Mandible and maxilla fracture repair (Proceedings)

Mandible and maxilla fracture repair (Proceedings)

Aug 01, 2009

The main goal of fracture repair is to regain a normal and comfortable occlusion. Good fracture healing without good occlusion is not acceptable. Teeth in a fracture line will usually need to be extracted. If a tooth is in the fracture line of a pathologic fracture it must be extracted. Orthopedic wire can be used to bring the fracture to proper alignment.

Dental acrylic is used as a splint in treating mandible and maxilla fractures. The fracture site is cleaned and boney fragments removed. The teeth are acid etched after cleaning. The acrylic is applied to the etched teeth. Stainless steel wire is incorporated into the acrylic. The wire is tied around and in the acrylic.

If IM pins are used to repair oral fracture it is very important they are not placed into teeth. This will kill the teeth and may cause a not healing wound.

The types of dental acrylics are Duralay, Jet-acrylic, Maxitemp and Protemp gurant. Jet-acrylic will generate much heat so it can not be formed in the mouth. This not used very much in veterinary dentistry any more. Duralay is a powder and liquid that can be formed in the mouth. Maxitemp and Protemp are in a syringe applicator and can be applied directly to the teeth. These two products do not produce any heat. They are very easy to use. Once the acrylic has hardened, it smoothed and shaped with an acrylic bur. These can be removed in 4-6 weeks. Some patients may need to have a feed tube placed. Tape muzzles may also be used to help with stability. The acrylic is removed with acrylic or high speed burs. The soft tissue may be irritated underneath the splints when removed, this heals very quickly. Flushing the mouth with an antiseptic rinse will help minimize this.

TMJ luxations can be repaired by bonding the canine teeth together allowing enough room to allow the patient to lap gruel for nourishment or a feeding tube can be placed. Most animals tolerate the splints very well.