MANDIBULAR BONE FRACTURE WITH MULTIPLE TOOTH LOSSES

The jaw bone

The jaw bone is the largest equine face, comprises two mandibles that fuse at the symphysis at 2-3 months of age. The mandible articulates with the temporal bone in Temporomandibular Joint and contains the alveoli of the mandibular incisors, canines, and wolf teeth (if present)

The ventral edge of the horizontal branch of the jaw is broad and rounded at the young horse, because it contains the reserve crowns of the teeth of the mandible and, conversely, becomes thinner and sharper in older horses submit molars erupt. Some breeds, especially the descendants of the Arabian horse (which in turn are descended from Equus Cracoviensis) have mandibles and jaws and proportionally shallow crowns short book, while most other breeds, eg derived from E. muniensis (Pony mountain) or E. mosbachensis and types of English pony race (as Exmoor ponies) have alveoli booking for deep and long crowns. It has been proposed that the junctions between these two types of horses can develop pronounced swelling ventral developing below the apices of the teeth of the second and third jaw due to an imbalance between the depth and length of the mandibular tooth. These erupting mandibular cysts ('bony tubercles')

(JAW WITH TEETH)

Incisors

The horses have incisors, canines and molars. Horses are DIFIODONTOS; ie have two types of dentures, are other words that there are teeth (deciduous) and permanent teeth (perennial). This means that when they are foals teeth are smaller according to their maxilla or mandible. When baby teeth fall out are replaced by larger parts provided to the growth of the mandible and maxilla.

The horses have 6 incisors, 2 canines and 6 molars in each jaw for a total of 40-42 teeth in males and 36-38 parts mares, some exceptions where some mares have canines or fangs.

Equine dental formula:

Decidua: 2 (DI 3/3, 0/0 DC, DPM 3/3) = 24 teeth

Horses: 2 (I 3/3 - 1/1 C - P 3-4 / 3 - M 3/3) = 40-42 teeth

Mares: 2 (I 3/3 - 0/0 C - P 3-4 / 3 - M 3/3) = 36-38 teeth

The incisors have a particularity and is a depression on your table or face chewing tapered and is called external tooth turbinate, plus its roots are shallow and have no internal depression called turbinate tooth.

The incisors are long and narrow. Neck poorly marked. The occlusal surface enamel presents an invagination to form the infundibulum, it lasts up to ten years. Permanent incisors are flattened back and forth in its upper half, its lower half side in the intermediate portion and has a transition between the two flattened. This arrangement will give us cross sections whose anger surface from the elliptical to biangular, passing successively through the oval, round and triangular. When wear reaches the pulp cavity, a new layer of dentin appears dental forming star or star Girard.

Rash Of Deciduous incisors

The central incisors erupt or tweezers during the first week of life, average between 4 and 6 weeks of age and extreme body 6 and 9 months old. This also varies between the different races.

Eruption Of Permanent Incisors

The change of the incisors can begin in the mandibular incisors (mandibular refers) or maxillary (refers to maxilla) interchangeably, but always by central incisors or tweezers happens at 2 years and a half, the incisors media and 3½ years and ends at 4 and a half years.The canine teeth erupt at 4 and a half to 5 years in males, in females are absent or rudimentary. Changes in the occlusal surface

Emergence of Dental Star

Star tooth structure is a yellow brown displayed on the occlusal surface through wear, which is linearly and then finally becomes rounded oval, is located facially (Lip) to the dental crown and then moves to the center. This structure appears sequentially in the central incisors to five years, in the media at age 6 yen ends to 7-8 years.

The characteristic blot dental star appears in the central incisors 7-8 years and in the media 9 to 11 years. At the ends is highly variable and it does between 9 and 15 years.

Brands

The brands relate to shape the contours of the chewing surface of the tooth. They are becoming smaller and are moved and rounded tongue. As the remaining cement wears the mark disappears from the occlusal surface. Trademarks are oval and large in the central incisors up to 6-7 years between 7 and 8 years become triangular. Anyway there are many racial differences and is one of the most variable characteristics, so it is not taken into account for determining age. This assessment also accounts for the disappearance of these brands, ranging between 12-20 years at the central incisors depending on the breed.

Changes In The Shape Occlusal Surfaces

They are very inaccurate indicators of age in addition to the various successive forms merge together. The forms are observed sequentially in central and middle incisors are oval, trapezoidal, triangular with sharp apex toward the lingual side and biangular respectively. The shape of the ends does not fit incisors sequential changes of the other incisors.

Brands have disappeared from all the lower incisors. The occlusal surfaces are triangular with apex at the central lingual and labial means and the ends.

The arch formed by the incisors of opposing jaws profile observed varies with age in young are positioned almost straight (180 °) from the 10 years the angle between them becomes more acute.

The upper and lower incisors are located almost straight with each other. Forming a hook (dovetail) on the incisal end observed

The angle between the lower incisors is sharper than in the previous figure. You can see in the upper end incisive Groove Galvayne over the full length of his labial surface.

About Incisive Superior Extreme Hook Or Swallow Tail

The dovetail is a hook formed on the upper incisor caudal end by the slower wear of the tooth. When the upper teeth acquire the inclined position with the bottom, the end in which the hook is formed again with the opposite contact and the hook tooth disappears.

It has always been considered as a typical characteristic of the horses of 7 or 14 years, however, only a very small percentage of horses 7 years and Horses 14 have the hook on the upper ends incisors ( 13% and 8% respectively). On the other hand a varied horses 5 and 6 percentage, between 8 and 12 years, and horses over 13 years also showed these characteristics (14%, 22% and 13% respectively). Therefore it is not related to any specific age and would be irrelevant to the estimated age.

Groove De Galvayne

It is a characteristic groove ends horse incisors over 11 years. However their presence, length and bilateral symmetry is variable and inconsistent so it has little use in determining equine age.

In conclusion The dental age estimation can be performed fairly accurately until 7 or 8 years old, based almost exclusively on the eruption of permanent incisors and canines, and the occurrence of dental and dental evenness star (disappearance of dental) crown. The other features are very specific to each individual and would be very risky consideration regardless of the above factors (anamnestic data, race, sex, age, food, containment system, dental conformation, approximate age, etc.)

Masticatory movement as equines is rotating and this produces a molar wear in certain areas while the opposite side that suffers a friction increases and form points or edges. These edges in the upper molars grow on the outside ie towards the cheeks while the lower molars grow inwards ie towards the language

(Skull Side View)

Mandibular fractures are the most frequent facial trauma after nasal fractures , be of veterinary medical consultations . Its etiology is determined by impacts in the lower third of the face being the most frequent accidents trauma, although the attacks , practice extreme sports like bull tailing , are other causes of lower frequency.

The agent may cause direct mechanism fracture (fracture occurring at the site of injury) or indirect (very common in severe condylar fractures sinfisarios trauma).

Fracture line which follows a path anterioinferior, ie downwards and forwards horizontal fractures are considered favorable because it tends to fracture

stability by action of the anterior and posterior muscles (masseter and medial pterygoid)

(FRONT FRACTURES)

Unfavorable vertical fractures in line passes from back to front and inward. The jaw bone is a U-shaped conditioning function. This is an exposed, strong, mobile and involved in speech and feeding bone. It is rather muscular and ligamentous insertion teeth being responsible for the articulation with the maxilla. We can distinguish two main divisions: horizontal (above) that supports the teeth and vertical (posterior) where the muscles of mastication are inserted and how the temporomandibular joint (TMJ). The mandibular anatomical regions are: a cellular and other symphyseal; the body, the angle and ramus and the coronoid and condylar process.

(SPLIT SIDE LEFT)

Mandibular fractures are usually located in regions with a weakness and bone structure which has a lower resistance (eg the mandibular condyle) or there is an edentulous or presence of impacted teeth, cysts or long tooth roots. The row of teeth of the jaw are arranged such that the front teeth are closer to the vestibular side, while molars are located toward the lingual side of the jaw. The mandibular dental arch resembles a parable in which occlusive surfaces of the molars tend to be rectangular (uppers are more diamond). The cusps are buccal and lingual provision. The lower molars have two roots, one medial and one distal. Finally, the blood supply is provided mainly from the inferior alveolar artery (branch of the maxillary artery), speaking also the facial artery and irrigation through the insertions of the regional muscles.

(RIGHT SIDE SPLIT)

There are two nerves that may be involved in this disorder: the marginal branch of the facial nerve and the mandibular division of the trigeminal nerve. The inferior alveolar nerve enters the medial aspect of the bone through the mandibular foramen and through the angle and into the body of the mandibular canal. The facial nerve divides at the level of the parotid gland in cervicofacial branches temporofacial and then giving the temporal, zygomatic, buccal, marginal, cervical branches. The latter moves towards the symphyseal region under the plane of the platysma muscle.

CLASSIFICATION

Fractures in the dental arch

Sinfisarias fractures and parasymphyseal: Isolated fractures of the mandibular symphysis are rare because when present are often accompanied condyle fractures. Represent a low displacement and when they are multiple staggering can be observed. The fracture is usually oblique or horizontal. The parasymphyseal are more frequent and, as sinfisarias, often accompanied by articular condyle fractures or angle of the jaw. Be careful when handling avoiding damage

the mental nerve.

Fractures of the region of canines: This is the place where most often settle fractures inside the dental arch. These are fractures that can pass through the mandibular body producing displacements due to the force exerted by the muscles responsible for chewing.

Fractures of the body of the mandible: are fractures of the posterior teeth ranging from canines to the mandibular angle. In such displacements and graduation are frequent.

Fractures outside the dental arch

Fractures of the mandibular angle: angle fractures are common and are associated on many occasions contralateral condyle fractures or other level. Are often underlying injuries that favor the existence of third molars or follicular cysts that weaken the bone and make more inclined mandibular angle fracture side impact (it is in these cases of open fractures to break the stroke in the molar or cystic region). They are fractures that can present problems of ossification.

Fractures of the mandibular branch: fractures are rare in the absence of displacement is most commonly found. The production mechanism is usually by direct impact.

Longitudinal fracture: No displaced.

Transverse fracture: You Displaced per share of the temporalis muscle.

Fractures of the mandibular condyle: The condyle is a place where often settle mandibular fractures due to their relative structural weakness, despite being protected within the glenoid fossa. Most fractures sometimes indirect or shearing and bending is not altering the current occlusion than the existence of a previous bite. Can I be unilateral or bilateral and classified according to the displacement and overlapping fragments. It is considered that serious deviation exceeding 30 ° to the distal fragment and major shift to one in which the overlap of the fragments is greater than 5mm. The commitment of the vascularity of the proximal fragment often results in avascular necrosis. Other common complications are osteoarthritis, temporomandibular joint pain, disc avulsions, hemarthrosis / hematoma which can result in ankylosis.

(Exposition of the incisors)

Classification of orthopedic surgery:

 Reconstruction: when it comes to soft tissue, capsules, ligaments, tendons, bone cartilage. Here the internal fixation of fragments included through fragmentary Inter compression, through screws, plates and external coaptation or through external fixation plaster splint. There are also surgical removal, you must remove fragments, if for example, some broken jaw, what is done is to remove the segments that may be driving the emergence of osteomyelitis, removing small fragments of bone or cartilage in case joints and also eliminate degenerated cartilage, osteophytes or hypertrophic synovial membranes, that includes the orthopedic surgical removal.

To treat only those not displaced, stable (favorable) or incomplete fractures in which no changes are objectified in the occlusion, subsidiaries will be treated only with a soft diet, rest all articulate and expectant attitude. Usually conservative and functional treatments are preferred. The goal of conservative treatment is to allow a good function without complete anatomic reduction due to early mobilization. Surgical treatment also seeks to restore most perfectly anatomical position.

Conservative Treatments

Cerclages: Cerclages are a good treatment for mandibular fractures as well as appropriate adjuvant option to other techniques

(Grafica cerclage)

This case is presented in Guayabo del Zulia state, an equine coleus called the congo, who suffered a product of a foot injury causing him other equine tip the injury.

  I reach the Lapita to the farm where is the horse with Dr. Manuel Velasco, veterinarian in the area with many years of experience and seeing astonishment us because we do not expect the magnitude of the injury, based on basic knowledge of anatomy, in the available resources had on hand and the help of God proceeded to demolish the horse under general anesthesia and I find what I can see in this video.

 https://youtu.be/zWNII9F2Qm8

(Video 1 compound fracture of mandible incisors exposure)

Only had on hand some medicines, antiseptics, gauze, surgical equipment and willingness to help this issue. I asked the owner sweet wire, drill and thin wicks and complements the team podiatry.

After fully anesthetized horse perform curettage eliminating all pollutants and the necrotic tissue, with drill trace lines in canines and incisors ends in order that the wire does not run so you can make the relevant cerclage for this case.

(Doctor Manuel Velazco helping with the procedure)

These were the results shown on the same day we attended the horse

(Left side view cerclage)

(Vista lateral Izquierda del cerclaje)

After being subjected to soft diets early days and helped with fluid, antibiotics and anti-inflammatory drugs the horse was released to pasture where he continued his normal life. Passing 8 weeks back and I get this:

Cerclage horse with multiple broken jaw:

All work was successful dental pieces were in place, jaw had successfully soldier, so I proceeded to remove the cerclage

(Removing the cerclage)

After removing the horse cerclage was observed as follows:

(Front View)

(Right Side View)

 (Front View)

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@CABALLOSALUDMÉRIDA

M.V. Hugo Antonio Useche Romero

Médico Veterinario Practicante en Equinos

Especialista en Reproducción y Podología Equina

Instagram: @caballosaludmerida

Mail: hugoantoniouseche@hotmail.com

Facebook: Hugo Antonio Useche Romero

Twitter: @mvhugouseche

Teléfono: 04149779165/ 0416 6760255

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Dr.Carlos Federico Rodriguez Garantón. GRADUADO EN LA UCV-FCV 1987 MI VIDA DEDICADA A LOS CABALLOS CRIADO EN EL CAFETAL CCS VENEZUELA. HE TRABAJADO CON CABALLOS DE PASO FINO EN TODOS LOS PAÍSES DONDE EXISTEN Y HE JUZGADO, MONTADO, HERRADO, CURADO CABALLOS TODA MI VIDA. PADRE DE CARLA GABRIELA Y ALEXANDRA RODRIGUEZ. HIJO DE ALÍ RODRÍGUEZ Y ELSA GARANTÓN NICOLAI. COLIE DESDE LOS 12 AÑOS HASTA LOS 25 Y CLASIFIQUE A 6 CAMPEONATOS NACIONALES POR EL ESTADO MIRANDA. TRABAJE 13 AÑOS COMO DIRECTOR DE LOS SERVICIOS VETERINARIOS DE LOS HIPÓDROMOS DE VENEZUELA. AHORA DEDICADO A ENSEÑAR TODO LO QUE SE A TODO EL QUE QUIERA APRENDER DE MI. DIOS ES MI GUÍA!. AMEN!