Oral and maxillofacial surgery in dogs and cats.

Advancements in diagnostic and treatment modalities for oral and maxillofacial surgery have allowed veterinarians to offer clients a range of alternatives for their pets. Categories of oral and maxillofacial surgery reviewed in this article include jaw fracture management, management of palatal/oronasal defects, recognition and treatment of oral masses, and management of several miscellaneous pathologic conditions. Miscellaneous oral lesions discussed in this article include odontogenic cysts, osteonecrosis and osteomyelitis, and lesions of the tongue and lips.

Fraturas odontomaxilares e mandibulares em eqüídeos tratados por diferentes técnicas de osteossíntese / Odontomaxillares and mandibularies fractures in equides treated with different osteosynthesis techniques

Oito eqüinos e um muar com fraturas odontomaxilares e mandibulares foram tratados com diferentes técnicas de osteossíntese modificadas, consistindo de cerclagens associadas ou não a bandas de tensão, placa de neutralização e pino intraosseo, sendo este aplicado com metodologia não encontrada na literatura consultada. Os procedimentos cirúrgicos nos eqüideos foram realizados com os animais em estação mediante contenção física, em brete, e química, com sedação ou neuroleptoanalgesia associada a bloqueios anestésicos regionais. Os animais apresentaram capacidade de mastigação e ingestão voluntária no pós-operatório imediato e recuperação óssea adequada.

Eight equines and one mule with odontomaxillaries and mandibularies fractures were treated with different osteosynthesis modified techniques, consisting of cerclages with or without tension bands, neutralization plates, and intraosseous pin applied by a methodology which was not found in the literature. The surgery procedures in equides were performed with the animals in stand position under physical contention, sedation, or neuroleptoanalgesy and regional nerve block. All animals were able to eat voluntarily in the immediate post-operatory time and had good bone recuperation.

Maxillofacial fracture repairs.

Oral trauma remains a common presentation in a small animal practice. Most fractures are the result of vehicular accidents. Among other causes are falls, kicks, gunshots wounds, and encounters with various hard objects ranging from baseball bats and golf clubs to horse hooves and car doors. Next in popularity are dog fights, especially when a large dog and a small dog are involved, and fights with other animals. With cats, falls from various heights are responsible for a large percentage of presentations.

Hemisection and partial retention of carnassial teeth in client-owned dogs.

Nine client-owned dogs presented with periodontally and/or endodontically involved mandibular or maxillary carnassial teeth that were either individually affected or adjacent to a jaw fracture. A total of 10 teeth were hemisected (8 mandibular first molar teeth and 2 maxillary fourth premolar teeth), and one crown-root segment was extracted for each tooth. Gingival tissues were approximated and sutured over the extraction sites, and the retained tooth portions were treated by means of standard root canal therapy or vital pulp therapy followed by standard root canal therapy. Retained crown-root segments of 2 of the 10 hemisected teeth were extracted following short- and long-term postoperative examinations due to continued periodontal complications. It was concluded that resection of a portion of a tooth can be a useful treatment for periodontally and/or endodontically involved carnassial teeth that are affected individually or located adjacent to a jaw fracture in dogs.

Intraoral acrylic splints for maxillofacial fracture repair.

Maxillofacial fractures in dogs and cats occur secondary to vehicular trauma, falls, kicks, gunshots, and fights with other animals. Pathologic mandibular fracture may occur secondary to periodontal disease, neoplasia, and metabolic diseases. The primary objective for repair of maxillofacial fractures in small animals is return to normal function. Therefore, it is necessary to maintain occlusal alignment while providing adequate stability for bony union. Basic principles of maxillofacial fracture repair include anatomic reduction and restoration of occlusion, application of a stable fixation to neutralize negative forces on the fracture, gentle handling of soft tissues, avoidance of iatrogenic dental trauma, extraction of diseased teeth within the fracture line, and minimizing excessive soft tissue elevation. This review article will describe the application of intraoral acrylic splints for maxillofacial fracture repair.

Maxillofacial surgery.

Maxillofacial surgery in dogs includes the management of jaw fractures various palatal surgical procedures, the management of oral tumors, and the surgical management of miscellaneous maxillofacial problems. Miscellaneous maxillofacial problems that may require surgical intervention include dentigenous cysts, bone sequestra or osteomyelitis, and an inability to open or close the month. Careful perioperative planning of maxillofacial surgical procedures will help ensure a successful outcome.

Traumatic dental disease and soft tissue injuries of the oral cavity.

Trauma to the oral cavity can result in an array of injuries affecting teeth, bone, and soft tissue. A thorough examination of the oral cavity is often facilitated by employing a full-mouth speculum after the horse has been tranquilized. Identification of broken, loose, or split teeth; fractures of the premaxilla or mandible; and avulsion or laceration of soft tissue structures such as the lips or tongue is usually straightforward. Treatment options vary depending on the structure involved; however, appropriate treatment generally results in a functional and cosmetically acceptable end result.

Dental sepsis.

Dental sepsis or periapical abscess formation constitutes a large percentage of dental conditions that afflict horses. Dental sepsis occurs when the pulp chamber of the tooth is exposed to the oral cavity or external environment, allowing bacterial localization with resulting infection. Although acute, primary, septic pulpitis in horses is rare, dental sepsis often results from colonization of the pulp chamber with pathogenic bacteria secondary to maleruption or impaction of teeth with secondary alveolar bone lysis, primary fractures of the tooth, mandible, or maxilla, periodontal disease, or infundibular necrosis. The sequela to pulpal infection are extensions into the periradicular tissues and mandibular or maxillary periapical abscess formation.

[Lip closure with buttons--a simple method for immobilization of temporomandibular joint injuries in the cat]. / Lippenverschluss mit Knöpfen--eine einfache Methode zur Immobilisierung von kiefergelenk(nahen) Verletzungen bei der Katze.

Injuries to the lower jaw in cats occur frequently in the area of the temporomandibular joint. In most of these cases, successful treatment necessitates a temporary surgical occlusion of the jaw. After a brief survey of various occlusion methods, a simple technique is opted for in which labial reverse sutures of non-absorbable material are threaded through buttons. This is the preferred method of treatment employed by the University of Munich Department of Animal Surgery. During the past ten years, 107 cats were treated using this method. It was possible to check the healing process via clinical and radiological examinations in 72 of these patients. In a further 21 cases, information was obtained through questioning the owners. The collected data revealed that the method described above, which originally had been intended to temporarily occlude the jaw in polytraumatized cats, has proven to be an effective final therapy in most cases. Of the total of 93 patients with a known case history, 81 cats (87%) showed no need for rigid fixation. Over all, 94% of treated patients were free of discomfort, while 68% of the fractures and luxations radiographically reevaluated had healed anatomically.

Treatment of jaw fractures in small animals with parapulpar pin composite bridges.

This article describes a 5-year study of 73 cats that were surgically treated for mandibular fractures or combinations of fractures with luxation of the temporomandibular joint. Surgical technique and results are described in detail.

Standing surgery and procedures of the head.

Although most surgical procedures of the head are technically easier to perform with the horse under general anesthesia, other factors will influence whether a surgical procedure is performed with the horse standing or recumbent under the influence of general anesthesia. The accessibility of the head lends itself to many standing surgical procedures if the proper combination of analgesia and physical and chemical restraint is used. Traumatic injuries of the head (lacerations, facial bone fractures, and oral fractures) may involve vital structures, and a thorough examination is indicated. Failure to treat a traumatic injury may result in facial deformity, bony sequestra, paranasal sinusitis, salivary-cutaneous fistula, cutaneous fistulas into a nasal passage or paranasal sinus, nasal septal deformities, and ocular dysfunction. Proper management of these injuries typically results in a cosmetic outcome because of the head's abundant blood supply. Other surgical procedures that can be performed in the standing horse include centesis and trephination of the paranasal sinuses, certain dental procedures, alar fold stabilization, and extirpation of epidermal inclusion cysts of the nasal diverticulum.

Problems associated with the management and treatment of jaw fractures.

Fractures of the mandible and maxilla occur frequently in the dog and cat. Appropriate preoperative, intraoperative, and postoperative management of jaw fractures is imperative for successful results. Various techniques of jaw fracture management, including tape muzzles, circumferential wiring, interarcade wiring, interosseous wiring, interdental wiring, acrylic splints, percutaneous skeletal fixation, intramedullary pinning, bone plating, and partial mandibulectomy, have unique advantages and disadvantages. Selection of the appropriate method of fixation depends on the signalment of the animal, type of fracture, and the veterinarian's experience and expertise with the various types of fixation. Careful postoperative evaluation will result in the early detection of problems and ensure proper postoperative care.

Restorative dentistry.

Various restorative methods like composite crowns, parapulpar pin reconstructions or vast crowns and bridges, are evaluated against each other. Also new methods for repair of jaw-fractures in dogs and cats by means of parapulpar pins and composites are discussed.

Oral diseases and veterinary dentistry.

Oropharyngeal disease is common in dogs and cats. Signs are seldom apparent to the owner until the disease is well advanced, and often are not specific for a particular disease. Signs include inappetence, pawing at the mouth, drooling of saliva, dysphagia, and halitosis. These signs can result from primary oral disease, or from effects of systemic or skin disease. Oral examination requires a cooperative patient; sedation may be necessary so that the entire oral cavity can be examined without causing the animal pain or risking injury to the examiner.

Oral surgery. Basic techniques.

Some of the clinical problems most frequently seen in veterinary dentistry and their surgical solutions are discussed. Extraction of teeth, surgical repositioning of teeth, tooth transplant, oral abscesses of tooth origin, impaction of teeth, repair of maxillary canine oronasal fistula, and simple techniques for oral wiring are among the issues considered.