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Abstract

Practical relevance:

Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice.

Clinical approach:

Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient’s ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries.

Treatment goals and techniques:

A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal’s oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain.

Aim:

This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.

Keywords

Skull fracture anatomy temporomandibular joint management

Introduction

The most common feline skull injuries are mandibular and maxillary fractures and various temporomandibular joint (TMJ) conditions. Road traffic accidents more frequently cause severe and multiple head injuries, while falls from a height tend to cause simple fractures, such as mandibular symphyseal separations or hard palate fractures. Bite wounds and gunshot injuries are other common causes of head trauma.^1–8

Feline trauma patients often sustain injuries to multiple body systems, including potentially life-threatening injuries of the thorax, abdomen and head.^{3–6
,9–11} Mortality rates for feline trauma patients presented at UK veterinary clinics have been reported to be around 12–22%.¹² Animals with head injuries frequently present with concurrent clinical injuries such as brain trauma or airway injuries, as well as shock. Therefore, it is crucial to perform a complete and thorough assessment and institute appropriate emergency management of the feline trauma patient, incorporating neurological examination, initial stabilisation and critical care, and nutritional support.^9,11

The main goals of treatment of mandibular and maxillary fractures are restoration of dental occlusion and TMJ function; both are essential for feeding and grooming.^{2,3,9,10,13,14}

Surgical anatomy

Mandible

Each hemimandible can be divided into a body (sometimes incorrectly termed ‘horizontal ramus’) and a ramus (‘vertical ramus’) (Figure 1). Both hemimandibles are joined rostrally by a fibrocartilaginous symphysis.^6,7,15,16 The mandibular body contains the roots of the teeth and the mandibular canal, which holds the mandibular alveolar artery and the inferior mandibular nerve. Familiarity with this local anatomy is crucial to avoid damaging these structures during implant placement.^2,7,13,15 The mandibular ramus has three prominences: the angular, condylar and coronoid processes. The masseteric fossa is located in the mandibular ramus and is where the masseter muscle inserts. Bone is very thin in the masseteric fossa, so implants should be placed more rostrally and cranially to this area, near the thicker coronoid crest, to maximise implant stability.^3,7,16

Figure 1

Anatomy of the feline skull relevant to the injuries discussed in this review. The blue dashed line encircles the temporomandibular joint

Maxilla

The maxilla includes the incisive, nasal, maxillary, palatine and zygomatic bones. The maxillary nerve and infraorbital artery exit the skull through the infraorbital foramen, which is located ventral to the orbit.^7,16

Temporomandibular joint

The mandibular fossa of the temporal bone and the condylar process form a stable joint that contains hyaline articular cartilage and a fibrocartilaginous meniscus between the articular surfaces.^{1–3
,5,7,10,13–17}

Clinical signs and diagnosis

The proportion of all traumatically induced fractures in cats that involve the skull is reported to be as high as 26.9%.¹⁰ Around 70% of cats with mandibular/maxillary fractures sustain other head injuries, including nasal trauma and epistaxis, brain and ocular injuries (Figure 2). It is essential to perform a complete examination of the patient and institute appropriate initial stabilisation treatment, which will be determined by the abnormalities found.^7,9 Any cat sus taining head trauma and/or with documented maxillary injuries should undergo a close ophthalmic and neurological examination. Cats may require oxygen supplementation, blood transfusions and supportive treatment.⁹

Figure 2

Right ocular proptosis and epistaxis in a cat with altered mental status after sustaining cranioencephalic trauma

In many cases, feline mandibular and maxillary fractures can be diagnosed by physical examination, though this may only be possible with the cat under sedation or general anaesthesia. Symphyseal separations and fractures of the mandibular body are easily detected visually and by palpation. Fractures of the caudal aspect of the mandible, maxilla or TMJ can be difficult to diagnose by manual examination, and other techniques may be required, such as radiography, which is performed with the patient under general anaesthesia. Dorsoventral and lateral radiographs, together with oblique and intraoral views, are essential to diagnose these skull fractures. Note, however, that superimposition of soft tissue and bony structures can hinder interpretation.

CT has been reported to be more sensitive (4.7 times in one study¹) for the detection of injuries compared with skull radiographs, and should be considered for head trauma patients, if available (Figures 3 and 4).^{1,5,7,8,10,17,18}

Figure 3

Transverse CT image of the right mandibular ramus showing a comminuted fracture and fluid accumulation (haemorrhage) in the nasopharynx

Figure 4

Transverse CT scan showing nasal bone fractures and a midline fracture of the palatine bone, with fluid accumulation (haemorrhage) in the nasal cavity and bone separation

Preoperative considerations

Surgical repair of mandibular and maxillary fractures may be necessary for restoration of the animal’s masticatory function and adequate dental occlusion (Figure 5).^{2–4,7,9,10,15} The presence of an endotracheal tube prevents complete closure of the mouth and thus adequate intraoperative evaluation of dental occlusion. This is especially relevant for comminuted fractures, where dental occlusion may be the only point of reference for judging adequate reduction of the fracture. In these situations, other intubation methods, such as intubation through a pharyngostomy incision, may be used (Figure 6). Tracheal intubation is an alternative option.^7,9

Figure 5

Correct dental occlusion in the cat. The lower canines are located medially to the upper canine teeth

Figure 6

Right-sided pharyngostomy intubation. To perform the incision, a curved Rochester–Carmalt or Kelly forceps is placed caudally to the mandibular ramus and externalised through an incision (a). The endotracheal tube is introduced through the incision and tracheal intubation is performed (b). The pharyngostomy tube should be placed on the right side to allow placement of a feeding tube on the left side

If the aims of treatment are met, return to function should be obtained. However, the clinician must consider how the patient will eat in the postoperative period. A feeding tube may need to be placed before fracture fixation to support nutrition (Figure 7).^5,7,11,15

Figure 7

Oesophagostomy feeding tube in a cat that had undergone stabilisation of a comminuted fracture with an external skeletal fixator

Mandibular fractures

The mandible has unique biomechanical characteristics. Bending forces are the primary dynamics acting on the bone during the functional stress of mastication.^15,19,20

Fractures of the mandibular body can be inherently stable or unstable, depending on the orientation of the fracture line and the forces applied by the local musculature (Figure 8).^6,11

Figure 8

Schematic representation of the orientation of (a) stable mandibular fractures (rostroventral orientation; single red line) and (b) unstable mandibular fractures (caudoventral orientation; double red lines). Arrows show the direction of the forces applied to the bone and fracture

The two main treatment options that can be considered for mandibular fractures are:

Conservative treatment This might be contemplated in cats with normal occlusion and good oral function, and closed, stable and pain-free fractures.

Surgical treatment In cats presenting with mandibular or maxillary deviation or malocclusion, open fractures, instability or abnormal oral function, surgery should be considered.

Symphyseal separation

Symphyseal separation is most commonly caused by falls from a height. This fracture type is treated surgically to provide stability between the left and right hemimandibles rostrally. A cerclage or hemicerclage wire or screw is placed between the two hemimandibles, caudal to the canine teeth (Figure 9).^{6,10,11,19,20}

Figure 9

Postoperative lateral (a) and dorsoventral (b) radiographs in a cat with a mandibular symphysis fracture/luxation. A cerclage wire has been placed around the hemimandibles, caudal to the canine teeth. This cat also sustained a caudal mandibular body fracture that has been stabilised with a K-wire and screw

A large gauge needle (18 G) can be used as a guide to facilitate passing a 0.6–0.8 mm cerclage wire around the mandible. The needle is placed, via a ventral skin incision, along the mandibular bone, exiting the oral mucosa caudal to the canine tooth. One end of the cerclage wire is passed through the needle from dorsal to ventral. The same procedure is repeated on the opposite side. The ends of the cerclage wire are twisted manually on the ventral aspect of the mandible while the mandible is realigned, continuing until instability has been addressed. The end of the twisted wire is cut, maintaining sufficient length so that it protrudes through the ventral skin incision. A small blob of epoxy putty placed on this end helps to protect the patient from injury (Figure 10).

Figure 10

Postoperative photograph of a cat with a mandibular symphysis fracture/luxation. An encircling cerclage wire was placed around the hemimandibles, caudal to the canine teeth. The ends of the cerclage wire are protruding through the ventral skin incision and have been protected with a small amount of epoxy putty

Implants can be removed at around 6 weeks postoperatively. The wire can be untwisted slightly to evaluate stability, and then cut if stability is considered adequate. Radiographs are not essential for informing the decision of when to remove the implant as generally there is no bony fusion between the hemi-mandibles.^{4,5,9,11,19,20}

Mandibular body fractures

Fractures of the mandibular body are easy to diagnose, and most are surgically stabilised through a ventral approach. Surgical management is particularly recommended for bilateral, unstable or comminuted fractures.^11,19

Simple and reducible fractures These fractures can be stabilised with inter-fragmentary wiring or plate fixation. Implants should ideally be positioned on the tension side, which is the dorsal/alveolar border of the mandible. However, the presence of tooth roots makes this challenging, so sizeable implants, such as plates, may need to be positioned more ventrally to avoid these structures. During stabilisation with interfragmentary wires, 0.6–0.8 mm cerclage wire can be placed through holes drilled approximately 5 mm away from the fracture line in an oblique direction.

Plate fixation has been recommended as the ideal method of fixation because the implant can function as a compression, neutralisation or buttress device. A 1.3–1.5 mm plate is placed along the alveolar border of the mandible. A minimum of two screws, ideally three, should be placed per bone fragment. Larger plates, such as a 1.5–2.0 mm dynamic compression plate (DCP) or 2.0 mm locking compression plate (LCP), can be used, but are positioned more ventrally.^{2–4,6,10,11,19,21}

Placement of an endotracheal tube via a pharyngostomy incision can be considered so that occlusion can be checked intraoperatively. Fracture reduction needs to be perfect and stable, otherwise malocclusion will occur.

Comminuted fractures These fractures can be stabilised with plates and screws, locking plates or external skeletal fixation. With these unstable fractures, larger plates (2.0 mm DCP or LCP) are generally used. The use of external skeletal fixation is usually reserved for comminuted or open fractures with bone loss or soft tissue damage (Figure 11). Fracture reduction is assessed indirectly based on normal dental occlusion; pharyngostomy intubation is needed in order to facilitate this assessment.^{2,4,6,10,11,15,19,20}

Figure 11

Postoperative dorsoventral radiograph showing placement of a free-forming external skeletal fixator to stabilise a bilateral mandibular fracture

Rostral mandibular fractures The lack of bone in the rostral mandibular area and the small size of the incisive teeth, limiting the structures where implants can be applied, mean that rostral mandibular fractures are challenging to stabilise. There are reports in the literature of successful use of modified interdental wiring, a lingual arc or a bilateral external skeletal fixator (ESF) for these fractures.^4,6,9,11

Mandibular ramus fractures

Many mandibular ramus fractures are minimally displaced due to the large muscle mass covering this area. If normal dental occlusion and oral function are preserved, these injuries may not require surgical stabilisation. However, cats with malocclusion and fracture instability will be candidates for surgical management.

Stabilisation with bone plates or interfragmentary wires can be used for simple and unstable fractures, but can be challenging owing to the bone being very thin in this location (Figure 12). Therefore, implants should be placed along the thicker cranial crest, to obtain better screw purchase.² If implant placement is difficult due to insufficient bone thickness, or if a comminuted fracture is present, then interarcuate immobilisation with wires, an ESF or dental bonding may be used. In this event, an endotracheal tube is placed via pharyngostomy, and nutritional support is mandatory through an oesophageal feeding tube.^{4,5,9,11,20,21}

Figure 12

Postoperative lateral radiograph of a caudal mandibular body fracture (base of the mandibular ramus) stabilised using a plate and screws

Maxillary–mandibular external skeletal fixation involves placement of a 1.6 mm K-wire through the skin of the upper lip and maxilla, caudal to the canine teeth, running from one side to the other dorsal to the palate (Figure 13a). A second K-wire is similarly placed in the mandible, caudal to the canine teeth (Figure 13b). The clinician should try to avoid the canine roots.^4,11,15 The maxillary and mandibular K-wires are bent 90° towards each other until they make contact. They are then temporarily stabilised with cerclage wires, radiographs are taken and oral occlusion is checked visually. The position of the mandible and maxilla can be adjusted until oral occlusion and dental position are adequate (ie, the lower canines are located medially to the upper canines; Figure 14a).^11,15,22

Figure 13

CT scans obtained after placing a maxillary–mandibular external skeletal fixator. In the maxilla, the K-wire is placed caudal to the canine teeth and dorsally to the palate (a). Another K-wire is placed caudal to the canine teeth in the mandibular bone (b)

Figure 14

(a) Normal feline dental occlusion. The lower canines are located medially to the upper canine teeth. (b) Following placement of a maxillary–mandibular external skeletal fixator, the recommendation is that oral opening should be sufficient to allow mouth breathing and eating/lapping of liquids without problems. The aim is that the canine teeth overlap by a few millimetres

While ensuring that adequate dental alignment and oral opening is maintained, epoxy putty is applied over the bent ends of the K-wires. It is recommended to leave the horizontal part of the wires free of epoxy putty so they can be cut in the event of an emergency or during ESF removal.^6,22 The importance of maintaining sufficient oral opening is so that the patient can breathe through the mouth (feline patients commonly suffer from nasal haemorrhage) and lap liquid food. Generally, a 10–15 mm gap between the incisors (equating to a few millimetres of canine tooth overlap) is enough (Figures 14b and 15).⁴ It is also important to bear in mind that these animals are at risk of aspiration pneumonia; therefore, they need to be closely monitored postopera-tively in order to anticipate this and act immediately (ie, cutting the K-wires in the event of retching and vomiting).^2,3,6

Figure 15

Cat with a maxillary-mandibular external skeletal fixator. Note that there is sufficient oral opening to allow mouth breathing and lapping of liquids. An oesophageal feeding tube has been placed in the left side of the neck for nutritional support

Maxillary fractures

The maxillary and premaxillary bones are approached by an incision in the buccal mucosa lateral to the teeth, with elevation of the soft tissues from the bones.¹¹

Traumatic split palate

Palatal fracture most commonly occurs after a fall from a height. Cats are susceptible to a midline fracture of the maxilla, frequently with concurrent injuries to the soft tissues, nasal turbinates and teeth.¹⁰ These injuries result in a communication between the oral and nasal cavities, allowing passage of water and food into the nasal cavity.¹¹

Small defects in patients with a stable fracture can often be treated conservatively and achieve reasonable healing. However, they should be evaluated after 5–7 days to assess progress. If the defect is not closing satisfactorily, then surgical treatment is indicated.

Large defects and unstable fragments are better treated surgically (Figure 16).^10,11 An interfragmentary pin, with or without a figure-of-eight wire, depending on the apposition of the fragments, is the treatment of choice (Figure 17).^10,11 Before placement of the inter-fragmentary pin, the fragments can be reduced with pointed reduction forceps applied laterally in the maxilla. Note that it is important only to appose the fragments and not to cause superimposition of the palate edges, as this would lead to dental malocclusion.² The mucosal defect can be repaired with absorbable suture; two-layer closure is recommended. Implants can be removed 6 weeks postoperatively. A common complication after repair is wound dehiscence due to tension, impaired blood supply and fracture mobility. Release incisions may be needed to allow closure of the soft tissues without tension.^2,11

Figure 16

Three-dimensional reconstruction of a CT scan of a cat with multiple cranial fractures. As well as a maxillary fracture with significant separation of the palatal bone, nasal and caudal maxilla, there is a mandibular symphyseal separation/fracture

Figure 17

Surgical repair of multiple cranial fractures in a cat. A cerclage wire has been used in the mandible (a) and a combination of a cerclage wire and an interfragmentary pin for the palatal fracture (b)

Fractures of the incisive, nasal, maxillary and zygomatic bones

Facial bones are often minimally displaced when fractures occur, and do not tend to cause malocclusion or exhibit instability. In these cases, conservative management is generally indicated.^4,11

If there are simultaneous facial bone and palatal fractures, malocclusion and instability may result.² Restoring dental occlusion and relief of severe nasal compression are the goals for these unstable fractures. Miniplates or interfragmentary wires are required because facial bones are very thin.^3,4,11

Disorders of the temporomandibular joint

Fractures and luxations, joint ankylosis and locking-jaw syndrome are the most common TMJ disorders.^{1,2,5,11,13,14,17}

Fractures and luxations

The TMJ generally luxates in a craniodorsal direction (ie, the mandibular condyle is cranially displaced), but caudal luxations can also occur (Figure 18).^1,5,11,17 Unilateral luxation results in mandibular deviation towards the contralateral side of the luxated TMJ (in the case of a craniodorsal luxation) or towards the ipsilateral side (if it is a caudal luxation). The luxation is usually rostral due to the anatomy and shape of the mandibular fossa and the large retroarticular process, which together prevent caudal displacement of the condyle. If bilateral luxation occurs, cranial or caudal translation of the mandible in relation to the maxilla is perceptible.^5,11

Figure 18

Craniodorsal (a) and caudal (b) temporomandibular joint luxation demonstrated in a feline skull

TMJ luxations are initially treated by closed reduction with the cat under general anaesthesia. A pencil or a syringe is placed between the upper and lower molars (Figure 19a). Rostral compression/closure of the mouth is performed to cause distraction of the TMJ (Figure 19b). Rostral or caudal rotation of the pencil then shifts the mandible rostrally or caudally, respectively, into position (Figure 19c).¹¹

Figure 19

Treatment of craniodorsal temporomandibular joint (TMJ) luxation by closed reduction. (a) With the cat under general anaesthesia, a pencil is placed between the upper and lower molars. (b) Rostral compression of the mouth causes distraction of the TMJ. (c) Caudal rotation of the pencil shifts the mandible caudally and allows reduction of the condyle into the articular fossa

When reduction can be readily achieved and the joints are stable, it may not be necessary to restrict TMJ motion during the post-reduction healing period. If additional security is desired, then 1–2 weeks of temporary immobilisation with a muzzle could be pursued to decrease the risk of reluxation and allow fibrosis. While patient size, temperament and the feline face shape mean that muzzles are not frequently used in cats, a custom-made tape muzzle has been described for temporary immobilisation after manual reduction of TMJ luxation in a cat.²³ Contraindications for muzzle application include canine tooth fractures that prevent the canines from remaining interdigitated, brachycephaly, pre-existing or post-traumatic respiratory distress, vomiting or regurgitation, bilateral mandibular fracture, and complicated, severely displaced or comminuted fractures.²³

In cats with unstable joints post-reduction or with TMJ fractures, more stable temporary immobilisation may be required in order to prevent reluxation and allow formation of stabilising fibrous tissue. In this situation a maxillary–mandibular ESF, cerclage wire, dental bonding, labial reverse suture through buttons or a bi-gnathic encircling and retaining device (BEARD technique) is recommended.^{2,3,5,6,11,13,24} Techniques more commonly used for uni- or bilateral caudal mandibular or TMJ injuries are described in the box above.

The temporary maxillary–mandibular immobilisation technique that the authors tend to use is external skeletal fixation and very good results have been obtained when this stabilisation method has been applied in cats with comminuted and caudal mandibular fractures. However, some surgeons may prefer other, less invasive techniques, such as dental bonding or the BEARD technique. The equipment and expertise required, patient morbidity, complications, postoperative care, cost and outcome of these techniques are likely to vary – a suitable cohort study would be necessary to provide comparison.

Fractures of the TMJ are usually minimally displaced and are difficult to stabilise with internal implants (Figure 20). For these reasons, they are generally treated conservatively if dental occlusion is adequate. Soft food should be fed for a few weeks to allow fracture healing. If dental occlusion is affected, then fracture reduction and stabilisation with maxillary–mandibular immobilisation is recommended. The immediate goals of fixation include stabilisation for return to normal occlusion and function, with the long-term objective of bony union. Most cats regain satisfactory joint function; however, some patients develop TMJ ankylosis owing to non-union, persistent instability, periarticular fibrosis or mineralisation. In such cases, excisional arthroplasty can be performed.^2,10,11,13

Figure 20

CT scan (transverse plane) of a feline skull, showing a minimally displaced fracture of the left temporomandibular joint

Ankylosis

TMJ ankylosis is characterised by difficulty in opening or inability to open the mouth. The ankylosis, which may occur uni- or bilaterally, may be articular (true) or extra-articular (false).

Articular ankylosis is more common in cats and involves the TMJ itself.

False ankylosis involves the periarticular structures.

TMJ ankylosis can develop secondarily to trauma, TMJ fractures/dysplasia, tumours, infection or pathology affecting the surrounding structures. Generally, affected cats show chronic and progressive difficulty in feeding and grooming. Manipulation of the mandible allows only minimal (or potentially no) opening of the mouth. Diagnostic imaging techniques, such as radiography or CT, are used to evaluate the TMJ.

Conservative treatment (with physiotherapy and steroids) is usually unsuccessful, and most cats require surgical resection. If false ankylosis occurs, excision of parts of the zygomatic arch and adjacent tissues is necessary. Postoperatively, physiotherapy should be considered to prevent the risk of recurrence.^{2,10,13,14,17}

Locking-jaw syndrome

Locking-jaw syndrome is caused by impingement of the dorsal edge of the coronoid process, which moves laterally, on the zygomatic arch (Figure 21), preventing closure of the mouth.²⁶ This occurs after maximal opening of the jaw (eg, during yawning, grooming or vocalisation). A breed predisposition to this condition is seen in Persian cats. Dysplasia or traumatic joint changes have also been described as possible causes.¹⁶

Figure 21

Locking-jaw syndrome: the coronoid process impinges on the zygomatic arch after maximal mouth opening

The syndrome presents great distress for the animal and the owner, and can last anything from seconds to days.¹¹ It is recommended these patients are sedated in order to decrease stress and allow adequate exploration of the area. Typically, the malpositioned coronoid process can be palpated laterally to the zygomatic arch and the mouth cannot be closed manually.^11,26

Radiography is the imaging modality commonly used in the investigation of open-mouth jaw locking. However, CT scanning is superior to radiography for assessment of the TMJ and to rule out other potential underlying causes, and makes the initial diagnosis of jaw locking easier.²⁶

There are two main approaches for the management of these patients – closed reduction and surgical treatment.

Closed reduction Under sedation or general anaesthesia, the mouth is opened further, and medial pressure is applied over the coronoid process to achieve reduction.

Surgical treatment If closed reduction is not possible, or reluxation occurs, definitive surgical treatment is recommended. A lateral approach to the zygomatic arch is performed, and the area of the zygomatic arch in contact with the luxated coronoid process is removed using rongeurs. Alternatively, or additionally, an ostectomy of the tip of the coronoid process can be performed.

Postoperative management of skull fractures

Postoperatively, nutritional support of these patients is essential. Many cats may not eat, as they are unable to smell due to facial trauma and occlusion of the nasal passages. In these cases and also when a maxillary–mandibular ESF has been applied, placement of a feeding tube is mandatory. The clinician should calculate the caloric requirements of the patient in order to provide adequate nutritional support. Patients that maintain their ability to eat can be fed with liquid or soft food for approximately 4 weeks.^4,10,11

Perioperative and postoperative analgesia is essential. Generally, opioids and non-steroidal anti-inflammatory drugs for 1 week postoperatively are sufficient. Antibiotic therapy is usually recommended perioperatively, but is not always required postoperatively as skull bones and oral mucosa heal quickly. In cats with ESFs, daily management of the pins is required in the early postoperative period.^{2,7,9,10,13,17}

Prognosis

In general terms, the prognosis is good for feline skull fractures and TMJ disorders, although cats with multiple mandibular fractures have a higher risk of complications, such as malocclusion. Misaligned canine teeth may damage the palate and dental treatment may be necessary later on.^2,7,10

Key Points

Cats with head injuries frequently present with other, potentially life-threatening conditions so it is crucial to perform a complete and thorough assessment and institute appropriate emergency management of the feline trauma patient.

Due to soft tissue and bony structure superimposition, skull radiographs may be difficult to interpret. CT is a more sensitive modality for detecting injuries compared with radiography.

Conservative management of skull fractures may be elected if the fracture is stable, oral function is maintained and there is adequate dental occlusion.

Footnotes

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

This work did not involve the use of animals and therefore ethical approval was not required.

Informed consent

This work did not involve the use of animals and therefore informed consent was not required. For any animals individually identifiable within this publication, informed consent for their use in the publication (either verbal or written) was obtained from the people involved.

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Feline skull injuries: Treatment goals and recommended approaches

Abstract

Practical relevance:

Clinical approach:

Treatment goals and techniques:

Aim:

Keywords

Introduction

Surgical anatomy

Mandible

Maxilla

Temporomandibular joint

Clinical signs and diagnosis

Preoperative considerations

Mandibular fractures

Symphyseal separation

Mandibular body fractures

Mandibular ramus fractures

Maxillary fractures

Traumatic split palate

Fractures of the incisive, nasal, maxillary and zygomatic bones

Disorders of the temporomandibular joint

Fractures and luxations

Ankylosis

Locking-jaw syndrome

Postoperative management of skull fractures

Prognosis

Key Points

Footnotes

Conflict of interest

Funding

Ethical approval

Informed consent

References