Authors of section

Author

Anton Fürst

Executive Editor

Jörg Auer

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Fixation using PMMA compounds

1. Preparation and approach

This procedure is performed with the patient placed in dorsal recumbency through the approach to the interdental space.

fixation using pmma compounds

2. Wound debridement

Fractures of the interdental space and horizontal ramus are almost always open fractures. Wound debridement and flushing is extremely important. Nevertheless, infections of soft tissues as well as the bone are common. Therefore, establishment of ventral drainage is important.

In older or infected fractures, wound débridement is important. All infected bone must be removed with a curette or rongeur.
Additional flushing is indicated.

fixation using pmma compounds

3. Surgical technique

Reduction

The fracture is reduced manually.

fixation using pmma compounds

Two to four small incisions are prepared through the ventral aspect of the mandible at different locations of the diastema and pre-mandible and two 2 mm holes are prepared across the bone through each incision.
If additional holes for the wire cerclage are required, they need to be prepared at this point in time.

fixation using pmma compounds

Bilateral interdental wiring is applied, the wire ends partially tightened, and the wire loops in front of the incisor teeth left open.

fixation using pmma compounds

The acrylic compound is then mixed and molded to the area to be reinforced at a thickness of 6 to 8 mm.
Implants that are too thick impair chewing.
The mold should have a U-shape so that the frenulum of the tongue is not restricted.
Cold-curing acrylic is used to prevent thermal tissue damage.

Wires are subsequently threaded through the holes in the jaw and the soft acrylic but not tightened yet. Additionally two wire loops are threaded through the soft acrylic and around the incisor teeth (see arrows).

fixation using pmma compounds

Once the acrylic has hardened the intraoral cerclage wires are tightened.

fixation using pmma compounds

Subsequently the two wire loops around the incisor teeth are tightened as well.

fixation using pmma compounds

Finally, the wire loops in front of the incisor teeth and the wire ends of the interdental wiring are tightened.

mandible horizontal ramus interdental space bilateral

Closure

The four small incisions are closed routinely. In old, infected or open fractures, a drainage should be placed.

fixation using pmma compounds

4. Aftercare

During the post-surgical period, the horse is confined to stall rest for one week and fed with soft fiber feed stuff; firm feed such as hay cubes, apples or carrots should not be fed. Antibiotics and anti-inflammatory drugs are given for 3 to 5 days or longer, if required, especially in open fractures. Intraoral cerclage and tension wires are cleaned once daily until their removal. Wound opening is cleaned and flushed daily with antiseptic solutions.
After the fracture has healed acrylic splint and wire can be removed under sedation and local anesthesia.