How do I best manage a maxillary fracture?

RE: How do I best manage a maxillary fracture?

Kate Richardson — Fri, 25 Apr 2025 09:12:35 GMT

Thanks Evelyn, that's good to know, less traumatic for the cat than I expected if no mandibular/maxillary fixing needed.

Cat is doing really well though but will definitely bear in mind for future cases!

RE: How do I best manage a maxillary fracture?

Evelyn Barbour-Hill — Thu, 24 Apr 2025 14:51:06 GMT

[quote userid="6386" url="~/f/clinical-questions/31172/how-do-i-best-manage-a-maxillary-fracture/247072#247072"]I'm really keen to know how you would fix the maxillary fracture Evelyn Barbour-Hill- does it involve fixing the canines as Sarah suggests? [/quote]

Well. Subject as ever to the caveat that I can't be sure without seeing the thing and actually laying my hands on it.

Under GA I'd manipulate and endeavour to reduce the fracture – put everything back where it's supposed to be. (If that can't be done, even with some force,then it's fixed itself and it might as well be allowed to heal deformed). Then look at it and decide how much fixation it needs (possibly very little) and how to achieve it. It would not involve any mandibular-maxillary fixing. I'm thinking probably a light wire from 104 to 204 with maybe composite that incorporates the incisors. It would only need to be on for 2-3 weeks I think.

An oesophagostomy tube would probably not be needed but I would not hesitate to place one if the need seemed possible.

If 304 needed to be modified I'd cut it short and do endodontics: quick, involves little trauma and just generally less messy.

RE: How do I best manage a maxillary fracture?

Kate Richardson — Wed, 23 Apr 2025 15:14:40 GMT

I'm really keen to know how you would fix the maxillary fracture Evelyn Barbour-Hill- does it involve fixing the canines as Sarah suggests?

RE: How do I best manage a maxillary fracture?

Kate Richardson — Thu, 17 Apr 2025 19:37:10 GMT

Much happier cat today so I am happy with decisions so far

RE: How do I best manage a maxillary fracture?

Kate Richardson — Wed, 16 Apr 2025 20:03:12 GMT

I really don't think this cat or owner would have tolerated this but good to know options. Will see how he does over next couple of days but initial response following 304 extraction today is positive (as in he seemed much more comfortable- however this could be simply due to getting better pain management)

Poor cat- he has a virulent pox virus infection 2 years ago and almost lost his left foreleg!!!

RE: How do I best manage a maxillary fracture?

Sarah Keir — Wed, 16 Apr 2025 19:46:48 GMT

I'm sure I've seen videos of vet dentists gluing the top and bottom canines together to form a secure bridge. May need a feeding tube but I believe most cats will lap liquid food through this - but bettter to put the feeding tube in and not need it than to find out several days later that you should of put one in. Most pain in these is the bone moving against soft tissues so this stops this while it heals.

I'm sure more knowledgeable people will be along soon.

RE: How do I best manage a maxillary fracture?

Kate Richardson — Wed, 16 Apr 2025 18:17:09 GMT

Apologies for my terminology- I was always rubbish at anatomical correctness and I tend to speak in client friendly terms now.

Xrays above/below- negligible movement on palpation and only malocclusion I can detect at this stage is from 304, so I did extract it (minimal trauma to cat and none to me

Cat's temperament and finances not an option for referral but how would you reduce and fix the maxilla? And within what time frame of the injury occurring?

RE: How do I best manage a maxillary fracture?

Kate Richardson — Wed, 16 Apr 2025 15:36:42 GMT

RE: How do I best manage a maxillary fracture?

Evelyn Barbour-Hill — Wed, 16 Apr 2025 13:33:13 GMT

Hallo Kate. Please explain more.

The premaxilla is fractured (presumably split at he suture) with gross displacement. Therefore either the maxillary palate must be split, or the premaxilla has split from the maxilla on one side at least (or there's a maxillary fracture giving the same effect.)

I think you need to take radiographs and palpate carefully under GA before you make any plan. Why not reduce and fix the upper jaw fracture, rather than traumatising both the cat and yourself by messing with 304 and leaving the upper jaw to heal deformed?

Personally I'd go to some lengths to avoid extracting a lower canine if it has a healthy periodontium (as this one seems to have). If you really do have to "get rid of it", then cut it short and do a vital pulpectomy and pulp capping.

Unquestionably place an oesophagostomy tube unless you are quite sure you don't need one.

RE: How do I best manage a maxillary fracture?

Kate Richardson — Wed, 16 Apr 2025 09:34:44 GMT

RE: How do I best manage a maxillary fracture?

Beats — Tue, 15 Apr 2025 20:42:59 GMT

is the palate split inside or ok?