Caudal mandibular fractures can have a bilateral comminuted pattern.
Introduction to mandibular fractures
Mandibular fractures can be classified into region of the mandible and severity of the fracture.
Mandible fracture classification
Ramus (including the coronoid process)
Temporomandibular joint (mandibular head of the condylar process)
The mandible is complex because of the interaction of hard, soft tissue and teeth. The majority of the mandibular bone volume is occupied by teeth roots, blood vessels and nerves, making the application of internal fixation difficult.
The periodontal status of the teeth affects the bone quality of the mandible and should be considered when selecting the fracture fixation method.
In the mandible, form and function are interdependent. Minor anatomical malalignment affects the occlusion of the teeth and function.
Fracture comminution and soft tissue damage will affect the repair method chosen.
Imaging allows analysis of fracture patterns and assessment of the fracture complexity. Dental radiography combined with computed tomography (CT) and 3D reconstruction is ideal to assess fracture complexity and dental involvement.
Postoperative CT is recommended to assess the surgical results.
Cone beam CT technology for craniomaxillofacial surgery provides additional precision in 3D planning.
The soft tissue resolution is inferior to conventional CT.
3D printing of the skull provides for precise surgical planning.
The model can be used for:
Prebending of the plate
Evaluation of surgical results
The diagnostic yield of plain skull radiographs is very limited compared to CT. It should only be used alone if CT is unavailable. Diagnostic imaging of the entire skull is recommended because mandibular fractures can be associated with other skull trauma.
MRI or ultrasound can be helpful for soft tissue injuries but are not included in the standard diagnostic work up.
Imaging of caudal mandibular fractures
Radiograph of a gunshot injury of the right caudal mandible of a dog.
3D CT image of a gunshot injury to the right caudal mandible of a dog.
Clinical signs of caudal mandibular fractures
Clinical signs of caudal mandibular fractures include:
Soft tissue trauma
Dysfunction and pain when eating
Pain on palpation
Caudal mandibular fractures typically result in pronounced malocclusion, and disfigurement due to mandibular drift. For unilateral fractures, drift typically occurs to the side of the fracture due to masticatory muscles acting on the bone.
Moderate to severe bleeding may occur if the inferior alveolar artery and vein are damaged.
Soft tissue trauma is seen as most caudal mandibular fractures are open. The degree of the soft tissue trauma in bone fractures depends on the inciting factors.