Mandibular fracture in 5 month old cat

RE: Mandibular fracture in 5 month old cat

Peter Southerden — Sat, 27 Feb 2016 21:45:31 GMT

Hi Evelyn

I agree it's on the hopeless side of guarded! However if the blood supply is intact then it could still mature. If that is the case there should be some evidence of change even in the three weeks that the splint is on.

RE: Mandibular fracture in 5 month old cat

Evelyn Barbour-Hill — Wed, 24 Feb 2016 12:18:34 GMT

Peter, almost a tangent, but is there a reason why your prognosis for the affected tooth would be "guarded" rather than "hopeless" ?

RE: Mandibular fracture in 5 month old cat

Rob Davis — Wed, 24 Feb 2016 08:48:51 GMT

Many thanks, Pete, I really appreciate your advice. I will have a chat with the owner.

RE: Mandibular fracture in 5 month old cat

Peter Southerden — Tue, 23 Feb 2016 22:13:17 GMT

You can place the circum-mandibular wires in a number of different ways. For instance, make a small incision ventral to the mandible and then dissect through the subcutaneous connective tissue to the periosteum. Then place needle through the oral mucosa just below the mucogingival junction on the buccal aspect of the mandible out through the ventral incision. Insert the wire so that the cut end is in the oral cavity. Replace the needle on the lingual aspect of the mandible out through the incision and pass the second cut end into the oral cavity. Twist the cut ends so that the wire tightens round the mandible. Cut the twisted ends and make a small loop with them which will be incorporated into the acrylic splint.

There may be some necrosis of the gingiva immediately beneath the wire but this is insignificant.

The splint will effect the eruption of the underlying unerupted permanent teeth but as the splint will only be on for 3 weeks it isn't likely to prevent eruption. Tooth eruption and vitality post fracture repair will need to be monitored.

Jaws are not limbs and rigid fixation can often be removed at an earlier stage of fracture healing if this is required.

Hope this helps

Yours, Pete

RE: Mandibular fracture in 5 month old cat

Rob Davis — Mon, 22 Feb 2016 17:02:54 GMT

[quote user="Peter Southerden"]and/or circum-mandibular wires to give additional retention.[/quote]

Oops - missed this bit on the first read!

These would presumably be placed via ventral skin incisions - at what location to they exit through the mucosa? Surely they must cause a degree of pressure necrosis and discomfort?

RE: Mandibular fracture in 5 month old cat

Rob Davis — Mon, 22 Feb 2016 16:59:00 GMT

Hi Pete, thanks for the prompt reply.

So you would be happy to place a splint which is only anchored to 09s and 04s? I would have though it would be difficult to secure it without other teeth present, but I have considerably less experience with these than you!

Would you be concerned about the deciduous lower 08s (or would you remove them first?), do you think the splint may interfere with the eruption of adult lower 07s and 08s?

I haven't used transmyelohyoid intubation before, though funnilly enough I was reading about it only yesterday. I assume they heal well afterwards - do you close the stoma?

Thanks for your thoughts,

Rob

RE: Mandibular fracture in 5 month old cat

Peter Southerden — Mon, 22 Feb 2016 16:31:30 GMT

Hi Rob

Quick reply to your question. Yes I would want to stabilise this fracture and would probably place an intraoral wire/acrylic splint for around 3 weeks.

You can use the contralateral canine and even the contralateral M1 to anchor your splint and/or circum-mandibular wires to give additional retention. I would use transmyelohyoid intubation so that I can get normal occlusion and would give a guarded prognosis for the left mandibular canine.

Yours

Pete