Techniques of Jaw Fracture Repair

Maxillomandibular Fixation

Tape muzzles can be used in minimally displaced fractures, in young animals with rapid bone healing, pathologic mandibular fractures, and as a means of additional support in cases where other fixation techniques did not achieve optimal stabilization. Muzzling can be temporary first-aid treatment when patient stabilization is necessary before surgical intervention. Proper occlusal alignment and stabilization of caudal mandibular fractures, pathologic mandibular body fractures or chronic temporomandibular joint luxation may also be achieved with a bilateral bis-acryl composite bridge that bonds maxillary and mandibular canines together. When fabricating the muzzles and bridges, the mouth is kept open slightly (5 to 10 mm in cats and small dogs and up to 20 mm in larger dogs) to permit the tongue to protrude and allow prehension of water and food.

Circumferential Wiring

This is usually performed for treatment of mandibular symphyseal separation or perisymphyseal fractures, which are common injuries in cats with high-rise or hit-by-car trauma. A stab incision is made at the ventral midline in the chin area. A large needle is inserted between bone and soft tissues of the mandible distal to the canines, through which a wire is passed. The needle is then reinserted on the other side and the oral wire end passed through the needle. The needle is removed, and while the symphysis is stabilized in proper alignment, the wire ends are twisted until the lower jaw is stable. The wire is trimmed and bent caudally, so that the skin covers it. The wire should be removed in 4 weeks. Leaving it in place for longer or overtightening it bears the risk of bone and soft tissue necrosis and exposure of canine tooth roots.

Interdental Wiring and Intraoral Splinting
Interdental wiring should be performed prior to splint application. The Stout multiple loop or modified Risdon wiring techniques make use of the gingiva and dental crowns as anchoring points to stabilize and align fracture segments and to provide additional retention surface for splint materials. Wiring should include at least two teeth of each fracture segment. Intraoral splints made of bis-acryl composite are ideal for the repair of jaw fractures where teeth are present for anchorage of the device. The splint material is applied primarily to the lingual surface of mandibular teeth and the buccal surface of maxillary teeth. The teeth are cleaned and polished with pumice, then dried with an air syringe and acid etched with 40% phosphoric acid gel. Selfcuring bis-acryl composite is applied to the teeth via an applicator gun. Once the material has set, the splint is trimmed and polished. The splint is removed by interdental sectioning with a bur and removing the material in segments, using an extraction forceps in a shearing motion. The teeth are then cleaned and polished. Gingival inflammation from splint and wire trauma usually subsides within a few days. [...]