Examining mandibular problems in a dog
The first in a series chronicling the progression of periodontal bone destruction resulting in mandibular fractures in a dog
Nov 01, 2010
An appointment was scheduled for later that month.According to the clients, the patient did well three days after the extractions by the referring veterinarian. But on the third day, he escaped and roamed unattended outdoors for a few hours before he was found. For the next two days he was anorectic. The patient was brought back to the referring hospital, and a right mandibular fracture was found in the region of the previously noted swelling. Referral was then expedited to our next available appointment.
Patient evaluation and diagnosis
Neoplasia is always a consideration, but the radiographs suggested a characteristic infrabony defect mesial to the mesial root of tooth 409 at the fracture site characteristic of a periodontal cause. Periodontal bone loss was severe in all four quadrants, further supporting a periodontal etiology. It is likely this patient had a pathologic mandibular fracture in the past with partial healing and stabilization. Concurrent focal osteomyelitis may also have played a role. In any case, this would create an ideal environment for refracture.
Edentulous pathologic mandibular fractures generally pose a challenge. In this case, tooth 409 required extraction before fracture repair, because leaving this tooth within the fracture line would beg failure. Traditional bone plates are usually poor options because of their intrusion on the mandibular canal and the presence of compromised bone density. External coaptation is generally futile for similar reasons. Interdental wiring or acrylic splints can be used to form the basis of primary repair only if adequate dentition is present surrounding the fracture site. Without teeth, creative measures are often needed to avoid mandibulectomy. In this case, a novel, malleable, titanium mesh material was chosen for primary repair.