4.1.2 Diagnosis
4.1.5.1 Intraoral fixation techniques
4.1.5.2 Extraoral fixation techniques
4.1.6 Postoperative management
4.2.5 Postoperative management
4.1 Mandible and maxilla fractures
Mandible fractures occur more frequently than maxilla fractures. More often only one ramus of the mandible is affected. In foals, the incisors are commonly involved. If the germinal buds were not badly damaged, maturation will be normal.
Maturation of incisors will be normal if the germinal buds have not been damaged.
4.1.1 Etiology
In most cases, fracture follows catching of the teeth in a mesh wire (Fig. F4A) [1]. Occasionally, kicking injuries occur (Fig. F4B) or the animal may injure that part of the face falling or running into an immovable obstacle (Fig. F4C). Pathologic fractures may be seen in progressive severe dental disease with chronic infection and osteolysis. On other occasions, tumors render the mandible fragile, predisposing it to fracture.
Fig. F4A: Fractures of the incisor region most frequently occur when the teeth are caught in a mesh wire fence during playing. Sudden pulling back results in a fracture.
Fig. F4B: Kicking injuries of the jaw may lead to mandible and maxilla fractures.
Fig. F4C: Jaw fractures may also occur when a horse runs into an object.
4.1.2 Diagnosis
In many cases, inanition is the first hint of fracture (Fig. S4A). Excessive salivation is common, possibly associated with asymmetry of the face, and open wounds [2]. Radiographs provide a definitive diagnosis (Fig. X4A). Multiple projections are recommended [3]. For rostral fractures of the mandible V-D intraoral radiographs are indicated. These are best carried out under anesthesia or heavy sedation. Mandibular and maxillary fractures have always to be looked upon as open fractures, since gingival bacteria quickly invade the bone.
Mandibular and maxiallary fractures are open fractures.
Fig. S4A: Fracture of the incisor region in a 7-year-old Arabian stallion. The rostral fragment could easily be displaced through finger pressure.
Fig. X4A: Intraoral radiographic view of a rostral mandible fracture. Several incisor tooth roots are fractured. Some displacement is visible.
4.1.3 Preoperative management
Carry out a detailed examination of the entire animal, with special emphasis on the injured region, prior to surgery. Pay special attention to metabolic disorders such as dehydration, acid base derangements, and nutritional status. The animal may not have eaten for a considerable time. Plan the surgical procedure carefully, and cleanse the mouth thoroughly before intubation. Do not remove any loose teeth prior to fracture repair because the teeth brace each other and can thereby confer stability. If necessary, the loose teeth can be removed at a later stage or at the time of implant removal. Often, such removal proves unnecessary.
4.1.4 Management options
Selected fractures of a single mandibular ramus may sometimes be treated conservatively. Surgical options will vary with the configuration of the fracture. Following repair, the incisors can be rasped down to prevent contact with the opposing arcade, protecting the repair from strain for several weeks.
4.1.5 Surgical procedures
A distinction is made between intraoral and extraoral fixation techniques. In some instances, combined modalities are used.
4.1.5.1 Intraoral fixation techniques
Cerclage wires
Cerclage
