Difference between revisions of "Mandibular Fractures - Cat & Dog"
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==Introduction== | ==Introduction== | ||
| − | Mandibular fractures often occur when animals catch their lower jaw under a manger or through a ring on the stable wall or on wire fencing. In their panic they pull back and avulse the lower jaw. Fractures can also occur in the ramus of the mandible, however these are much less common. | + | '''Mandibular fractures''' often occur when animals catch their '''lower jaw''' under a '''manger''' or through a '''ring on the stable wall''' or '''on wire fencing'''. In their panic they pull back and '''avulse''' the lower jaw. Fractures can also occur in the ramus of the mandible, however these are much less common. |
==Signalment== | ==Signalment== | ||
| − | It is most common in young animals. | + | It is most common in '''young''' animals. |
==Clinical Signs== | ==Clinical Signs== | ||
| − | The horse usually presents with a history of inappetance. Clinical signs include dysphagia, halitosis, salivation, | + | The horse usually presents with a history of '''inappetance'''. Clinical signs include '''dysphagia''',''' halitosis''', '''salivation''', |
| − | oral haemorrhage, crepitus, abnormal incisor occlusion and discharging-tracts. The fracture can be visualised on oral exam; it is normally open and located in the rostral mandible, caudal to the incisor teeth (with or without involving the incisors). This avulsion fracture can be unilateral or bilateral. Soft tissue structures adjacent to the fracture may also be damaged. Care should be taken when using a gag as this may displace the fracture. | + | '''oral haemorrhage''', '''crepitus''', '''abnormal incisor occlusion''' and '''discharging-tracts'''. The fracture can be '''visualised''' on oral exam; it is normally '''open''' and located in the '''rostral mandible''', caudal to the incisor teeth (with or without involving the incisors). This avulsion fracture can be unilateral or bilateral. '''Soft tissue structures''' adjacent to the fracture may also be '''damaged'''. Care should be taken when using a gag as this may displace the fracture. |
==Diagnosis== | ==Diagnosis== | ||
| − | Diagnosis should be achievable from clinical signs alone, however radiography is a useful ancillary test - multiple views should be taken to show the extent and position of the fracture and also reveal any additional fracture that may be present. | + | Diagnosis should be achievable from '''clinical signs alone''', however '''radiography''' is a useful ancillary test - multiple views should be taken to show the extent and position of the fracture and also reveal any additional fracture that may be present. |
==Treatment== | ==Treatment== | ||
| − | Initially, contamination of the site should be grossly removed and then lavaged with copious amounts of isotonic fluids. Then the fracture can be reduced and stabilised on its oral (tension) side by means of wires placed around the incisors anchored either to the canines or to cortical screws placed in the diastemal region on each side. This should be performed under general anaesthesia. Due to the high level of contamination, antibiotic treatment is recommended. Implants should be removed if the fracture is stable after 6-12 weeks to avoid chronic infection. | + | Initially, '''contamination''' of the site should be grossly '''removed''' and then '''lavaged''' with copious amounts of isotonic fluids. Then the fracture can be '''reduced''' and '''stabilised''' on its oral (tension) side by means of '''wires''' placed around the incisors anchored either to the canines or to cortical screws placed in the diastemal region on each side. This should be performed under '''general anaesthesia'''. Due to the high level of contamination, '''antibiotic''' treatment is recommended. Implants should be removed if the fracture is stable after '''6-12 weeks''' to avoid chronic infection. |
==Prognosis== | ==Prognosis== | ||
| − | The prognosis is good. The superior blood supply to the mandibular region means that, despite gross contamination, these fractures virtually always heal quickly and without complications, with an acceptable cosmetic appearance. This can be compared to open contaminated fracture elsewhere in the body, which, unless they have small fragments that can be removed carry a very guarded, if not hopeless prognosis due to the high incidence of osteomyelitis of the fracture leading to failure of healing. | + | The prognosis is '''good'''. The superior '''blood supply''' to the mandibular region means that, despite gross contamination, these fractures virtually always '''heal quickly''' and '''without complications''', with an '''acceptable cosmetic appearance'''. This can be compared to open contaminated fracture elsewhere in the body, which, unless they have small fragments that can be removed carry a very guarded, if not hopeless prognosis due to the high incidence of osteomyelitis of the fracture leading to failure of healing. |
==References== | ==References== | ||
Revision as of 18:19, 27 July 2011
Introduction
Mandibular fractures often occur when animals catch their lower jaw under a manger or through a ring on the stable wall or on wire fencing. In their panic they pull back and avulse the lower jaw. Fractures can also occur in the ramus of the mandible, however these are much less common.
Signalment
It is most common in young animals.
Clinical Signs
The horse usually presents with a history of inappetance. Clinical signs include dysphagia, halitosis, salivation, oral haemorrhage, crepitus, abnormal incisor occlusion and discharging-tracts. The fracture can be visualised on oral exam; it is normally open and located in the rostral mandible, caudal to the incisor teeth (with or without involving the incisors). This avulsion fracture can be unilateral or bilateral. Soft tissue structures adjacent to the fracture may also be damaged. Care should be taken when using a gag as this may displace the fracture.
Diagnosis
Diagnosis should be achievable from clinical signs alone, however radiography is a useful ancillary test - multiple views should be taken to show the extent and position of the fracture and also reveal any additional fracture that may be present.
Treatment
Initially, contamination of the site should be grossly removed and then lavaged with copious amounts of isotonic fluids. Then the fracture can be reduced and stabilised on its oral (tension) side by means of wires placed around the incisors anchored either to the canines or to cortical screws placed in the diastemal region on each side. This should be performed under general anaesthesia. Due to the high level of contamination, antibiotic treatment is recommended. Implants should be removed if the fracture is stable after 6-12 weeks to avoid chronic infection.
Prognosis
The prognosis is good. The superior blood supply to the mandibular region means that, despite gross contamination, these fractures virtually always heal quickly and without complications, with an acceptable cosmetic appearance. This can be compared to open contaminated fracture elsewhere in the body, which, unless they have small fragments that can be removed carry a very guarded, if not hopeless prognosis due to the high incidence of osteomyelitis of the fracture leading to failure of healing.
References
RVC staff (2009) Urogenital system RVC Intergrated BVetMed Course, Royal Veterinary College
May, SA & McIlwraith, CW (1998) Equine Orthopaedics and Rheumatology Self-Assessment Colour Review Manson Publishing Ltd
Tremaine, H (1997) Dental care in horse In Practice 1997 19: 186-19
Tremaine, H (2004) Management of skull fractures in the horse In Practice 2004 26: 214-22