Feline head trauma: a CT analysis of skull fractures and their management in 75 cats.

Rebekah Knight,Richard L Meeson

doi:10.1177/1098612x18819183

Abstract

The aim of this study was to describe and evaluate the configurations and management of feline skull fractures and concurrent injuries following head trauma. Medical records and CT images were reviewed for cats with skull fractures confirmed by CT that were managed conservatively or with surgery. Details of signalment, presentation, skull fracture configuration, management, re-examination, and complications or mortality were recorded and analysed. Seventy-five cats (53 males, 22 females) with a mean age of 4.8 ± 3 years met the inclusion criteria. Eighty-nine percent of cats had fractures in multiple bones of the skull, with the mandible, upper jaw (maxilla, incisive and nasal bones) and craniofacial regions most commonly affected. Temporomandibular joint injury occurred in 56% of cats. Road traffic accidents (RTAs) were the most common cause of skull fractures, occurring in 89% of cats, and caused fractures of multiple regions of the skull. RTAs were also associated with high levels of concurrent injuries, particularly ophthalmic, neurological and thoracic injuries. A more limited distribution of injuries was seen in non-RTA cats. Equal numbers of cats were managed conservatively or surgically (47%). Mortality rate was 8% and complications were reported in 22% of cats. Increasing age at presentation and presence of internal upper jaw fractures were risk factors for development of complications. No risk factors were identified for mortality. RTAs were the most common cause of feline skull fractures and resulted in fractures in multiple regions of the skull and concurrent injuries occurred frequently. Problems with dental occlusion were uncommon post-treatment. An increased risk of implant loosening and malocclusion was seen with palatine and pterygoid bone fractures and hard palate injuries. This study provides useful additional information regarding feline skull fractures, concurrent injuries and management techniques following head trauma.

Highlights

Inclusion criteria were the presence of a fracture of any part of the skull, managed either conservatively or surgically, where computed tomography (CT) imaging was used in their diagnosis
The majority of skull fractures occurred following Road traffic accidents (RTAs) (67 cats; 89%), with the others caused by dog or cat bites, falls and being shot
The mean age was 4.8 years, consistent with previous reports and males were over-represented,[9,11,13] a recent study showed that cats between seven months and two years old have the highest risk of RTA.[24]

Summary

Introduction

Trauma is a common cause of injury in cats, with the head being one of the most frequently injured areas.[1,2] Fractures of various bones of the skull are reported following head trauma, with up to 27% of trauma-related fractures affecting the skull.[3,4,5] Road traffic accidents (RTAs) are the most common cause,[6,7,8] skull fractures can be caused by falling from a height or fighting.[9,10,11,12,13,14]Skull fractures in cats may be managed conservatively or surgically. Reported surgical techniques include mandibular cerclage, interfragmentary wiring, interarcuate stabilisation with dental acrylic, bignathic encircling and retaining device (BEARD), external skeletal fixation (ESF), miniplate fixation and mandibulectomy.[15,16,17,18,19] For temporomandibular joint (TMJ) injuries, conservative management, maxillomandibular fixation, closed or open reduction of luxations, and condylectomy have all resulted in a successful functional outcome.[13] Morbidity associated with skull fractures and potentially their management include inability to eat, malocclusion of the dental arcade, TMJ ankylosis, soft tissue swelling, implant failure, damage to tooth roots and neurovascular structures, and regurgitation.[13,16,17,19] Depending on the severity of the fractures and the type of fixation, feeding tubes may be placed.[20]

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