MAY 2009: OSCAR

Oscar is an 11-month-old, neutered male, shih tzu that presented with a rostral mandibular fracture that occurred during a dog fight several days previously. He was referred to the hospital for consultation and evaluation of the fracture. The recommendations were anesthesia for evaluation including radiographs with fixation to follow as appropriate.

After an intravenous catheter was placed, Oscar was anesthetized with propofol and maintained on isoflurane throughout the procedures. A full regimen of multimodal pain management was implemented before, during and post therapy. The radiographs showed a vertically oriented, oblique fracture of the right hemimandible with symphyseal separation. The fracture was centered at the level of tooth #405 (right mandibular 1st premolar). The initial repair by the referring veterinarian was done with 22ga orthopedic wire. After removal of the wires, a single cerclage wire was placed around the fracture immediately cranial to #405 and another single cerclage wire was placed around the rostral mandible immediately rostral to the canine teeth. The fracture was stable to palpation following wire placement and alignment appeared adequate. Post-op radiographs were obtained and fracture alignment and implant placement appeared appropriate. Interdental bridging material was then placed over the teeth spanning the fracture and symphyseal separation for additional fracture stabilization. Following extubation, occlusion appeared smooth and free of impingement.

Medications had been dispensed by the referring physician and would be continued by the owner at home.

The 2-week recheck showed a good occlusion with materials intact and minor gingival inflammation along the buccal aspect of teeth #405 and 406. No evidence of any complications from the orthopedic wire was seen and the patient appeared comfortable on oral exam with good stability of the mandible. At 4 weeks, Oscar was sedated with a combination of butorphanol and Domitor®. The oral radiographs showed a bony union evident at the fracture line. The interdental acrylic material was removed along with the wires. The fracture was palpably stable; tooth #405 was removed during the removal of the bonding material. The roots of the adjacent teeth appeared to be unaffected radiographically. The recommendations at this point were to continue with limited chewing for an additional 2 weeks, then return to normal function. No further rechecks would be needed.