Abstract
Treatment of craniomaxillofacial (CMF) trauma in dogs requires a thorough understanding of the CMF skeletal structures involved. The human medical literature has several examples of CMF trauma and fracture classification, including the classically described Le Fort fractures. The recent classification schemes require large studies using computed tomography (CT). In the veterinary medical literature, such studies are lacking. The aims of part II of this retrospective study were to use a large number of CT studies of dogs evaluated for CMF trauma to determine whether specific fracture locations in the CMF region occur concurrently, and whether trauma etiology influences fracture morphology. This information may then be used to form a fracture classification scheme in the future. The medical records and CT studies of 165 dogs over a 10-year period were evaluated. The skeletal location of CMF fractures as well as the severity of displacement and fragmentation of each fracture was recorded. Dogs' demographic data and trauma etiology were also recorded. Fractured portions of the mandible tended to occur with fractures of adjacent bones, with the major exception of symphyseal separation, which occurred simultaneously with fractures of the cribriform plate. Fractures of the maxillary bone were accompanied by many concurrent fractures affecting the majority of the midface, skull base, and cranial vault. When the zygomatic bone was fractured, the other bones comprising the orbit also tended to fracture. Fractures of the relatively superficially located frontal and nasal bones were often accompanied by fractures of the skull base. Fracture etiology influenced fracture morphology such that vehicular trauma resulted in a relatively higher number of severely displaced and comminuted fractures than did other trauma etiologies. This study provides examples of fractures that, when found, should prompt veterinarians to look for additional injuries in specific locations. In addition, it further highlights the need for thorough CT evaluation of the entire CMF region, even when clinically apparent fractures appear relatively superficial.
Highlights
Over a century has passed since the studies performed by Rene Le Fort in 1901, who demonstrated that fracture morphology and location are often closely related to trauma etiology [1]
As we demonstrated in Part I, fracture location does tend to change based on etiology, but the resultant fracture morphology has yet to be reported
The number of significant associations varied according to the primary fracture location being examined, with some fracture locations only being associated with a single additional fracture location while others were associated with several additional locations
Summary
Over a century has passed since the studies performed by Rene Le Fort in 1901, who demonstrated that fracture morphology and location are often closely related to trauma etiology [1]. As in the human craniomaxillofacial (CMF) skeleton [2], the bones and anatomy of the canine CMF skeleton have many complex structures and interdigitations Given this complexity, it is likely that neighboring bones will be fractured simultaneously as a result of trauma. Fracture of the pterygoid bones is a feature of all Le Fort fractures and, when noted, should immediately prompt the clinician to look for evidence of additional fractures. No such indicators exist for dogs that have sustained CMF trauma, and the potential usefulness of such indicators is evident
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