Location and distribution of craniomaxillofacial fractures in 45 cats presented for the treatment of head trauma.

OBJECTIVES: The aim of this retrospective study was to describe the location and distribution of craniomaxillofacial (CMF) fractures in 45 cats presented to a veterinary referral centre between 2012 and 2017. METHODS: Cats with a history of head trauma, one or more CMF fractures and a pretreatment CT scan of the CMF region were included in this study. For the purpose of the study, the CMF skeleton was divided into 15 functional anatomical regions and the fracture sites were allocated to one of these functional regions. Statistical analysis was performed using R. RESULTS: Skull fractures were evident in 80.0% of cats, and mandibular fractures in 86.7% of cats in this study. The median number of anatomical functional regions affected was eight and there was evidence of moderate or strong correlation between fractures of different regions of the mid-face. Where fractures were recorded in the nasopharynx and orbit they were bilateral in 93.5% and 89.7%, respectively. Twenty-six (57.8%) of the cats had fractures affecting one or both temporomandibular joints, which included fractures of the mandibular fossa, condylar neck and condyle. Twenty-nine cats (64.4%) had tooth fractures and seven cats (15.6%) had significant eye injuries. CONCLUSIONS AND RELEVANCE: Cats presenting with a single symphyseal separation or parasymphyseal fracture are very likely to have further fractures at other locations. Fractures in the nasopharynx, orbit, nose, upper jaw, intermaxillary suture and zygomatic arch regions (the 'mid-face') are likely to occur together. The pattern of distribution of mandibular fractures is not as predictable as that for maxillary fractures. CT imaging is required to achieve a complete diagnosis of the location and distribution of skull fractures in cats after head trauma.

Surgical repair of a severely comminuted maxillary fracture in a dog with a titanium locking plate system.

A four-year old male Labrador Retriever was admitted with head trauma after being hit by a car. The dog had sustained multiple nasal, maxillary, and frontal bone fractures that resulted in separation of the maxilla from the base of the skull. A severely comminuted left zygomatic arch fracture was also present. These fractures were all repaired using a point contact, locking titanium plate system, in a single procedure that resulted in excellent postoperative occlusion and immediate function. Healing was uneventful. Full function and excellent cosmetic appearance were evident 13 months after surgery. This case illustrates the ease of repair and the success of treatment of severely comminuted maxillofacial fractures by conforming to basic biomechanical principles taken directly from the human experience and successfully applied to the dog; these included multiple plate application along the buttresses and trusses of the facial skeleton. The plate fixation was applied to bridge the multiple fractures along the most appropriate lines of stress. The small size of the plates, and the ability to easily contour them to adapt to the bone surface in three-dimensions, allowed their placement in the most appropriate positions to achieve sufficient rigidity and lead to uncomplicated healing without any postoperative complications.

Prevalence and nature of dentoalveolar injuries among patients with maxillofacial fractures.

OBJECTIVE: Although not previously reported, experience suggests that dentoalveolar injury is -common among patients with maxillofacial fractures. The objective of this study was to evaluate and describe the prevalence and nature of dentoalveolar injuries in patients identified with maxillofacial fractures. METHODS: Medical records of 43 dogs and cats diagnosed with maxillofacial fractures between 2005 and 2012 were reviewed to identify patients with concurrent dentoalveolar injury. Medical records of patients with dentoalveolar injury were abstracted for the following information: signalment (including sex, age and skull type), mechanism of maxillofacial trauma, location and number of maxillofacial fractures, dentoalveolar injury type and location and the number of dentoalveolar injury per patient. Statistical evaluation was performed to determine associations between signalment, mechanism of trauma, location and number of maxillofacial fractures and the prevalence and nature of concurrent dentoalveolar injury. RESULTS: Dentoalveolar injuries are common among patients with maxillofacial trauma. Age and mechanism of trauma are significant predictors of the presence of dentoalveolar injuries in patients with maxillofacial trauma. CONCLUSIONS AND CLINICAL RELEVANCE: The findings of this study serve to encourage veterinarians to fully assess the oral cavity in patients with maxillofacial fractures as dentoalveolar injuries are common and can be predicted by age and mechanism of trauma.

[Computed tomography in cats with craniofacial trauma with regard to maxillary and orbital fractures]. / Computertomographische Untersuchung des Schädels von Katzen mit kraniofazialem Trauma im Hinblick auf Maxilla- und Orbitafrakturen.

OBJECTIVE: Computed tomographic examination of the skull of cats with craniofacial trauma. Analysis of diagnostic findings with regard to the occurrence of isolated and combined maxillary and orbital fractures. MATERIAL AND METHODS: Prospective study (August 2006 - June 2010): Computed tomography (CT) of the skull of cats with craniofacial trauma. RESULTS: Thirty-eight cats met the inclusion criteria. Breeds were 36 Domestic Shorthair cats, one Maine Coon and one Somali cat. Age at admission ranged from 11 to 187 months. The ratio of the numbers of males to females was 22:16 (1.4). Computed tomographic examination revealed a maxillary fracture in 27 (71%) animals. Sixteen (42%) cats had multiple maxillary fractures (≥2). Twenty-eight animals (74%) displayed orbital fractures. Combined maxillary and orbital fractures occurred in 26 (68%) patients. The odds ratio of this combined occurrence was 87 (p<0.001). Sixteen (57%) of 28 cats with orbital fractures showed multiple orbital fractures (≥2). The incidence of bilateral orbital fractures was 67% (25 patients). The medial orbital wall was the most commonly fractured orbital wall (66%), and the orbital floor the second most common (61%). CONCLUSION: Computed tomographic examination of the skull of cats with craniofacial trauma showed that maxillary and orbital fractures are more common than previously described. Combined maxillary and orbital fractures occurred in more than half of the patients. In cats, orbital fractures mainly affect the medial orbital wall and the orbital floor. CLINICAL RELEVANCE: Cats with craniofacial trauma often have maxillary and orbital fractures. The additional information taken from the computed tomographic examination could lead to an optimised therapeutical concept.

Use of an osteoconductive compound as an aid in the management of a maxillary fracture in a boa constrictor.

A boa constrictor was presented with a short oblique compound fracture of the rostral third of the right maxilla. The fracture was reduced and biomaterial was placed around the fracture. A computed tomography scan at 1.5 mo post-surgery showed that the fracture had healed with slight displacement of the bone fragments.

Bilateral iatrogenic [corrected] maxillary fractures after dental treatment in two aged horses.

This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fractures during or after routine dental treatment are rare, but can occur, especially in older horses. Appropriate sedation and, if necessary, regional nerve blocks might reduce the risk of iatrogenic fractures of the maxilla. General anesthesia must be considered for tooth extraction in horses that are difficult to restrain.

Complications of equine oral surgery.

The vast majority of equine oral procedures are dental-related and, unless great care is taken, almost all such procedures have the potential to cause marked short- or long-term damage to other oral structures. This review of the more common complications of oral surgery begins at the rostral oral cavity with procedures of the incisors, and then moves caudally to deal with complications related to procedures of wolf teeth and cheek teeth, including salivary duct disruption and dental sinusitis. Finally, complications associated with maxillary and mandibular fractures are discussed.