Repairing Jaw Fractures in the Field (AAEP 2011)
A veterinarian will wire the fracture back into proper position. Immediately after wire application, the horse will look a bit like he's wearing braces, the metal is quickly covered with acrylic to prevent injury to sensitive lip and gum tissue.
Photo: David A. Wilson, DVM, MS, Dipl. ACVS
Nobody wants to find their horse with a bloody mouth, displaced teeth, and broken, displaced jaw bones. But despite their ghastly appearance most jaw fractures can be repaired relatively easily in a field setting, noted one veterinarian at the recent American Association of Equine Practitioners convention.
David A. Wilson, DVM, MS, Dipl. ACVS, professor of equine surgery at the University of Missouri-Columbia, described the steps in one method of repairing rostral (closest to the front of the nose) jaw and cheek fractures in the field. He presented on the subject at the convention, which was held Nov. 18-22 in San Antonio, Texas.
"Picture a young horse, chewing on things like they always do," Wilson began. "And then, all of a sudden, they end up way over there. A few minutes later, they're thinking 'Damn, I wish I'd opened my mouth first.' " A number of things can cause a horse to flee, even if his teeth are still clamped on a solid object, as Wilson alluded to, and the end result is often a fracture.
Horses, especially young ones, sustain mandible (jawbone) and maxilla (cheekbone) fractures in a number of ways, including biting and pulling back on a stationary object, crashing through or becoming entangled in a fence, and getting kicked by other horses. Although some fractures are evident, others might not be, he explained. Whether subtle or readily apparent, these horses often have signs of anorexia, difficulty eating, quidding (dropping chewed food), ptyalism (excessive salivation), halitosis (bad breath), incisor misalignment, pain and swelling at and around the injury site.
Upon arrival the veterinarian will perform an oral examination and oftentimes, Wilson noted, this is the only evaluation needed to confirm injury and develop a treatment plan. Radiographs are rarely required.
The method of repair Wilson described makes use of just a few pieces of equipment:
- Stainless steel wire;
- Needle holders or pliers;
- Wire cutters;
- Acrylic; and
- A drill.
The veterinarian sedates the horse and administers local anesthesia to numb the affected and surrounding anchor teeth (ones that are not displaced and remain well-rooted to anchor the healing fracture to), he explained. Wilson noted that if the vet needs "improved access" to the mouth, he or she can use a spool speculum or insert a piece of PVC piping between the cheek teeth to accomplish this easily.
Then, using anchor teeth and drilling the occasional hole when necessary, the veterinarian wires the fracture back into proper position. Immediately after wire application, the horse will look a bit like he's wearing braces, however the veterinarian quickly covers the metal with acrylic to prevent injury to the sensitive lip and gum tissue.
Wilson recommended administering three to five days of broad-spectrum antibiotics after surgery ("These fractures are often open with significant contamination," he explained) and one to three days of non-steroidal anti-inflammatory drugs. The horse should also be current on his tetanus vaccination.
He noted that horses typically can return to their normal diet immediately after surgery, however some horses find pelleted feed or "gruel" easier to consume. He also suggested pulling hay flakes apart for easier access (the less pressure the horse needs to place on the healing fracture, such as when pulling hay out of a flake, the better chance the fracture will heal without incident). Finally, he stressed that the owner should not allow the horse to graze for two to four weeks to minimize the use of the incisors (nipping and biting grass).
For the first week, Wilson recommended rinsing the mouth at least twice daily, also checking the steel for breakage.
Barring complications, Wilson said, most fractures heal in four to six weeks and "in most cases, the wires can be removed in the standing horse with minimal sedation." Wilson said that potential complications include:
- Pus drainage;
- Bone sequestration (lack of blood flow to the bone, causing it to "die");
- Septic osteitis or osteomyelitis (inflammation of bone beginning in the periosteum, or the membrane surrounding bone);
- Difficulty chewing;
- Unusual incisor eruption (in horses with still-erupting teeth);
- Wire loosening; and
- Fixation failure.
"Fortunately, the long-term prognosis for functional and cosmetic outcome is favorable," Wilson noted.
Rostral mandibular and maxillary fractures are relatively easy to repair in the field, he concluded, and these injuries have a good prognosis for a full recovery. Rapid veterinary attention can reduce wound contamination and get the horse started on the road to recovery.
About the Author
Erica Larson, news editor, holds a degree in journalism with an external specialty in equine science from Michigan State University in East Lansing. A Massachusetts native, she grew up in the saddle and has dabbled in a variety of disciplines including foxhunting, saddle seat, and mounted games. Currently, Erica competes in eventing with her OTTB, Dorado.
POLL: Colic Surgery