Page 958 - Cote clinical veterinary advisor dogs and cats 4th

469.e4 High-Rise Syndrome

Pratschke M, et al: High rise syndrome with impale- RELATED CLIENT EDUCATION How to Provide General Postoperative Care
ment in three cats. J Small Anim Pract 43:261-264, SHEETS at Home, Especially Lifting or Picking Up
2002.
VetBooks.ir Vnuk D, et al: Feline high-rise syndrome: 119 Consent to Perform Abdominal Ultrasound How to Use and Care for an Indwelling Feeding
a Pet, and Pain Control
cases (1998-2001). J Feline Med Surg 6:305-312,
Tube
Consent to Perform Radiography
2004.
Whitney WO, et al: High-rise syndrome in cats. J
at Home
Am Vet Med Assoc 191:1399-1403, 1987. How to Provide Bandage Care and Upkeep AUTHOR: Claire R. Sharp, BVMS, MS, DACVECC
EDITOR: Benjamin M. Brainard, VMD, DACVAA,
DACVECC
High-Rise Syndrome, Orofacial Client Education
Sheet

BASIC INFORMATION between mesiobuccal and mesiopalatal TREATMENT
crown-root segments), and mandibular first
Definition molars Treatment Overview
Triad of orofacial, thoracic, and limb injuries • Temporomandibular joint subluxation, • Stabilize animal, especially upper and
sustained by an animal that falls from a height luxation, or fracture lower airways and cardiovascular system
of one or more stories. The term orofacial high- • Zygomatic arch fracture (hypotension/blood loss).
rise syndrome was originally coined in reference • Facial wounds • Preserve normal anatomic structure and func-
to cats and associated primarily with falls from • Orofacial abrasions and hematomas tion. Orthopedic manipulations or surgical
a height of two or more stories. Systemic procedures may initially need to be delayed,
effects of high-rise syndrome are discussed Etiology and Pathophysiology with adjunctive pain control, if the patient
separately. • Jumping during play or while chasing a is unstable at the time of presentation.
squirrel, bird, insect, or other animal
Epidemiology • Slipping while walking on the edge of a Acute General Treatment
SPECIES, AGE, SEX balcony railing or window • Initial treatment for shock (fluid therapy)
Predominantly affects cats < 3 years old and • Range of heights fallen by surviving cats and thoracic injury (thoracocentesis for
dogs < 5 years old. There is no sex predisposi- (2-32 stories) is high compared with those pneumothorax) if needed followed by
tion in either species. fallen by dogs (1-6 stories), probably because orthopedic/neurologic exam. Further treat-
most dogs do not survive falls from distances ment, if sedation or general anesthesia is
RISK FACTORS higher than 6 stories. required, depends on the successful outcome
• Urban areas of this initial stabilization.
• Tall buildings DIAGNOSIS • Surgical treatment of skeletal injuries
• Open windows and balcony doors; roofs • Mandibular symphyseal separation/
Diagnostic Overview parasymphyseal fracture: circumferential
GEOGRAPHY AND SEASONALITY The combination of history and characteristic wiring begins with a stab incision at the
Falls occur more frequently in summer, followed lesions on physical exam is diagnostic. The ventral midline in the chin area through
by autumn, when windows and balcony doors extent of diagnostic imaging performed for a which an 18- or 20-gauge needle is inserted
are open and outdoor play is a factor. case depends on the distribution and severity of and advanced between bone and soft tissues
lesions; most cases require thoracic radiographs of the mandible distal to the canine tooth
Clinical Presentation to assess for pneumothorax, pulmonary contu- on one side. A 20- or 22-gauge orthopedic
DISEASE FORMS/SUBTYPES sions, and chest wall injuries. wire is passed through the needle opening.
Triad of craniofacial, thorax, and limb injuries; The needle is removed and reinserted on the
focus in this chapter is on orofacial injury. Differential Diagnosis other side, and the oral wire end is again
• Hit-by-car trauma passed through the needle opening. The
HISTORY, CHIEF COMPLAINT • Hit by a blunt object needle is removed, and while the lower jaw
• Known fall from windowsills, narrow ledges, • Kicked by an ungulate animal is held in proper alignment, the wire ends
balconies, and roofs • Fights with other animals are tightened. The wire twist is trimmed and
• Encounter of animal with typical injuries in • Foreign-body penetration bent caudally under the skin. Healing of
location consistent with prior fall • Gunshot trauma the injury is sufficient after about 4 weeks
• Animal abuse so that the wire can be removed.
PHYSICAL EXAM FINDINGS • Extraction of teeth with pulp exposure or
Typical craniofacial findings: Initial Database displacement injury
• Mandibular symphysis separation and • Orthopedic and neurologic exam (pp. 1143 • Fresh midline separation of the hard palate:
perisymphyseal fracture (malalignment in and 1136) elevation of medially positioned flaps with
the mandibular incisor area) • CBC, serum biochemistry panel, urinalysis full-thickness releasing incisions made into
• Separation of soft and hard tissues of the • Full-mouth (intraoral) dental radiographs palatal mucoperiosteum 1 mm away from
hard palate (with or without extension into • Radiographs of the head, temporomandibular the teeth along the dental arches (unilateral
soft palate and malalignment in the maxillary joints, and tympanic bullae or bilateral, depending on the extent of
incisor area) • Radiographs of thorax, abdomen, spine, separation), followed by approximation of
• Epistaxis pelvis, and limbs, as appropriate the displaced bony structures with digital
• Fractured maxillary canines (crown fractures pressure and suturing of the torn palatal
with or without pulp exposure), maxillary Advanced or Confirmatory Testing soft tissues in a simple interrupted or
fourth premolars (traumatic hemisection CT of head and spine, as appropriate horizontal mattress pattern. If the separation

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