Mandibular # - options?

RE: Mandibular # - options?

David Mills — Tue, 20 Sep 2016 17:14:29 GMT

Alas, this cat did not have surgery in the end - developed severe flu and was euthanased yesterday. Thanks for all advice in any case.

RE: Mandibular # - options?

Evelyn Barbour-Hill — Thu, 08 Sep 2016 22:49:54 GMT

[quote user="Emily Rainbow"]Sorry should have been clearer. I mean looking at her face-on the fractured mandible is slightly lower than the unfractured. (Symphysis is stable) but there's no malocclusion laterally and the teeth aren't preventing the jaw from closing as she chews as we o-tube feed her.[/quote]

Ah I see.

By the way, all, if you are a member of BVDA you will find a concise guide to transmylohyoid intubation in the issue of BVDA Journal which I am about to distribute. Plug, plug.

RE: Mandibular # - options?

Emily Rainbow — Thu, 08 Sep 2016 21:19:59 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Emily Rainbow"] Her occlusion is altered but all ok re: soft tissues vs teeth.[/quote] makes me uneasy. In what way is her occlusion altered?

[/quote]

Sorry should have been clearer. I mean looking at her face-on the fractured mandible is slightly lower than the unfractured. (Symphysis is stable) but there's no malocclusion laterally and the teeth aren't preventing the jaw from closing as she chews as we o-tube feed her.

RE: Mandibular # - options?

David Mills — Thu, 08 Sep 2016 20:29:33 GMT

[quote user="Peter Southerden"]

Hi David

From what I can see, we would plate this fracture with a small, ideally locking, plate. Transmyelohyoid intubation is easy and will help you get good occlusion. If the fracture is old I'd place a bone graft.

Hope it goes well

Peter

[/quote]

Thanks Peter.

Yes looked it up in Denny this pm hadn't considered that intubation but see the point now! Thanks for grafting tip.Quite looking forward to it- booked in on my birthday next week, lovely present

Will post up some post op rads.

RE: Mandibular # - options?

Peter Southerden — Thu, 08 Sep 2016 17:24:33 GMT

Hi David

Hope it goes well

Peter

RE: Mandibular # - options?

Evelyn Barbour-Hill — Thu, 08 Sep 2016 16:32:50 GMT

Emily, I'm not criticising your approach to a case I know practically nothing about, but:

[quote user="Emily Rainbow"] Her occlusion is altered but all ok re: soft tissues vs teeth.[/quote] makes me uneasy. In what way is her occlusion altered?

And interdental bonding need not be expensive, especially if looked at in proportion to what you've done already.

If the fracture is rather caudal (through or caudal to the molar tooth, say), interdental bonding is not mechanically sound though. On the other hand it can be enough to stabilise things – more appropriate to a fresh fracture perhaps than a possible non-union.

RE: Mandibular # - options?

David Mills — Thu, 08 Sep 2016 15:48:14 GMT

Thanks for replies.

No bonding available here. Lateral rad is pretty useless. Symphysis is intact in this case, strangely.

In that case will probably look to plate it next week. There's a decent chunk caudally to fit a small plate on I think.

RE: Mandibular # - options?

Rob Davis — Thu, 08 Sep 2016 15:15:05 GMT

[quote user="Evelyn Barbour-Hill"]

Certainly some old unfixed fractures can be left alone if the patient has adapted.

But here even though the cat has adapted, I'd be wanting to fix it sufficiently to bring the occlusion back to something like normal.

[/quote]

Wot he said!

Difficult to tell from this view alone, but intercanine bonding would probably be sufficient to hold things in the right place and allow healing (unless it is an old fracture with non-union, in which case I would be inclined to leave it alone if not causing problems)

RE: Mandibular # - options?

Emily Rainbow — Thu, 08 Sep 2016 13:31:41 GMT

We've got a very similar one in at the moment. Also fractured symphysis. No money for fixation so wired symphysis and put in an O-tube. 6d post RTA she's eating soft food and is going home with O-tube in place for owners to continue at home. Her occlusion is altered but all ok re: soft tissues vs teeth.

RE: Mandibular # - options?

Evelyn Barbour-Hill — Thu, 08 Sep 2016 10:34:29 GMT

Certainly some old unfixed fractures can be left alone if the patient has adapted.

But here even though the cat has adapted, I'd be wanting to fix it sufficiently to bring the occlusion back to something like normal.