Page 126 - Manual of Equine Field Surgery

CHAPTER 20

lntraoral Wire Fixation of Rostral Mandibular

and Maxillary Fractures

David A. Wilson

lated feed material, and the area surrounding the
INDICATIONS
fracture site is scrubbed with povidone-iodine

soap and rinsed again. If a wire will be passed

Fractures of the rostral mandible, maxilla, and around the premolars, stab incision sites are

incisive bones that can be repaired with wire and/ clipped and prepared aseptically.

or acrylic. Only fractures that can be readily

repaired with stainless steel wires are discussed.

ANATOMY

EQUIPMENT The primary structures potentially involved in the

repair of these fractures are the maxilla, incisive

Stainless steel wire (16 or 18 gauge), needle bone, incisive part of the mandible, incisors,

holders or pliers, wire cutters, acrylic, and drill. A canine teeth, mental and infraorbital nerves,

spool speculum or section of PVC tubing placed intermandibular synchondrosis, and permanent

between the cheek teeth improves access to the tooth roots. The permanent incisors, canines, and

oral cavity. Ideally, a nasotracheal tube is also premolars are formed from separate enamel

placed during the surgery to facilitate breathing. organs that are derived from lingual (medial)

extensions of the dental laminae of the deciduous

teeth.1 The permanent incisors erupt on the

POSITIONING AND PREPARATION lingual aspect of the deciduous incisors.

The mental nerve emerges from the mental

Simple fractures involving one to three incisors foramen on the rostrolateral aspect of the hori-

can be repaired in the standing, sedated horse zontal rarnus, approximately midway between the

with local anesthesia. Mental and infraorbital second premolar and the third incisor, A smaller

nerve blocks provide effective regional anesthesia portion of the mental nerve continues rostral in a

in these cases. Alternatively, local anesthesia can smaller canal along with the vasculature of the

be used. Fractures involving the interdental space lower incisors.1

are more commonly repaired under general anes-

thesia in either lateral or dorsal recumbency

depending on fracture configuration. Antibiotics PROCEDURE

and nonsteroidal antiinflammatory agents are

administered prior to surgery. Ideally, a nasotra- Various methods have been described to repair

cheal tube is placed to protect the airway. The fractures of the rostral mandible and incisive

mouth is rinsed with water to remove accumu- bone.2-12 The first step of the surgery is thorough

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