Wednesday, February 13, 2008

All Mandibles

Last Friday I got to do surgery on two broken mandibles (lower jaw). Well, actually, one was a healed mandible.

The broken one was on a cat who had been dragged around like a rag doll by her head. A 8 month old boxer that she lives with was the culprit. She came in the day before with major head trauma. We stabilized her, and the next day she came back much more alert but she looked like hell - her face was all swollen, her eye was bulging, and her jaw was wonky. Cats just have a fibrous symphysis - bone does not go all the way across the middle - and it frequently breaks there. The repair is relatively easy - I placed orthopedic wire across her jaw behind the canine teeth, exited either end of the wire under her chin, and twisted it closed like a bread bag tie. It will come off in 6 weeks. The battered cat ate ravenously a few hours after surgery.

The other patient was a lot more complicated. A coworker saw a dog with a painful mouth in December, and it was obvious her mandible was broken on the lateral side. Her owner claimed she'd been in the backyard the whole time, but an injury like that requires a really forceful blow. She had other injuries consistent with being hit by a car, so I'm sure that's was the cause.

That's the side of her right jaw, just in front of the molar. You can't pin or plate a mandible because all the screws would go right into the roots of the teeth. You can use the remaining teeth as orthopedic pins, placing an acrylic bridge to stabilize the fracture.

That's the simple version. I have been anxious to do a case like this for a long time, so I was so thrilled to try it out. However, the first time I tried to fix it something was wrong with my acrylic, and it wouldn't set up. We tried to call a local dentist to borrow a replacement, but it was Friday afternoon, and all the human dentists were off. We did find one eventually, but by then I had so many different layers on this thing... anyway, it broke the next day. So, I repeated on Monday, starting off this time with the correct product, and got a great reduction of the fracture in less than an hour.

The young guy who owned this dog was less than ideal. First of all, his dog was unspayed and not on heartworm prevention. Also, I told him to feed her a gruel-consistency diet (as in mix canned food with water), then later he told me she couldn't eat the food he was "grinding up." It turned out he was mashing up dry dog food, adding water, and giving that to her.

I was worried he would let her go outside and do something to break her acrylic appliance, so I sent home DETAILED instructions about all the things she was not allowed to do. I also offered him FREE weekly rechecks so I could make sure nothing was going awry. He only came in once, and that was because she had developed an ulcer on the cornea of her eye!

I wanted the appliance to come off after 6 weeks, so we started calling him to schedule the appointment. He usually didn't answer; once he told my receptionist he was too busy and had to work. I called and left him an urgent message, and he finally brought her in 3 weeks behind schedule. Fortunately, her mouth looked good, and her Xray was excellent.

I took off all the acrylic and polished her up. I made her reminders to come in for vaccinations and a heartworm test next month, but realistically I know I probably will never see her again. So I kissed her on her squished little mouth, took a picture, and said goodbye.


EdamameMommy said...

Well, at least you patient seems grateful. What a lil cutie! I like boston terriers. ps ever figure out what was wrong with your acryllic the first go round?

Anonymous said...

I bet you tied the twistie-tie with a counter-clockwise motion, huh?

You are my very favorite sinistral Vet

Good work.

peevish said...

Aw, poor puppy! At least you know you gave her the best care possible.

G in Berlin said...

It's just too bad that pet owners can be so careless of their animals. At least he brought her in and was responsible for the surgery.
I always enjoy reading your blog: being a vet was an earlier (and never realized) dream.

Anonymous said...

What a cute looking Vet - my favorite pic to follow up on your always informative blog.
Love, M

Emily said...

Cool cases as usual. I, too, like the picture of the happy patient and the cute doc at the end.

Michelle said...

How do you keep from taking these poor pups home and telling the irresponsible owners, ", I actually don't know where your dog is. He said he had a ride and he left....sorry."

Jennifer said...

Steph - the acrylic is mixed together in 2 parts, then sets within 6 minutes. The dentist figured there was a small plug on one chamber, so the mixing proportion was all wrong, thus no hardening.

Michelle - yes, we very occasionally want to abduct our cutest and most neglected patients. One of my techs offered to drive by the owner's house and lift her from the back yard when he wouldn't make the recheck appointment.

Leah said...

Look how happy she was. You did a GREAT job on this lil one.

Calvin said...

i have a 6 year old shih tzu and he fractured his mandible today in two places >_< we took him to the vet emergency and they said he'll most likely require surgery but putting plates in his mandible. After reading your post, it seems as though that may not be a good idea.
The vet at the emergency gave us pain medicine for him and told us to put him on the diet you suggested to your other patient. (the one with the canned dog food and water). Are there any solutions to his problem besides the surgery as it is very costly.

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