cat with fracture mandible

RE: cat with fracture mandible

Julie Innes — Fri, 27 Jul 2018 17:17:39 GMT

yay ! Not as wrong as I thought I was! I'm sure she'll do well- like I say, I couldn't open my mouth very well for almost a year (managed to eat though !)

RE: cat with fracture mandible

Anthony Todd — Fri, 27 Jul 2018 16:35:07 GMT

[quote user="Martin Atkinson"]They're feeding her moist food but she apparently raided a packet of treats and ate some![/quote]

I think you can up-rate your prognosis......

I've had yorkies whose jaw sort of broke apart when the linking molar was removed so the lower jaw was then hinged by gum and soft-tissue.

Ate and behaved normal and happy! [probably had some A/Bs though

RE: cat with fracture mandible

Martin Atkinson — Thu, 26 Jul 2018 17:37:15 GMT

They're feeding her moist food but she apparently raided a packet of treats and ate some!

RE: cat with fracture mandible

Anthony Todd — Thu, 26 Jul 2018 12:40:31 GMT

Soft moist food ie not dried biscuit I assume??

RE: cat with fracture mandible

Anthony Todd — Thu, 26 Jul 2018 12:39:48 GMT

Soft moist food ie not dried biscuit I assume??

RE: cat with fracture mandible

Martin Atkinson — Thu, 26 Jul 2018 09:51:04 GMT

Update on this case. Cat was referred to a veterinary dentist, had a CT scan and they decided to manage it conservatively. I saw her this morning the mandible and occlusion of the lower canines is stable, as in the original photograph, and the cat is eating well and grooming, there is some restriction opening the mouth but I didn't want to force it.

RE: cat with fracture mandible

Rob Davis — Thu, 19 Jul 2018 09:25:46 GMT

[quote user="Martin Atkinson"]It might be the difference between the technique of a dental specialist and an orthopod - I'm sure Evelyn would have something to say about that![/quote]

[quote user="Evelyn Barbour-Hill"]Utter nonsense[/quote]

[quote user="Evelyn Barbour-Hill"]No! What would you want to do that for? Sounds as if you've been talking to orthopods.[/quote]

RE: cat with fracture mandible

Evelyn Barbour-Hill — Wed, 18 Jul 2018 19:26:55 GMT

I've just noticed this:

[quote user="Martin Atkinson"]trans mandibular/maxillary pinning [/quote]

No! What would you want to do that for? Sounds as if you've been talking to orthopods.

RE: cat with fracture mandible

Evelyn Barbour-Hill — Wed, 18 Jul 2018 19:23:47 GMT

[quote user="Martin Atkinson"]Other opinions suggest that inter-canine bonding with dental acrylic rarely works as the bond fails and can damage the teeth.[/quote]

Utter nonsense

[quote user="Martin Atkinson"] And as the mandible is not displaced laterally, is it not true that a tape muzzle wouldn't have much effect on the minimal caudal deviation of the lower canines?[/quote]

Yes.

[quote user="Martin Atkinson"]Isn't the logical conclusion to draw that if there is only limited malocclusion i.e. that cat can close its mouth and eat that there is even less likely to be a risk of ankylosis if its treated conservatively?[/quote]

Yee.....eess. Perhaps. I think that in this case (which I haven't actaully seen) the joints are not stabilsed enough without fixation of some sort. And we don't really want caudal deviation of the lower canines, even minimal, if we can help it.

RE: cat with fracture mandible

Martin Atkinson — Wed, 18 Jul 2018 18:38:19 GMT

[quote user="Julie Innes"]I would have been tempted to leave it, given the fact the cat is eating and seems to be managing, but looks like I would have been wrong![/quote]Not necessarily - the jury is still out.

RE: cat with fracture mandible

Julie Innes — Wed, 18 Jul 2018 18:28:49 GMT

I would have been tempted to leave it, given the fact the cat is eating and seems to be managing, but looks like I would have been wrong!

I damaged my TMJ in a car accident many years ago, had lots of MRI scans. I couldn't open my mouth fully for over a year (which the cheeky misogynistic specialist I saw deemed to be a blessing!!) but he said it would return to normal function and it did.

RE: cat with fracture mandible

Martin Atkinson — Wed, 18 Jul 2018 17:21:33 GMT

[quote user="Rob Davis"]I'm interested to know whose opinions these are, as this is a widely used technique among dental specialists.[/quote]Not fair to name names but he is Cert SA, Dip SAS and an RCVS specialist. It might be the difference between the technique of a dental specialist and an orthopod - I'm sure Evelyn would have something to say about that! Problem is the client doesn't want to travel far and AFAIA there are no dental specialists close by. I would be capable of bonding or doing a trans mandibular/maxillary pinning but as I've got older I've realised my limitations and if a client is insured then I think its best to refer to a specialist.

RE: cat with fracture mandible

Rob Davis — Wed, 18 Jul 2018 16:45:13 GMT

[quote user="Martin Atkinson"]Other opinions suggest that inter-canine bonding with dental acrylic rarely works as the bond fails and can damage the teeth[/quote]

I'm interested to know whose opinions these are, as this is a widely used technique among dental specialists.

I would say there is a good chance of a good outcome by adopting a policy of benign neglect, but if it doesn't work then you are in a worse position than you were to start with. As long as the owner is aware of this, and they make an informed choice not to use any stabilisation then I see no problem with this approach.

RE: cat with fracture mandible

Martin Atkinson — Wed, 18 Jul 2018 15:43:12 GMT

Thanks folks for your input. Other opinions suggest that inter-canine bonding with dental acrylic rarely works as the bond fails and can damage the teeth. And as the mandible is not displaced laterally, is it not true that a tape muzzle wouldn't have much effect on the minimal caudal deviation of the lower canines?

[quote user="Evelyn Barbour-Hill"]it doesn't matter if there is slight movement, indeed that may be a good thing in order to reduce the small risk of ankylosis. [/quote]Isn't the logical conclusion to draw that if there is only limited malocclusion i.e. that cat can close its mouth and eat that there is even less likely to be a risk of ankylosis if its treated conservatively?

RE: cat with fracture mandible

Evelyn Barbour-Hill — Wed, 18 Jul 2018 15:01:51 GMT

Wot Rob Davis said.

But then, some of us don't have access to CT... and some clients don't have the "resources" for CT... and we have to use our nous.

I'd agree with your tame orthopod on his assessment of the radiographs....

Fractures around the TMJ generally heal nicely if the jaws are fixed in occlusion for a few weeks; and it doesn't matter if there is slight movement, indeed that may be a good thing in order to reduce the small risk of ankylosis. So I can see how a tape muzzle might work, but personally I would never put my trust in such a thing for a cat.

I'd always put an oesophagostomy tube in, even if I did nothing else, and it might only be needed for four or five days.. As far as I can judge in this case, I"d be doing intergnathic ( cool term ) fixation. Two weeks might be enough.

RE: cat with fracture mandible

Martin Atkinson — Wed, 18 Jul 2018 12:33:47 GMT

In order of appearance: tilted 30 degrees left and right; oblique left & right; open mouth; plain DV.

RE: cat with fracture mandible

Rob Davis — Wed, 18 Jul 2018 12:12:01 GMT

Can you post the radiographs?

RE: cat with fracture mandible

Martin Atkinson — Wed, 18 Jul 2018 11:34:09 GMT

Here is a picture of the cat's mouth: the teeth occlude perfectly laterally, the cat can close its mouth and eat and the lower K9s occlude rostrally to the uppers without impinging into the palate. My inclination is to leave it.

RE: cat with fracture mandible

Rob Davis — Wed, 18 Jul 2018 10:10:47 GMT

These can be very difficult to assess accurately with radiographs. There are normally multiple fractures and if it is possible then CT is by far the best way of assessing them. Personally I prefer maxillomandibular fixation as in this case (though care when removing!)but tape muzzles can work well and various designs are described in the literature.

The problem with leaving it is that the oral conformation in cats makes then intolerant to all but the most minor of malocclusions, and if it goes wrong, it is likely to be more difficult to correct once healing has started. Whatever the method of stabilisation, it only needs to be kept on for 2-3 weeks (longer will increase the risk of TMJ analysis). Although I would always place a feeding tube then applying the MMF, cats normally manage to eat ok for themselves.