What would you recommend for this mandible fracture in a dog?

RE: What would you recommend for this mandible fracture in a dog?

Evelyn Barbour-Hill — Tue, 22 Oct 2024 17:55:23 GMT

[quote userid="12930" url="~/f/clinical-questions/31054/what-would-you-recommend-for-this-mandible-fracture-in-a-dog/245771#245771"]could I simply remove a section of the mandible and the dog would be able to eat again at that point? [/quote]

You could and it would – not at that point but eventually, and probably in a quite messy manner. I don't think this is an idea to pursue seriously.

If it's unstable either now or when you remove the wire, you need to do it again. Reduce that fracture and fixate it by a different method.

Sorry.

RE: What would you recommend for this mandible fracture in a dog?

Beats — Mon, 21 Oct 2024 07:25:09 GMT

Thanks, Evelyn - really appreciate the further thoughts and advice.

I was not very aggressive palpating it, so while the dog has been eating well from day one when wire was placed, there could be instability if I had been rougher with it on repeat exam. Overall, I think was stable however.

I half had in my head (as a back-up to avoid euthanasia, not an ideal solution) if it all failed to progress to healing and wire was removed and proved unstable and not able to eat, could I simply remove a section of the mandible and the dog would be able to eat again at that point? The equivalent of a femoral head and neck ostectomy so to speak to ensure no further procedures would be required?

RE: What would you recommend for this mandible fracture in a dog?

Evelyn Barbour-Hill — Mon, 21 Oct 2024 00:29:08 GMT

[quote userid="12930" url="~/f/clinical-questions/31054/what-would-you-recommend-for-this-mandible-fracture-in-a-dog/245760#245760"]

Skin all healed now and could do more stabilisation if needed, but as has been eating fine decided to just elave the wire in place another 6 weeks and then remove at that stage and see how things are. Wire is perhaps cutting into gum a little, but seems comfortable otherwise (small lesion under tongue I think is from sharp premolar on other side).

I was disappointed with the lack of radiographic bone healing in these at 6 weeks, and did wonder if once the wire comes away will it be properly stable or not. Would others have left this wire in place for longer, or removed it +/- done more intervention now that skin and gums all a bit more helaed up etc?

The tooth that was removed I thought the front root was possibly bad and infected, but could jsut have been dried blood caked to it. The other tooth with exposed root I did not remove as thought would be needed as anchor point, but did think both it and the main molar might benefit from removal at some point in future.

[/quote]

Well, I can't resist commenting.

The first point is, if it's presently stable to palpate, don't start revisions now! Yes, leave it another 6 weeks. On the other hand, if it's not stable on palpation by now (be honest with yourself), you must do something else.

The comminution is even more than i thought on the original pictures. Which may be a problem.

Absolutely you must extract the 309 once the bone has healed (unless you fancy root division and endodontics on the distal root...no, not really).. I'm afraid you've damaged it boring through. I'm pretty sure you'll be wise to extract 307 also.

The lack of radiographic bone healing, and the apparent huge gaps between fragments, are indeed disappointing.I think you are going to need to revise your present wire and put two or three cerclages in. Subject only to what I said above.

This is proving a really tricky one, from both the nature of the fracture and the breed of dog.

Acrylic splinting – if you like courses, keep your eyes peeled, because they crop up quite regularly – go on a BVDA one if you can. Or join BVDA and you'll get good notice of all the courses. If you're comfortable with a textbook, any of the basic veterinary dentistry ones – try the BSAVA manual.

No, it isn't difficult at all to remove the acrylic.

RE: What would you recommend for this mandible fracture in a dog?

Beats — Sat, 19 Oct 2024 12:25:24 GMT

Xrays posted above are approximately 6 weeks after placing a 0.7mm wire between two of the teeth and removing one of the teeth. had meant to drill between the roots of the molar rather than through one...

There was significant damage to skin outside of jaw - sorry didn't have any pictures. Put on antibiotics and would be interested what everyone's approach to use and duration of antibitoics in case like this is?

Felt very unstable with large comminuted butterfly fragment ventrally in mandible and 2 x points of bone just intraorally with fair size of hole and cavity into this mess. Not sure what folks would advise to deal with this and not get food going in. I had considered esophagostomy tube, but in end just hand fed chicken for a week to give time for the gum to heal with reduced risk of food material getting stuck in it.

I considered could this be partly pathological fracture with the removed tooth having been rotten? But I guess level of comminution would suggest more a forecful impact. Car couldn't have been going more than 5mph owner thinks and he heard yelp but didn't see what happened.

Really appreciate all the advice - I don't see mandibular fractures in dogs often. Don't think a muzzle on this dog would have been easy as a pug with short nose, but I can see how that could work in longer nosed dog. Ditto with placing a BEARD or equivalent.

I'm not familiar with acrylic splints - can anyone point me to a good learning resource about these? Is it difficult to remove the acrylic afterwards?

RE: What would you recommend for this mandible fracture in a dog?

Beats — Sat, 19 Oct 2024 08:55:16 GMT

RE: What would you recommend for this mandible fracture in a dog?

Evelyn Barbour-Hill — Wed, 16 Oct 2024 16:47:09 GMT

Oh, and you might just want a cerclage wire to stabilise the rostral limb of the fracture, say at the level of 306/7 interproximal, or through the furcation of 307 if that's more practical. I don't know if this will be needed, but I'd do it at the drop of a hat if it were. Of course you'll take all these wires out later when everything's healed.

RE: What would you recommend for this mandible fracture in a dog?

Evelyn Barbour-Hill — Tue, 15 Oct 2024 17:08:33 GMT

[quote userid="8991" url="~/f/clinical-questions/31054/what-would-you-recommend-for-this-mandible-fracture-in-a-dog/245681#245681"]Deal with any teeth later on (IME all will probably be fine). [/quote]

Sorry, but from my experience they will definitely not.

RE: What would you recommend for this mandible fracture in a dog?

David Mills — Sun, 13 Oct 2024 19:17:29 GMT

Muzzle or an adapted BEARD / button stabilisation. Mandibles heal quickly with even modest immobilisation. Deal with any teeth later on (IME all will probably be fine).

Thankfully things seem to have moved away from. Those god awful ex fixes of about a decade ago which IMO did next to nothing amongst all the complications.

RE: What would you recommend for this mandible fracture in a dog?

Evelyn Barbour-Hill — Sun, 13 Oct 2024 18:01:21 GMT

Absolutely

RE: What would you recommend for this mandible fracture in a dog?

Rob Davis — Sat, 12 Oct 2024 09:22:00 GMT

[quote userid="2131" url="~/f/clinical-questions/31054/what-would-you-recommend-for-this-mandible-fracture-in-a-dog/245673#245673"]The more I look, the more sure I am that 309 will need extracting later, once it's done its job as an anchor[/quote]

Extraction rather than root canal?

RE: What would you recommend for this mandible fracture in a dog?

Evelyn Barbour-Hill — Fri, 11 Oct 2024 16:17:14 GMT

I'd add, if I may – if you're not happy that your interdental wire and acrylic gives adequate immobilisation, add a cerclage wire round the mandible at the level just mesial to the 309. And if necessary (though I'd guess not in this case) another cerclage wire at the level of the furcation of 309, bringing the wire through the furcation. If the wire is buried adjacent to the bone, but exposed intra-orally, that's no problem.

The more I look, the more sure I am that 309 will need extracting later, once it's done its job as an anchor.

RE: What would you recommend for this mandible fracture in a dog?

Evelyn Barbour-Hill — Fri, 11 Oct 2024 15:54:23 GMT

Before you posted the intra-oral radiographs I was going to post this – which may be of interest anyway. From the extra-oral radiographs you can see the mandibular fracture but the details are inadequate. But if that's all you've got, then careful sensitive palpation under GA can probably tell you all you need to know right now.

Otherwise I'd agree with Rob. I'd extract 308 as a preliminary, and both 309 and 307 would want monitoring (and I'd not be afraid to extract one or both of these once the fracture is well healed).

And of course an oesophagostomy tube for a couple of days at first, maybe a little longer. Mandibular fractures heal quickly given immobilisation and rest.

RE: What would you recommend for this mandible fracture in a dog?

Rob Davis — Fri, 11 Oct 2024 13:40:07 GMT

Fabulous, thank you!

I think this could be a good candidate for interdental acrylic and wire splinting. The 309 and 310 appear to be periodontally healthy with sufficient attachment to provide at strong anchor point for your wire. 308 appears to have marked periodontal bone loss around the mesial root, and I would probably extract this as the periodontal infection is likely to affect healing. The splint would then extend rostrally at least to 304.

If that is not an option, then provided the dog tolerates it, a tape muzzle may be worth trying, though it will be difficult to fit properly in a pug....

There may be future problems with the vitality of 309 given the obvious disruption to the apical delta on the mesial root, so ideally that would be monitored radiographically over the next couple of years.

I am assuming that referral is not a option....

RE: What would you recommend for this mandible fracture in a dog?

Beats — Fri, 11 Oct 2024 13:13:17 GMT

RE: What would you recommend for this mandible fracture in a dog?

Rob Davis — Fri, 11 Oct 2024 12:56:32 GMT

From what I can see, there appears to be and oblique fracture to the mandibular body at the level of the mesial root of the lower first molar.

Ideally intra-oral radiography would give a much better impression of the fracture site and orientation and would also give vital information about the periodontal health of the teeth in the fracture line which could significantly impact choice of repair and likelihood of complications, but I appreciate that this may not be available.

If there are sufficient teeth with adequate periodontal attachment on both sides of the fracture site, then a non-invasive technique such as interdental wiring with an acrylic splint may be appropriate. Plating could be an option, but the curvature of a pug's mandible and the proximity of tooth roots and the mandibular canal in a small jaw may make this technically very difficult to achieve.

If there is no money for surgery, then using a muzzle to keep the mouth partially closed (approximately 0.5-1cm gap between incisors with canines properly aligned to maintain normal occlusion) may be sufficient to allow healing, but it could end up with a non-union etc, so owners much be aware of the limitations.

RE: What would you recommend for this mandible fracture in a dog?

Marianne Thomas — Fri, 11 Oct 2024 09:50:10 GMT

My phone won't let me zoom in (also I'm only a very novice orthopod) but I have follow up questions

Do the TMJs seem stable to you? I had a nightmare trying to resolve a luxation a few months ago & I know that can be a bad prognostic indicator

How unstable is the fracture? It doesn't look displaced as far as I can tell. If there's enough bone stock & it's a closed # then a tiny bridging plate might be an option? Otherwise I've seen folks exfix these, but I'm not sure how you protect the mandibular nerve in those cases.

I once saw a (more rostral) mandibular # heal with 6w soft food & analgesia, so depending on the situation that can be possible

RE: What would you recommend for this mandible fracture in a dog?

Arlo Guthrie — Fri, 11 Oct 2024 07:56:39 GMT

Evelyn Barbour-Hill - just in case you didn't spot it (and thanks for reposting Beats)