Craniomaxillofacial Trauma in Dogs—Part II: Association Between Fracture Location, Morphology and Etiology

Abstract

Treatment of craniomaxillofacial (CMF) trauma in dogs requires a thorough understanding of the CMF skeletal structures involved. The human medical literature has several examples of CMF trauma and fracture classification, including the classically described Le Fort fractures. The recent classification schemes require large studies using computed tomography (CT). In the veterinary medical literature, such studies are lacking. The aims of part II of this retrospective study were to use a large number of CT studies of dogs evaluated for CMF trauma to determine whether specific fracture locations in the CMF region occur concurrently, and whether trauma etiology influences fracture morphology. This information may then be used to form a fracture classification scheme in the future. The medical records and CT studies of 165 dogs over a 10-year period were evaluated. The skeletal location of CMF fractures as well as the severity of displacement and fragmentation of each fracture was recorded. Dogs' demographic data and trauma etiology were also recorded. Fractured portions of the mandible tended to occur with fractures of adjacent bones, with the major exception of symphyseal separation, which occurred simultaneously with fractures of the cribriform plate. Fractures of the maxillary bone were accompanied by many concurrent fractures affecting the majority of the midface, skull base, and cranial vault. When the zygomatic bone was fractured, the other bones comprising the orbit also tended to fracture. Fractures of the relatively superficially located frontal and nasal bones were often accompanied by fractures of the skull base. Fracture etiology influenced fracture morphology such that vehicular trauma resulted in a relatively higher number of severely displaced and comminuted fractures than did other trauma etiologies. This study provides examples of fractures that, when found, should prompt veterinarians to look for additional injuries in specific locations. In addition, it further highlights the need for thorough CT evaluation of the entire CMF region, even when clinically apparent fractures appear relatively superficial.

Agreement of Magnetic Resonance Imaging With Computed Tomography in the Assessment for Acute Skull Fractures in a Canine and Feline Cadaver Model

“…The overarching goal of this and similar studies is to identify instances where MRI can be used in lieu of CT to provide adequate concurrent assessment of traumatic brain injuries and associated fractures of the cranial vault. Despite the good diagnostic performance of MRI in facial fracture assessment in this study, CT will likely remain the gold standard for imaging of animals with maxillofacial trauma, especially when planning surgical interventions (38,39). MRI had least agreement with CT in the detection of TMJ fractures.…”

Surgical Treatment and Outcome of Acquired Midline Palate Defects in Cats

“…The separation of the median palatine suture occurs frequently with fractures of the orbit, nasopharynx, and nasal bones ( 2 ). In the presence of maxillofacial/head trauma, a CT is recommended for full assessment of any fractures ( 2 , 4 , 10 ). The cats that had CT performed in this study presented with more severe clinical findings which explains the association found between CT imaging and the presence of more severe head injury, orbital or ocular injury, symphyseal separation, and placement of a feeding tube.…”

“…The hard palate is formed by the paired incisive, maxillary, and palatine bones that are fused together at the intermaxillary suture. The separation of the median palatine suture or fracture of the bones of the hard palate occurs frequently with multiple and bilateral fractures of the midface (incisive bone, maxilla and palatine bone, orbit, zygomatic arch, and nasopharynx) ( 2 , 4 ). Dental, ocular, and neurologic injuries also are common.…”

Application of a bilateral temporal fascia free graft in a dog with multifragmented frontal sinus and nasal bone fracture

“…The best treatment, conservative or surgical, should be chosen after an attentive evaluation of the extension of the lesions. Computed tomography allows excellent visualization of bone defects, soft tissue damage, and the detection of the presence of foreign bodies and hematomas 1,17,18 . It also permits 3‐dimensional reconstructions that are useful for surgical planning 17,19 .…”