Case studies that highlight the importance of timely veterinary dental referrals.
Case 4: Pathologic mandibular fracture
Noninvasive repair is readily accomplished in most mandibular fractures by using existing teeth to construct splints that normalize occlusion and provide stabilization for healing. Pathologic fractures secondary to periodontal disease pose considerable challenges. They occur most commonly because of improper extraction techniques in which periodontal disease has compromised bone to the point of near fracture (Figure 4A). Most occur as a result of failure to obtain radiographs before extraction. These cases always should be referred to a veterinary dentist for definitive care.
In cases of pathologic mandibular fracture, severe bone compromise and an edentulous mandible are often present. Further compromise of bone occurs when plates are used for repair. Tooth roots and inferior alveolar neurovascular damage are common secondary to improper screw placement.
This patient presented 2 1/2 years after repair of a pathologic fracture secondary to an extraction attempt on the left mandibular first molar. Mobility of the plate due to the lack of screw purchase in severely compromised bone resulted in inevitable failure (Figure 4B).
Because of the severe compromise of this patient’s bone (Figures 4C and 4D, see next page), mandibulectomy was the treatment of choice.
Only board-certified veterinary dentists or surgeons should attempt plate placement for any mandibular fracture. Mini-plates are available for this purpose, but splints are the noninvasive procedure of choice. The patient in Figure 4E (a different one than that pictured in Figures 4A-4D) had bilateral mandibular fractures. Both mandibles had only the mandibular canines present. Two circum-mandibular wires were placed rostral and caudal to each fracture site, and a device similar to that in Case 1 was constructed. This case, among others, was presented in detail in “Bilateral mandibular fractures due to periodontal disease,” available at dvm360.com/MandibularFracture.