Head and mandibular fractures Flashcards
Describe the initial management of facial trauma/ fracture
ABC- generally have dyspnoea
TPOCUS/TFAST
assess neuro status
analgesia and fluid support
once stable assess skull and mandible - this needs GA (radiography or CT
Describe what is assessed in cases of facial trauma/ fracture
consciousness
can it walk in co-ordinated fashion
head symmetry
can the animal close its mouth
are pupils symmetrical
bleeding from ear?
is the mandibular symphysis intact
can you see any fractures to the mandible
Describe radiographic assessment of facial trauma/ fractures
Orthogonal views and occasionally oblique views can be helpful
The skull is a complex structure
The views should be well positioned and avoid asymmetry although this can be difficult
CT superior
Describe the anaesthetic considerations when manageing the facial trauma case
These patients will often have compromised airways, both as a result of the trauma and
subsequent swelling and may also have reduced local reflexes
many cases may be better to place ETT through either a tracheostomy or pharyngotomy
what is the most important clinical outcome for fractures of the skull and mandible
is for the patient to be able to close its mouth and any depression fractures to the brain are addressed
List some surgical considerations for fractures of the skull
Surgery is best performed with either a tracheal or pharyngeal ET tube
Relatively weak fixation is adequate in these non load bearing bones
Mandibular fractures are invariably open and antibiotics are advisable
Place feeding tube at time of surgery
Describe intercanine acrylic bonding
It keeps the mouth in a stable position, allows patient to lap up water
these patients show ptyalism- as they can’t swallow
what can the BEARD technique be used to fix
caudal mandibular fractures or damage to the TMJ in the young dog and small dog and cat
Describe the BEARD technique to treat fractures of the skull
The suture is placed through subcutaneous tunnels and tightened to close mouth
can be left in place for 4-6 weeks
What is a big risk of BEARD technique to fix skull/mandible fractures
Provision must be available to cut the suture if the animal vomits and the mouth needs to be cleared
when can interfragmentary wiring be used to treat fracture of mandible/ maxilla
reconstruct maxillary fractures and close the maxilla when the hard palate is split
generally use on its own unless used for symphysial separations
Describe how to treat mandibular symphyseal separation
simple- use wire or PDS
wire placed caudal to canine teeth and around the mandibular symphysis
soft foods for up to 6 weeks
the wire usually loosens after a few weeks and will require removal
Describe fracture to calvaria
often result in death - uncommon
these fractures require management if the bone fragments impinge on the brain
specialised surgery
Describe temporomandibular luxation
seen almost exclusively in the cat
Deviation of jaw away from side of luxation as a result or trauma e.g. RTA
inability to close mouth
Describe temporomandibular dysplasia (locking jaw syndrome)
Jaw locks open with slight deviation to side of the lock
Due to increased lateromedial laxity in the TMJ
Occurs when yawning and can be present on either side
