Alternatively, a minimally invasive approach can be used.
Note: External skeletal fixation of the mandible can be done in a closed fashion, with percutaneous pin placement, as long as reduction can be achieved.
The mandible and maxilla should be closed in the desired occlusion. This will align the bones into normal occlusion
The technique uses 26 or 28 gauge wire. The wires are looped around all four canine teeth and twisted together to lock the mouth in normal occlusion.
General considerations for K-wires insertion
The external skeletal fixator is applied to span the fracture site and K-wire placement must avoid the mandibular tooth roots.
At least two percutaneous smooth K-wires should be placed on either side of the fracture margin.
Either a surgical incision or small percutaneous incisions are performed to insert the K-wires.
The K-wires are placed at a 15°-20° angle to enhance purchase of the K-wires in the bone. Smooth K-wires are used to avoid trauma to the neurovascular bundle in the mandibular canal if the K-wires penetrate the canal.
The rostral K-wire closest to the fracture site should be inserted first alternating until all the K-wires are inserted.
K-wires will engage one mandible and not cross over the intermandibular space reaching the other mandible. This is true in application of bilaterally placed external skeletal fixator.
Application of tube and dental acrylic
A silicon tube is placed over the K-wires with at least 2-3 K-wires present on each side of the fracture.
The tube should only be penetrated on one side to avoid the escape of the material.
Dental acrylic or custom tray material is mixed to prescribed consistency and placed into a catheter tip syringe.
It is injected into the tube in the liquid phase.
Dental acrylic or custom tray material is allowed to solidify.
5. Case example
External skeletal fixator applied to repair a mandibular fracture in a dog.
The patient should wear an Elizabethan collar until removal of the construct.
Multimodal analgesia is recommended. Non-steroidal medication for 10-14 days and opioids for the first 5 days post-surgery as needed.
Antibiotic therapy is prescribed for a period of 10-14 days following surgery.
The exposed pins are cleaned at least once daily using 0.12% chlorhexidine gluconate solution. Another option is to use a water-flossing device.
A radiographic recheck is performed every 6 weeks until the fracture is healed.
The external skeletal fixator is removed when the fracture is healed.