ISSN 2398-2977      

Mandible / maxilla: fracture - repair

pequis

Synonym(s): Incisive fracture repair


Introduction

  • Common fracture Mandible / maxilla: fracture.
  • Thre are many different types and configurations of fractures in this region:
    • Not all fractures will need surgical repair.
    • Unilateral fractures of the mandible, maxilla, premaxilla and incisor bone, that are minimally displaced with no malocclusion, can be treated conservatively.
  • Indications for repair include fractures that are unstable, result in malocclusion or are bilateral.
  • Surgical repair decreases callus formation thereby improving the cosmetic appearance, improves the rate of healing, and stabilizes the fracture → rapidly decreased pain and quicker return to a normal appetite.
  • Good soft tissue covering and a good blood supply aid healing.
  • Surgical repair usually does not need to be done as an emergency.
  • The tension side of the upper and lower jaw is the oral surface and this determines where the implants should ideally be placed. Unilateral fractures, particularly of the mandible, have the advantage of support from the opposite intact side, which increases their stability.
  • Intra-oral wiring is the easiest technique and the most commonly used for simple fractures.
  • Can be repaired under GA Anesthesia: general - overview or standing Anesthesia: standing chemical restraint.

Uses

Intra-oral splints should be made before surgery, usually on a cadaver of similar body size.

Advantages

  • Intra-oral wiring: relatively simple procedure Mandible: fracture 01 - incisiveMandible: fracture 02 - incisive repair with wire.
  • Wiring pattern can be adapted to almost any fracture configuration.
  • Bone is not under loading forces of the same magnitude sustained by limb fracture repair so less force on implants.
  • Fractures heal well, even in spite of contamination.

Disadvantages

  • Intra-oral wires may not be suitable for more complex or caudal fractures.
  • Intra-oral wires can be broken by the horse.

If the horse rubs the wire twists, the twists can be placed on the lingual side of the incisors although this is technically more difficult.

  • Screw holes can easily be stripped as the bone is soft.
  • Plate application can be difficult because the tooth roots must be avoided by screws.
  • External fixators are prone to becoming trapped, eg in water bucket.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good: in fractures of the incisive alveoli, incisive body, the symphysis or interdental space, the frontal, nasal and maxillary bones.
  • Good to guarded: in horizontal and mandibular rami, and the angle of the mandible.
  • Poor to guarded: in fractures of the temporomandibular joint.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Caldwell F J & Davis H A (2012) Surgical reconstruction of a severely comminuted mandibular fracture in a horse. Equine Vet Educ 24 (5), 217-221 VetMedResource.
  • Kuemmerle J M (2012) Mandibular fractures in horses. Equine Vet Educ 24 (5), 222-224 WileyOnline.
  • Ramzan P H L (2008) Management of rostral mandibular fractures in the young horse. Equine Vet Educ 20 (2), 107-112 VetMedResource.
  • Belsito K A & Fischer A T (2001) External skeletal fixation in the management of equine mandibular fractures - 16 cases (1988-1998). Equine Vet J 33 (2), 176-183 PubMed.
  • Henninger R W, Beard W L, Schneider R K, Bramlage L R & Burkhardt H A (1999) Fractures of the rostral portion of the mandible and maxilla in horses: 89 cases (1979-1997). J Am Vet Med Assoc 214 (11), 1648-1652 PubMed.

Other sources of information

  • Furst A E & Auer J A (2019) Fractures of the Head in Equine Fracture Repair. 2nd edn. Ed: Nixon A J. Wiley Blackwell, USA.
  • Furst A E & Auer J A (2018) Craniomaxillofacial Disorders in Equine Surgery. 5th edn. Eds: Auer J A & Stick J A. Elsevier Saunders, USA.

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