Fracture of the Maxilla in Dogs
Dr. David Diamond
Examination of the oral cavity and palpation of the skull. Commonly found abnormal findings include broken teeth, disruption of the palate or gum line, hemorrhage from the gum line, palpation of instability of the entire nose in relation to the rest of the skull, crepitation (abnormal "crunchy" feeling with motion), swelling, and pain along the side of the face, or malocclusion (misalignment of the upper and lower teeth). Also, a finding of blood tinged fluid or decreased airflow from one or both nostrils may indicate fracture of the maxillary bones.
A thorough physical examination is very important to make sure your pet is not showing signs of hypovolemic shock secondary to the trauma or blood loss. It is also important to make certain that there are no other injuries present. No laboratory tests are required to make the diagnosis. After stabilization, additional tests may include:
Thoracic radiographs (chest X-rays). Chest trauma, in the form of pulmonary contusions (bruising) or pneumothorax (collapsed lung lobes secondary to free air within the chest cavity), must be ruled-out with chest radiographs prior to anesthesia to repair the jaw.
Complete orthopedic examination. A complete orthopedic examination must be performed to look for other possible injuries in other bones or joints caused by the trauma. Examination involves palpation of all of the bones and joints of each leg for signs of pain or abnormal motion within a bone or joint as well as an assessment of the neurological status of each leg. The thorough orthopedic examination is especially important for an animal that is unable or unwilling to get up and move.
A complete neurological examination. This is extremely important for an animal that has suffered trauma to the head. Damage to the brain and other important nerves in the head may result in temporary or permanent deficits that may need to be treated quickly and must be considered when planning a course of treatment for other injuries, such as a maxillary fractures.
Radiographs of the jaw. Several radiographic view of the animal's skull are used to confirm the diagnosis of maxillary fracture. In order to get useful information from the radiographs, general anesthesia is usually necessary to take the X-rays. Because of the location of the maxilla in the skull, normal radiographs often are not the best method for identifying these fractures. Computed tomography (CT scan) of the skull is a much better way of determining the extent of the fractures and their impingement on the nasal cavity. The CT scan also requires general anesthesia.
Based on the location and severity of the fractures, a more informed discussion with the owner can occur regarding potential treatments, prognosis, and costs.
Emergency care for concurrent problems is paramount. Shock is a frequent result of major trauma and must be treated quickly. Treatment for shock involves intravenous fluid administration to maintain blood pressure and adequate oxygen delivery to the body. Injury to the lungs and chest cavity are also commonly seen after major trauma and may require supplemental oxygenation or removal of free air (pneumothorax) from around the lungs. After stabilization, other treatments may include:
Soft-tissue injuries must be addressed in order to minimize the chance for the development of wound infections. Lacerations and other open wounds or open fractures must be cleaned of debris and covered or closed to minimize infections.
In the interim between treating the emergency patient and surgical repair of the maxillary fracture, all of the orthopedic injuries that have been found should be addressed with splints and/or pain medications to keep the animal comfortable until they can be properly addressed.
Depending on the specific fracture type, location, and age of the animal, maxillary fractures may be repaired in many different ways. Many fractures require no surgical intervention at all. Fractures in which the entire nose is unstable, airflow through the nasal cavity is impaired, or (occasionally) for cosmetic reasons, surgical stabilization of the fractured bones may be necessary. Most commonly, the fractures are stabilized with small wires placed in the bone or around the teeth. In some cases miniature bone plates and screws can be used to reconstruct the shape of the face.
Maxillary fractures, as well as any other traumatic injuries that the animal might have, are painful and the animal will be given analgesics before and after surgery.
Open fractures of the mandible are susceptible to infection from bacteria and other debris in the animal's mouth and antibiotic therapy may be given while the animal is in the hospital and continued at home to prevent systemic infection.