Changes

==Introduction==

==Introduction==

'''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 and free themselves by pulling backward. 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''' 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.

==Signalment==

==Signalment==

It is most common in '''young''' animals.

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

==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'''.  

'''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.

 

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==

==Treatment==

==Treatment==

Initially, '''contamination''' of the site should be grossly '''removed''' and then '''lavaged''' with copious amounts of isotonic fluids. Then the fracture should then be 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.

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.

==Prognosis==

==Prognosis==

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''', with an '''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.

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.

 

==References==

==References==

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

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

[[Category: To Do - Siobhan Brade]]

 

[[Category:To Do - Manson review]]

[[Category:Musculoskeletal Diseases - Horse]]

[[Category:Expert Review - Horse]]