Vet Comp Orthop Traumatol 2014; 27(05): 398-404
DOI: 10.3415/VCOT-14-03-0044
Case Report
Schattauer GmbH

Surgical repair of a severely comminuted maxillary fracture in a dog with a titanium locking plate system

E. Illukka
1   Department of Clinical Sciences, Tufts University School of Veterinary Medicine, N. Grafton, MA, USA
,
R. J. Boudrieau
1   Department of Clinical Sciences, Tufts University School of Veterinary Medicine, N. Grafton, MA, USA
› Author Affiliations
Further Information

Publication History

Received: 17 March 2014

Accepted: 29 June 2014

Publication Date:
22 December 2017 (online)

Summary

A four-year old male Labrador Retriever was admitted with head trauma after being hit by a car. The dog had sustained multiple nasal, maxillary, and frontal bone fractures that resulted in separation of the maxilla from the base of the skull. A severely comminuted left zygomatic arch fracture was also present. These fractures were all repaired using a point contact, locking titanium plate system, in a single procedure that resulted in excellent postoperative occlusion and immediate function. Healing was uneventful. Full function and excellent cosmetic appearance were evident 13 months after surgery. This case illustrates the ease of repair and the success of treatment of severely comminuted maxillofacial fractures by conforming to basic biomechanical principles taken directly from the human experience and successfully applied to the dog; these included multiple plate application along the buttresses and trusses of the facial skeleton. The plate fixation was applied to bridge the multiple fractures along the most appropriate lines of stress. The small size of the plates, and the ability to easily contour them to adapt to the bone surface in threedimensions, allowed their placement in the most appropriate positions to achieve sufficient rigidity and lead to uncomplicated healing without any postoperative complications.

 
  • References

  • 1 Boudrieau RJ, Kudisch M. Miniplate fixation for repair of mandibular and maxillary fractures in 15 dogs and 3 cats. Vet Surg 1996; 25: 277-291.
  • 2 Boudrieau RJ. Miniplate reconstruction of severely comminuted maxillary fractures in two dogs. Vet Surg 2004; 33: 154-163.
  • 3 Arzi B, Verstraete FJM. Internal fixation of severe maxillofacial fractures in dogs. Vet Surg 2014 Feb 11; [Epub ahead of print]
  • 4 Gerlach KL, Pape H-D. Midface fractures. In Härle F, Champy M, Terry BC. editors Atlas of Craniomaxillofacial Osteosynthesis: Miniplates, Microplates, and Screws. Stuttgart: Thieme; 1999: 76-80.
  • 5 Bos RRM. Panfacial fractures: Planning an organized treatment. In Härle F, Champy M, Terry BC. editors Atlas of Craniomaxillofacial Osteosynthesis: Miniplates, Microplates, and Screws. Stuttgart: Thieme; 1999: 85-89.
  • 6 Gruss JS, Phillips JH. Rigid fixation of LeFort maxillary fractures. In Gruss JS, Manson PN, Yaremchuk MJ. editors Rigid Fixation of the Craniomaxillofacial Skeleton. Boston: Butterworth-Heinemann; 1992: 245-262.
  • 7 Manson PN. Organization and treatment in panfacial fractures. In Prein J. editor. Manual of Internal Fixation in the Cranio-Facial Skeleton. Berlin: Springer; 1998: 95-107.
  • 8 Gruss JS. Complex craniomaxillofacial trauma: Evolving concepts in management. A trauma unit’s experience--1989 Fraser B. Gurd Lecture. J Trauma 1990; 30: 377-383.
  • 9 Forrest CR, Phillips JH, Prein J. LeFort I-III fractures. In Prein J. editor Manual of Internal Fixation in the Cranio-Facial Skeleton. Berlin: Springer; 1998: 108-126.
  • 10 Boudrieau RJ. Mandibular and maxillofacial fractures. In Tobias K, Johnston S. editors Veterinary Surgery - Small Animal. St. Louis: Elsevier; 2012: 1054-1077.
  • 11 Boudrieau RJ. Maxillofacial fracture repair using miniplates and screws. In Verstraete FJM, Lommer MJ. editors Oral and Maxillofacial Surgery in Dogs and Cats. Edinburgh: Elsevier; 2012: 293-308.
  • 12 Boudrieau RJ, Verstraete FJ. Principles of maxillofacial trauma repair. In Verstraete FJM, Lommer MJ. editors Oral and Maxillofacial Surgery in Dogs and Cats. Edinburgh: Elsevier; 2012: 233-242.
  • 13 Boudrieau RJ. The Advanced Locking Plate System (ALPS): Design rationale, biomechanics and early clinical use. Proceedings of the 2009 ACVS Veterinary Symposium. 2009. October 8-10 Washington DC, USA: 482-486.
  • 14 Guerrero TG, Kalchofner K, Scherrer N. et al The Advanced Locking Plate System (ALPS): A retrospective evaluation in 71 small animal patients. Vet Surg 2014; 43: 127-135.
  • 15 Reddy LV, Pagnatto M. Midface fractures. In Fonseca RJ, Turvey TA, Marciani RD. editors Oral and Maxillofacial Surgery. Volume II. 2nd ed. St. Louis: Saunders; 2009: 239-255.
  • 16 Reiter AM, Lewis JR, Rawlinson JE. et al Hemisection and partial retention of carnassial teeth in client-owned dogs. J Vet Dent 2005; 22: 216-226.
  • 17 Henney LHS, Galburt RB, Boudrieau RJ. Treatment of dental injuries following craniofacial trauma. Semin Vet Med Surg (Small Anim) 1992; 7: 21-35.
  • 18 Abubaker AO, Papadopolous H, Giglio JA. Diagnosis and management of dentoalveolar injuries. In Fonseca RJ, Turvey TA, Marciani RD. editors Oral and Maxillofacial Surgery. Vol II. 2nd ed. St Louis: Saunders; 2009: 104-138.
  • 19 Flores MT, Andersson L, Andreasen JO. et al Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Dent Traumatol 2007; 23: 6671.
  • 20 Bilgili H, Kurum B. Treatment of fractures of the mandible and maxilla by mini titanium plate fixation system in dogs and cats. J Aust Vet 2003; 11: 671-673.
  • 21 Arens S, Schlegel U, Printzen C. et al Influence of materials for fixation implants on local infection: An experimental study of steel versus titanium in rabbits. J Bone Joint Surg [Br] 1996; 78: 647-651.
  • 22 Arens S, Eijer H, Schlegel U. et al Influence of the design for fixation implants on local infection: experimental study of dynamic compression plates versus point contact fixators in rabbits. J Orthop Trauma 1999; 13: 470-476.
  • 23 Perren SM, Buchanan JS. Basic concepts relevant to the design and development of the Point Contact Fixator (PC-Fix). Injury 29 (Suppl. 02) Suppl 1995; S-B1-4.
  • 24 Tepic S, Perren SM. The biomechanics of the PC-fix internal fixator. Injury 29 (Suppl. 02) Suppl 1995; S-B5-10.
  • 25 Tepic S, Remiger AR, Morikawa K. et al Strength recovery in fractured sheep tibia treated with a plate or an internal fixator: An experimental study with a two-year follow-up. J Orthop Trauma 1997; 11: 14-23.
  • 26 Eijer H, Hauke C, Arens S. et al PC-Fix and local infection resistance--influence of implant design on postoperative infection development, clinical and experimental results. Injury 32 (Suppl. 02) Suppl 2001; B38-43.
  • 27 Schlegel U, Perren SM. Surgical aspects of infection involving osteosynthesis implants: implant design and resistance to local infection. Injury 37 (Suppl. 02) Suppl 2006; S67-73.