading */

2014-10-22T09:00:46Z

Bara: /* Further Reading */

2014-10-21T17:09:29Z

Bara: /* Further Reading */

2014-10-21T17:08:42Z

Bara: /* Temporomandibular Joint Fractures */

2014-10-21T17:08:13Z

Temporomandibular Joint Fractures

Bara: /* Temporomandibular Joint Fractures */

2014-10-21T17:06:59Z

Temporomandibular Joint Fractures

Bara: /* Temporomandibular Joint Fractures */

2014-09-10T16:52:53Z

Temporomandibular Joint Fractures

Bara at 16:04, 10 September 2014

2014-09-10T16:04:55Z

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 ==Introduction==
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 {{Waltham}}
+{{OpenPages}}
 [[Category:Traumatic Dental Conditions]]
 [[Category:Waltham reviewed]]

← Older revision		Revision as of 10:53, 30 October 2014
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		+	{{Lisa Milella written
		+	\|date = 22 October 2014}}
		+
		+	{{Waltham}}



	[[Category:Traumatic Dental Conditions]]		[[Category:Traumatic Dental Conditions]]
−	[[Category:Waltham ~~reviewing~~]]	+	[[Category:Waltham reviewed]]

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 ==Introduction==
-===Imaging and Diagnosis ===
+====Imaging and Diagnosis ====
 [[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.
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 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:
 ==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).
 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.
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 </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).
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 </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.
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 </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.
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 </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.
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 </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.
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-[[Category:To Do - Dentistry preMars]]
 [[Category:Traumatic Dental Conditions]]
 [[Category:Waltham reviewing]]

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 ==Further Reading ==
-:The Diagnostic Yield of Conventional Radiographs and Computed Tomography in Dogs and Cats with Maxillofacial Trauma, Bar-am et al Y, Veterinary Surgery, Volume 37, Issue 3, pages 294–299, April 2008
+*The Diagnostic Yield of Conventional Radiographs and Computed Tomography in Dogs and Cats with Maxillofacial Trauma, Bar-am et al Y, Veterinary Surgery, Volume 37, Issue 3, pages 294–299, April 2008
-:Dental Composite for the Fixation of Mandibular Fractures and Luxations in 11 Cats and 6 Dogs, Bennet J et al, Veterinary Surgery, Volume 23, issue 3, pages 190-194, May 1994
+*Dental Composite for the Fixation of Mandibular Fractures and Luxations in 11 Cats and 6 Dogs, Bennet J et al, Veterinary Surgery, Volume 23, issue 3, pages 190-194, May 1994
-:Horner's syndrome associated with a mandibular symphyseal fracture and bilateral temporomandibular luxation, Baines S, Journal of Small Animal Practice, Vol 42, issue 12, pages 607-610, Dec 2001
+*Horner's syndrome associated with a mandibular symphyseal fracture and bilateral temporomandibular luxation, Baines S, Journal of Small Animal Practice, Vol 42, issue 12, pages 607-610, Dec 2001
-:Verstraete FJ & Lommer M, ed, Oral and Maxillofacial Surgery in Dogs and Cats. Edinburgh, UK : Saunders Elsevier, 2012, p363-372
+*Verstraete FJ & Lommer M, ed, Oral and Maxillofacial Surgery in Dogs and Cats. Edinburgh, UK : Saunders Elsevier, 2012, p363-372

← Older revision		Revision as of 17:09, 21 October 2014
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	[[Category:To Do - Dentistry preMars]]		[[Category:To Do - Dentistry preMars]]
	[[Category:Traumatic Dental Conditions]]		[[Category:Traumatic Dental Conditions]]
		+	[[Category:Waltham reviewing]]

← Older revision		Revision as of 17:08, 21 October 2014
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	[[Category:To Do - Dentistry preMars]]		[[Category:To Do - Dentistry preMars]]
	[[Category:Traumatic Dental Conditions]]		[[Category:Traumatic Dental Conditions]]
−	~~[[Category:To Do - Dentistry Images]]~~

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 ===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. <font color="red">'''(fig9)'''</font color>
+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.
 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.
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 <center><gallery widths=250px heights=180px mode="traditional">
 File:Temporomandibular joint fracture radiograph.jpg|Mandibular fossa fracture
 File:Maxillomandibular fixation 1.jpg|Maxillomandibular fixation
 File:Maxillomandibular fixation 2.jpg|Maxillomandibular fixation

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 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.
 <center><gallery widths=250px heights=180px mode="traditional">