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| Bailey on presentation with
broken jaw |
Bailey is a 10 year old, 6.6 pound toy poodle
who presented to us a few weeks back with a possible fractured jaw.
Bailey had been taken to a local grooming salon for his monthly bath
that day and the groomer offered to have a "non anesthetic" dental
cleaning performed by a dental hygienist while he was at the shop.
The owner advised the groomer that Bailey wasn't very cooperative and
would probably give the hygienist a hard time, but he was assured that
everything would be fine. Later in the day, when he picked up
Bailey, after having paid for the grooming and dental work, the
hygienist informed the owner that the dog may have dislocated his jaw
and that they should take him to a veterinarian.
On presentation, Bailey was very agitated and
painful, so much so that we had to sedate him to examine the jaw.
Once sedated, it was clear that the jaw was completely broken in two
places. The teeth were still full of tartar and there were
multiple teeth that were abscessed and in need of extraction.
We took radiographs of the jaw and teeth and
discussed options with the owner. Due to all of the infections
surrounding the teeth, the quality of the jaw bone was very weak.
Given the age of the dog, the presence of overt infection and the poor
bone quality, the prognosis for being able to fix this jaw was very
guarded. The owners wanted to do whatever we could to save
Bailey's jaw, so we prepared him for surgery the next day.
Standard pre operative bloodwork was unremarkable and we felt confident
that the surgery could be performed safely, even if we were uncertain
whether the bone would eventually heal.
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| severe periodontal disease |
Open Fracture site |
Fracture from side view |
Bailey was anesthetized and the Jaw and face
were shaved and cleaned in preparation for surgery. A full
dental cleaning was performed and 14 teeth had to be extracted due to
excessive bone loss from advanced periodontal disease.
 Because
the bones were so fragile, we could not repair them with a bone plate,
instead, an external fixator device was constructed using surgical pins
and epoxy to keep the bones aligned in order for them to heal in a
functional manner. Since there was such poor bone quality
and missing bone at the area of the fracture, we introduced a synthetic
bone graft material, called velosity. This is a product which acts
as a scaffolding for new bone to grow across moderate sized defects.
Pins were placed across the entire jaw and connected with a ring of fast
setting epoxy to create a stable construct which would immobilize the
bone fragments. In addition, the jaw was wired to the upper
maxilla to prevent any motion of the bones and to prevent attempts at
chewing.
With the apparatus in place, there would be no
way for Baily to eat, so we introduced an esophagostomy tube into the
left side of the neck. This is a soft rubber tube which is
inserted into the esophagus, down to the level of the stomach. The
tube is wide enough that soft, blenderized food can be squirted down it
to make certain that Bailey gets enough food during the 8 week recovery
phase.
Bailey was discharged a few days later with
antibiotics and pain medication. He has an elizabethan collar
around his head to protect the fracture site. We are now 6 weeks
post op, and Bailey has been coming in once a week for inspection.
His surgical implants are stable and there is no sign of infection.
We will be taking radiographs again at 8 weeks to see if the fracture
has healed. It is possible that it may take even longer, but for
now things are looking promising.
Non Anesthetic teeth cleaning is being offered
by many groomers, and this case shows an excellent example of why it
should not be considered. Equally important, is the fact that
"cleaning" the teeth without anesthesia cannot achieve the goal of truly
cleaning the teeth on all sides and particularly beneath the gum line
where periodontal disease is slowly destroying the teeth and bone. When
we perform a dental cleaning, the patient is safely anesthetized with
isoflurane gas. Under anesthesia, we have the ability to
radiograph the teeth (x-ray), determine what, if any problems are
occurring below the gum line, and then clean each tooth on all 5 sides.
We are able to probe below the gum line and currette away any sub
gingival tartar. Pets are placed on prophylactic antibiotics due
to the potential for shedding of bacteria into the bloodstream during
the procedure. Owners who have this procedure done get a
false sense of security that their pet's dental needs are being taken
care of, when, in fact, they are not, which may ultimately lead to
further decay, tooth loss and even bone fractures.
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