Authors of section

Author

Boaz Arzi

Executive Editor

Amy Kapatkin

General Editor

Frank Verstraete

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Maxillomandibular fixation

1. Principles

Restoring and maintaining occlusion is the primary goal of fixation of the rostral midface. This can be achieved by bonding the maxillary and mandibular canine teeth to each other. If possible, other methods should be used to allow earlier return to normal function.

2. Positioning and approach

This procedure is performed through the intraoral approach to the hard palate, with the patient placed in dorsal recumbency or in sternal recumbency.

3. Debridement

Gentle debridement followed by copious irrigation with sterile saline 0.9% is performed. Suturing of soft tissue lacerations is done using 4.0 or 5.0 poliglecaprone 25 in a simple-interrupted fashion.

Placement of an esophagostomy tube is required prior to bonding of the canine teeth.

4. Bonding of the canine teeth

The canine teeth are cleaned, acid-etched for 20-30 seconds and then rinsed with water.

maxillomandibular fixation

The teeth are dried and placed in correct dental occlusion. The canine teeth should be positioned overlapping each other by approximately one half of the length of the crown, allowing enough space for eating, drinking, and movement of the tongue.

maxillomandibular fixation

A composite temporization material is applied covering the canine teeth forming two pillars.

maxillomandibular fixation

Note: Care should be taken to avoid sharp edges or points.

Once the composite solidifies, it should be smoothed with a Goldie bur on a surgical handpiece, or a diamond bur on a high-speed handpiece.

maxillomandibular fixation

5. Aftercare

The dog should be kept on soft food for one or two weeks after surgery.

Intraoperative intravenous administration and then oral antibiotics for one to two weeks is recommended. Antibiotics used should have an excellent oral cavity penetration and spectrum. Example: ampicillin at 20 mg/kg intravenous antibiotics followed by oral antibiotics amoxicillin/clavulanic acid at 15-20 mg/kg orally twice daily.

Pain medication, such as opioids and non-steroidal anti-inflammatory medications, are used for 7-14 days.

If the fracture involved the oral cavity, oral rinse with 0.05-0.12% chlorhexidine gluconate solution is recommended (not for maxillomandibular fixation).

Recheck is recommended in 10-14 days and at three and six months post-surgery.

If there are any signs of complications (i.e. purulent nasal discharge), CT and rhinoscopy are indicated.

Recheck is recommended in 10-14 days and at three and six months post-surgery.

If there are any signs of complications (i.e. purulent nasal discharge), CT and rhinoscopy are indicated.

Homecare

The splint should be cleaned twice daily using 0.05-0.12% chlorhexidine gluconate solution. Another option is to use a water-flossing device.

The composite with or without wires are kept in place for six to eight weeks. They are removed under general anesthesia using debonding pliers.

maxillomandibular fixation

The teeth involved in the fixation require periodontal cleaning. Moderate to severe gingivitis is commonly seen with the presence of an intraoral splint.

intraoral splint fixation