Download PDF
Vet Comp Orthop Traumatol 2010; 23(02): 102-108
DOI: 10.3415/VCOT-09-03-0034
Clinical Communication
Schattauer GmbH

Treatment of caudal mandibular fracture and temporomandibular joint fracture-luxation using a bi-gnathic encircling and retaining device

I. Nicholson
1   Department of Veterinary Medicine, University of Cambridge Veterinary School, Cambridge, UK
,
J. Wyatt
2   Connaught House Veterinary Hospital, Wolverhampton, UK
,
H. Radke
1   Department of Veterinary Medicine, University of Cambridge Veterinary School, Cambridge, UK
,
S. J. Langley-Hobbs
1   Department of Veterinary Medicine, University of Cambridge Veterinary School, Cambridge, UK
› Author Affiliations
Further Information

Publication History

Received: 27 March 2009

Accepted: 11 February 2009

Publication Date:
19 December 2017 (online)

    Permissions and Reprints

Summary

Fractures of the caudal portion of the mandible and temporomandibular joint (TMJ) fracture-luxation can be challenging to treat with direct fixation methods. This paper describes a simple technique for the indirect treatment of caudal mandibular fracture and TMJ fracture-luxation using a subcutaneous loop of nylon leader line tunnelled around the maxilla, incisive and nasal bones, and under the mandible, placed just caudal to the canine teeth, and crimped ventral to the mandibular skin: a bi-gnathic encircling and retaining device (BEARD). A BEARD was used to treat two immature dogs with simple, unilateral caudal mandibular fractures, six cats with unilateral injury (two with TMJ luxation, three with TMJ fracture-luxation, one with caudal mandibular fracture), and two cats with bilateral injury (comminuted caudal mandibular fracture with contralateral TMJ luxation; bilateral condylar neck fracture). The BEARD treatment failed short-term due to poor tolerance in one cat, and concurrent injuries and poor initial reduction in another cat. One cat was lost to long-term follow-up. Rostral dental occlusion was normal in six out of seven cases, and reported jaw function was normal in seven out of seven cases. The case with poor occlusion had imperfect initial reduction. Complications included dorsal nasal skin swelling or discharge, oesophagostomy tube dislodgement or blockage, BEARD loosening, and regurgitation. Treatment of uni- or bilateral caudal mandibular trauma using a BEARD can lead to clinical union, and normal rostral occlusion, provided that case selection is appropriate and immediate-post-surgical occlusion has been corrected.

Keywords

Mandible - temporomandibular joint - fracture - luxation

 

  • References

  • 1 Umphlet RC, Johnson AL.. Mandibular fractures in the cat – a retrospective study. Vet Surg 1988; 17: 333-337.
    CrossrefPubMedGoogle Scholar
  • 2 Umphlet RC, Johnson AL.. Mandibular fractures in the dog – a retrospective study of 157 cases. Vet Surg 1990; 1: 272-275.
    PubMedGoogle Scholar
  • 3 Withrow SJ.. Taping of the mandible in treatment of mandibular fractures. J Am Anim Hosp Assoc 1981; 17: 27-31.
    PubMedGoogle Scholar
  • 4 Lewis DD, Oakes MG, Kerwin SC. et al. Maxillarymandibular wiring for the management of caudal mandibular fractures in two cats. J Small Anim Pract 1991; 32: 253-257.
    CrossrefPubMedGoogle Scholar
  • 5 Bennett JW, Kapatkin AS, Marretta SM.. Dental composite fixation of mandibular fractures and luxations in 11 cats and 6 dogs. Vet Surg 1994; 23: 190-194.
    CrossrefPubMedGoogle Scholar
  • 6 Boudrieau RJ, Kudisch M.. Miniplate fixation for repair of mandibular and maxillary fractures in 15 dogs and 3 cats. Vet Surg 1996; 25: 277-291.
    CrossrefPubMedGoogle Scholar
  • 7 Bilgili H, Kurum B.. Treatment of fractures of the mandible and maxilla by mini titanium plate fixation systems in dogs and cats. Aust Vet J 2003; 81: 671-673.
    CrossrefPubMedGoogle Scholar
  • 8 Owen MR, Langley-Hobbs SJ, Moores AP. et al. Mandibular repair in dogs and cats using epoxy resin and acrylic external skeletal fixation. Vet Comp Orthop Traumatol 2004; 17: 189-197.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Boudrieau RJ.. Fractures of the mandible. In Johnson AL, Houlton JEF, Vannini R. editors AO principles of fracture management in the dog and cat. Switzerland: AO Publishing; 2005: 98-115.
    Google Scholar
  • 10 Moores AP.. Feline skull fractures. Vet Comp Orthop Traumatol 2009; 22: A18.
    PubMedGoogle Scholar
  • 11 Baines SJ, Langley-Hobbs S.. Horner’s syndrome associated with a mandibular symphyseal fracture and bilateral temporomandibular luxation. J Small Anim Pract 2001; 42: 607-610.
    CrossrefPubMedGoogle Scholar
  • 12 Marretta SM, Schrader SC, Matthiesen DT.. Problems associated with the management and treatment of jaw fractures. Probl Vet Med 1990; 2: 220-247.
    PubMedGoogle Scholar
  • 13 Weigel JP.. Trauma to oral structures. In Harvery CE. editor Veterinary Dentistry. Philadelphia: Saunders; 1985: 140-155.
    Google Scholar
  • 14 Crowe Jr DT , Devey JJ.. Esophagostomy tubes for feeding and decompression: clinical experience in 29 small animal patients. J Am Anim Hosp Assoc 1997; 33: 393-403.
    CrossrefPubMedGoogle Scholar
  • 15 Jaqodzinski M, Krettek C.. Effect of mechanical stability on fracture healing – an update. Injury 2007; 38 S1 S3-S10.
    CrossrefPubMedGoogle Scholar
  • 16 Kern DA, Smith MM, Stevenson S. et al. Evaluation of three fixation techniques for repair of mandibular fractures in dogs. J Am Vet Med Assoc 1995; 206: 1883-1890.
    PubMedGoogle Scholar
  • 17 Cascone P, Spallaccia F, Fatone FM. et al. Rigid versus semirigid fixation for condylar fracture: experience with the external fixation system. J Oral Maxillofac Surg 2008; 6: 265-271.
    PubMedGoogle Scholar
  • 18 Nussbaum ML, Laskin DM, Best AM.. Closed versus open reduction of mandibular condylar fractures in adults: a meta-analysis. J Oral Maxillofac Surg 2008; 66: 1087-1092.
    CrossrefPubMedGoogle Scholar
  • 19 Palmer RH.. Biological osteosynthesis. Vet Clin North Am Small Anim Pract 1999; 29: 1171-1185.
    CrossrefPubMedGoogle Scholar
  • 20 Hudson CC, Pozzi A, Lewis DD.. Minimally invasive plate osteosynthesis: applications and techniques in dogs and cats. Vet Comp Orthop Traumatol 2009; 22: 175-182.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Grandage J.. Functional anatomy of the digestive system. In Slatter D. editor Textbook of small animal surgery. Philadelphia: Saunders; 2003: 499-521.
    Google Scholar
  • 22 Wallace AM, Cutting ED, Sutcliffe MP. et al. A bio-mechanical comparison of six different double loop configurations for use in the lateral fabella suture technique. Vet Comp Orthop Traumatol 2008; 21: 391-399.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Banwell MN, Kerwin SC, Hosgood G. et al. In vitro evaluation of the 18 and 36kg Securos cranial cruciate ligament repair systemTM . Vet Surg 2005; 34: 283-288.
    CrossrefPubMedGoogle Scholar
  • 24 Schwarz T, Weller R, Dickie AM. et al. Imaging of the canine and feline temporomandibular joint: a review. Vet Rad Ult 2002; 43: 85-97.
    PubMedGoogle Scholar
  • 25 Ireland LM, Hohenhaus AE, Broussard JD. et al. A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes. J Am Anim Hosp Assoc 2003; 39: 241-246.
    CrossrefPubMedGoogle Scholar
  • 26 Song EK, Mann FA, Wagner-Mann CC.. Comparison of different tube materials and use of Chinese finger trap or four friction suture technique for securing gastrostomy, jejunostomy and thoracostomy tubes in dogs. Vet Surg 2008; 37: 212-21.
    CrossrefPubMedGoogle Scholar
  • 27 Strube P, Sentuerk U, Riha T. et al. Influence of age and mechanical stability on bone defect healing: age reverses mechanical effects. Bone 2008; 42: 758-764.
    CrossrefPubMedGoogle Scholar
  • 28 Holmes M, Cockroft P.. Designing questionnaires. In Holmes M, Cockroft P. editors Handbook of veterinary clinical research. UK: Blackwell; 2008: 135-146.
    Google Scholar
  • 29 Maas CPHJ, Theyse LFH.. Temporomandibular joint ankylosis in cats and dogs – a report of 10 cases. Vet Comp Orthop Traumatol 2007; 20: 192-197.
    Article in Thieme ConnectPubMedGoogle Scholar