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Mandibular Fractures - Cat & Dog (view source)

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~~=Small Animals=~~

==Introduction==

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'''[[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'''.

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'''[[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==

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===Symphyseal Fractures===

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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.

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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===

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

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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.

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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''':

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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.

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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)''':

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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.

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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''':

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'''Bone plates''':

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

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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.

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

'''Hemimandibulectomy''':

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==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'''.

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~~=Large Animals=~~

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~~==Introduction==~~

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'''Mandibular fractures''' often occur when animals catch their '''lower jaw''' for example on ''' wire fencing''', '''the rings on the stable walls''' or under a '''manger'''. Normally the rostral mandible is '''avulsed''' as they try to free themselves by pulling backward. Fractures can also occur in the ramus of the mandible, however these are much less common.

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~~==Signalment==~~

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~~It is most common in '''young''' animals, particularly horses.~~

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~~==Clinical Signs==~~

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The horse usually presents with a history of '''inappetance'''. Clinical signs include '''dysphagia''', ''' halitosis''', '''salivation''', '''oral haemorrhage''', '''crepitus''', '''abnormal incisor occlusion''' and '''discharging-tracts'''.

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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.

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~~==Diagnosis==~~

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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.

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~~==Treatment==~~

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Initially, '''contamination''' of the site should be grossly '''removed''' and then '''lavaged''' with copious amounts of isotonic fluids. Then the fracture should be '''reduced''' and '''stabilised''' using '''wires''' looped around the incisors, which are then anchored either to the canines or to bilateral cortical screws located in the diastemal region. 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.

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~~==Prognosis==~~

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The prognosis is '''good'''. The excellent '''blood supply''' to the head, in particular the mandibular region, means that these fractures almost always '''heal quickly''' and '''without complications'''. there is usually '''acceptable cosmetic appearance''' despite being grossly contaminated. This can be compared to open contaminated fractures elsewhere in the body, which, unless they have small fragments that can be easily removed, carry a very guarded prognosis due to the high incidence of [[osteomyelitis]] at the fracture site.

{{Learning

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

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

}}

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=References=

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==References==

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''

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~~May, SA & McIlwraith, CW (1998) '''Equine Orthopaedics and Rheumatology Self-Assessment Colour Review''' ''Manson Publishing Ltd''~~

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

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~~Tremaine, H (1997) '''Dental care in horse''' ''In Practice 1997 19: 186-19''~~

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~~Tremaine, H (2004) '''Management of skull fractures in the horse''' ''In Practice 2004 26: 214-22''~~

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[[Category:Oral Diseases - ~~Horse~~]]

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[[Category:Oral Diseases - Dog]]

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[[Category:Musculoskeletal Diseases - ~~Horse~~]]

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[[Category:Musculoskeletal Diseases - Dog]]

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[[Category:Expert Review - ~~Horse~~]]

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[[Category:Expert Review - Snall Animal]]

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[[Category: ~~To Do~~ - ~~Siobhan Brade~~]]

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[[Category:Oral Diseases - Cat]]

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[[Category:~~To Do~~ - ~~Manson review~~]]

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[[Category:Musculoskeletal Diseases - Cat]]

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