Transmylohyoid Orotracheal Intubation in Surgical Management of Canine Maxillofacial Fractures: An Alternative to Pharyngotomy Endotracheal Intubation

Mandibular fracture repair techniques in cats: a dentist's perspective

PRACTICAL RELEVANCE

Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular fracture repair will facilitate evidence-based decision-making in clinical practice.

CLINICAL CHALLENGES

Feline maxillofacial and oral anatomy brings unique challenges in comparison with dogs. It has been commonplace to adapt techniques and equipment that are better suited to other body regions or are species-inappropriate for use in feline maxillofacial surgery, and this has traditionally resulted in high morbidity.

AIMS

This review presents an overview of the diagnosis of, and decison-making for, maxillofacial trauma in cats, specifically with reference to the feline mandible. The challenges associated with the management of these injuries are presented. Techniques for repair that can be employed in general practice, as well as more advanced surgical options, are discussed, as well as the indications for invasive vs non-invasive management. Underutilised methods involving composite dental materials and their versatility for the repair of mandibular fractures in cats, and miniplates for caudal mandibular fractures in cats, are specifically covered, as well as other recent advances in the field, including three-dimensional printing and custom-printed implants.

EVIDENCE BASE

Management of feline facial fractures is an often neglected topic, with very few published studies choosing to focus on head trauma outcomes in cats. Where available, however, this review draws on the published literature, as well as the authors' own clinical experience.

Patient Triage, First Aid Care, and Management of Oral and Maxillofacial Trauma

Maxillofacial trauma is a common presentation in veterinary medical practice. Accurate assessment, diagnostics, pain management, and finally repair are tenants to treatment. In addition to typical tenants for fracture repair, the restoration of occlusion and return to function (eating, drinking, grooming) are unique to trauma management in these patients. Options for repair include conservative management (tape muzzles), noninvasive repair techniques (interdental wiring and composite splinting), and invasive repair techniques (interfragmentary wiring and plate and screw fixation).

Repair of Bilateral Comminuted Mandibular Fractures in a 12-Week-Old Puppy Using Locking and Nonlocking Maxillofacial Reconstruction Plates

A 12-week-old male intact French bulldog presented to a university teaching hospital for bilateral comminuted caudal mandibular fractures following an altercation with another dog. The fractures were stabilized using locking and standard maxillofacial miniplates. The 8-week and 14-week postoperative reexaminations and radiographs revealed eventual bony healing and remodeling of both mandibular rami, but multiple complications associated with the miniplates were encountered. These included intraoral wound dehiscence, implant fracture, implant loosening, sequestrum formation, and an impacted right mandibular fourth premolar. Implant failure on the alveolar border in this case report was associated with the resorption and new bone deposition of the rostral/caudal ramus, respectively, associated with mandibular growth. An alternate surgical option would have been use of a longer, larger bridging plate placed on the ventral border without use of a dorsal plate to minimize these complications.

Modified Labial Button Technique for Maintaining Occlusion After Caudal Mandibular Fracture/Temporomandibular Joint Luxation in the Cat

Maxillofacial trauma in cats often results in mandibular symphyseal separation in addition to injuries of the caudal mandible and/or temporomandibular joint (TMJ). Caudal mandibular and TMJ injuries are difficult to access and stabilize using direct fixation techniques, thus indirect fixation is commonly employed. The immediate goals of fixation include stabilization for return to normal occlusion and function with the long-term objective of bony union. Indirect fixation techniques commonly used for stabilization of caudal mandibular and temporomandibular joint fracture/luxation include maxillomandibular fixation (MMF) with acrylic composite, interarcade wiring, tape muzzles, and the bignathic encircling and retaining device (BEARD) technique. This article introduces a modification of the previously described “labial reverse suture through buttons” technique used by Koestlin et al and the “labial locking with buttons” technique by Rocha et al. In cases with minimally displaced subcondylar and pericondylar fractures without joint involvement, the labial button technique can provide sufficient stabilization for healing. Advantages of the modified labial button technique include ease of application, noninvasive nature, and use of readily available materials. The construct can remain in place for a variable of amount of time, depending on its intended purpose. It serves as an alternative to the tape muzzle, which is rarely tolerated by cats. This technique can be easily used in conjunction with other maxillomandibular repairs, such as cerclage wire fixation of mandibular symphyseal separation. The purpose of this article is to demonstrate a modified labial button technique for maintaining occlusion of feline caudal mandibular fractures/TMJ luxations in a step-by-step fashion.