What are some examples of intra-oral fixation techniques?
Cerclage wiring, steinmann pins, screws, u bar, dental acrylic, plates
What is cerclage wire fixation used for?
Dental fractures of the rostral mandible and maxilla
What are the techniques for applying cerclage wire?
wiring teeth in a figure 8 fashion from left to right or overlapping wire loops (obgeweser technique)
How does cerclage wire fixation change with the location of the fracture?
When the fracture is more caudal the fixation may need to incorporate the canines or the premolars
What are the advantages and disadvantages of cerclage wire fixation?
A= easy, versatile, inexpensive D= loosening of wires, getting exposure to certain fracture
When are steinmann pins used?
Fractures of diastema, usually in foals, rarely as a sole fixation. Pin can damage tooth buds
When are screws used?
Symphysis or oblique fractures or to anchor cerclage wire in the diastema
When is a u bar used?
Very unstable fractures
How is a u bar used?
Bar is fixed in place with wire loops around the incisors and around the pre- and molars
What is the benefit of dental acrylic?
Serves as a buttress & enhances stability
Where can plates be applied
To bone or teeth
What is a disadvantage of using plates for maxilla/ mandible fixation?
Tension side is the occlusal surface so the plates is not applied to the biomechanically ideal location
What are some examples of extra-oral fixation techiniques?
External fixator, pinless external fixator
What are the 2 types of external fixators?
Type 1 has 1 longitudinal bar & 4-5 schanz or intermedullary screws inserted in 1 ramus (mandible) or maxilla. Type 2 has through and through steinmann pins in both rami or mandible or maxilla and bilateral longitudinal fixation bars
What are the components of the pinless external fixator?
asymmetric clamps, large and small symmetric clamps, adjustable connecting bars, and longitudinal connecting rod
How many clamps should be applied to the pinless external fixator?
What is the post-operative management for mandible/ maxilla fractures?
Monitoring (discharge, pain, swelling, odor, fever, dysphagia), clean mouth daily, follow-up rads 6-12 weeks
What is the biggest post-operative complication for maxilla/ mandible fractures?
Infection, especially when compounded by instability
What is the prognosis for mandible/ maxilla fractures?
Good. Foal > adults, 1 ramus > both, rostal > caudal
What is the prognosis for skull fractures?
Good depending on location, those near/ involving cranium can be fatal
What are some methods of skull fracture repair?
Elevation (+/- Richards bone hook), cerclage wiring of fragments & adjacent bone, contour bone plate for unstable depressed fracture
What are the indications for skull reconstruction procedures?
Fractures with bone defects
What are the 2 types of reconstruction procedures?
Periosteal flap - prepared in area of bone defect with base near edge of defect, flap inverted, pulled over defect & sutured to other flap or opposite periosteum. Muscle flap- muscle dissected & transected at tendon of insertion, rotated over defect, sutured.
What are some complications post-operative for skull fractures?
Trauma leading to fixation failure, disfigurement, infection