For most mandibular and maxillary fractures, the horse is placed in dorsal recumbency because this allows access to both sides of the head. For all other fractures, the position of the horse depends on the location of the fracture. The teeth are often involved in fractures and this presents a special problem, especially when the alveoli of the incisors or cheek teeth are involved.
2. Preparation for surgery
The head region involved is generously clipped and surgically prepared. The oral cavity is thoroughly cleaned and rinsed.
General anesthesia with the horse in dorsal recumbency is suitable for most situations.
Less invasive procedures such as intraoral wire fixation of rostral fractures involving the incisors are commonly carried out in the standing, sedated horse. Alveolar and infraorbital nerve blocks provide regional anesthesia for these cases.
If manipulations inside the mouth are required, intubation is carried out through the nose. The mouth is held open using an appropriate mouth gag that does not apply any pressure on the fracture site(s); wedges made from hard rubber or plastic placed between the cheek teeth not involved in the fracture work well for this purpose.
As with other head fractures, the full extent of the lesion may only become apparent during surgery, and therefore the surgical team should be prepared for all eventualities. This includes preparation for intraoperative imaging, orthopedic measures as well as dental procedures.
In complicated cases requiring intraoperative imaging, the horse should be positioned accordingly; fluoroscopy is well suited for such cases.
The range of instruments that should be available to the surgical team is considerable and includes instruments for orthopedic procedures and wire fixation, a drill with special drill bits for dental drilling, various surgical plates and screws, as well as arthroscopy equipment for intraoral examination. Grinding tools are often required to lower the occlusal surface of the incisor teeth to decrease pressure on the fracture site during eating while the fracture is healing. Dental extractors should also be available.