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Equine field surgery: Head and neck surgery (Proceedings)

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Aug 01, 2010

Head & Neck Surgeries

     Lip lacerations
     • Intra-oral wire fixation of rostral mandibular and maxillary fractures
     • Tracheotomy
     • Tracheostomy
     • Staphylectomy (Partial resection of the soft palate)
     • Sternohyoideus myectomy and sternothyroideus tenectomy
     • Modified Forssell's Operation for Cribbing

Rostral Mandibular & Maxillary Fractures

     • Indications    – Fractures of the rostral mandible and premaxilla/incisive bones that can be repaired with wire or acrylic.
     • Equipment    – 16 or 18 gauge stainless steel wire
                            – needle holders or pliers
                            – wire cutters
                            – Acrylic
                            – Drill
     • Ideally, a nasotracheal tube is placed during the surgery

     Anatomy
     • The structures potentially involved are:
          – premaxilla (incisive bone)
          – incisive part of the mandible
          – Incisors
          – canine teeth
          – mental and infra-orbital nerves
          – the intermandibular synchondrosis
          – permanent tooth roots

Surgical procedure

     • Thorough debridement of the fracture site
     • Maintain loose deciduous teeth if possible
     • "freshen" the edges of exposed bone with a bone curette
     • Fractures that involve 4 or fewer incisors can generally be repaired with cerclage wire fixation techniques
     • A minimum of two loops
     • wires should engage a minimum of three teeth
     • Ideally, there should be overlap
     • A 14-16-gauge hypodermic needle or 2.0 mm drill hole used as a guide
     • wires are bent flat +/- covered with acrylic
     • When necessary, additional stabilization can be achieved by securing the corner incisor(s) to the exposed canine or second premolar

Post-operative management

     • Generally no problems eating, but a pelleted feed or gruel may be of benefit
     • Rinse mouth at least 2X/day for the first week
     • Consider antibiotic therapy
     • NSAIDs are typically administered for 1-3 days
     • No grazing for 2-4 weeks
     • Check wires regularly for breakage

     Complications • purulent drainage
     • bone sequestration
     • septic osteitis
     • difficult mastication
     • unusual incisor eruption
     • wire loosening
     • fixation failure