- The aims of surgical fracture repair are to:
- Attain perfect dental occlusion.
- Provide rigid fracture stabilization.
- Minimize soft tissue damage.
- Preserve dentition.
- Maintain patient's ability to eat.
- Repair of mandibular fractures in order to restore normal occlusion and normal function of the jaw.
- Repair can range from the simplicity of circumferential wiring of symphyseal fractures to the complexity of reducing multiple/bilateral fractures using interfragmentary wires, external fixation and plates. Selection of an appropriate technique is essential for a good outcome.
- In many cases is essential to attain normal occlusion - malalignment of 2-3mm can prevent the jaw from closing.
- Early return to pain free function.
- Reduces risk of malunion/delayed union.
- General anesthesia required in a cat which may present in shock or have pulmonary contusions/pneumothorax - these conditions must be treated first.
- Plating and external fixation are expensive.
- Interarcade wiring or muzzle taping can potentially result in heat stroke and aspiration pneumonia as a result of inability to open mouth.
- Placement of implants can damage teeth and mandibular blood supply if placed inappropriately.
- Circumferential wiring - heavy duty needle holders or wire twisters.
- Interdental wiring - wire twisters.
- Interarcade wiring - hand chuck, wire twisters, k-wires.
- Interfragmentary wiring - standard surgical pack, periosteal elevator, hand held or self retaining retractors, hand chuck, wire twisters, k-wires.
- Plating - standard surgical pack, periosteal elevator, hand held or self retaining retractors, 1.1mm drill, 1.5mm tap, mini depth gauge, drill guide, bone holders, orthopedic drill.
- External fixation - orthopedic drill, drill guide.
- Circumferential wiring - 24 gauge wire, 16-18 gauge needles.
- Interdental/interarcade wiring - 24 gauge wire.
- Interfragmentary wiring - 24 gauge wire, suture material.
- Plating - mini plate or 1.5/2 cuttable plate, 1.5mm screws, suture material.
- External fixation - acrylic, K-wires.
- Dependent on technique - ranges from 5 minutes to swab the oral cavity prior to placement of interdental or interarcade wires, to 45 minutes to clip and prepare the jaw prior to open repair of bilateral mandibular fractures.
- Malocclusion is the most frequent complication. This is more common when the mandibular body is fractured or if multiple fractures are present and is possibly the result of difficulty in reducing and stabilizing these fractures. Minimize this complication by using a pharyngostomy site placement of the endotracheal tube and delaying surgery until soft tissue swelling has reduced.
- Soft tissue infection is the second most common complication. Extensive trauma, the naturally high numbers of bacteria in the oral cavity and difficulty in keeping wounds clean may contribute to this problem.
- Damage to tooth roots and mandibular alveolar artery can result from inappropriate placement of implants.
- Osteoathritis of the temporomandibular joint can develop secondary to condylar fractures.
- Nonunion , delayed union and osteomyelitis are uncommon complications.
- Excellent for mandibular symphyseal separations.
- Good for other mandibular fractures as long as normal dental occlusion is achieved.
Reasons for treatment failure
- Failure to restore occlusion or provide adequate fracture stabilization.