KÜRŞAT ÖZER, MURAT KARABAĞLI, Gamze KARABAĞLI

Interdental and Interfragmentary Stabilisation (IAIS) of Mandibular Symphysis Separations and Parasymphyseal Fractures in Cats: A New Technique

Veteriner literatürde kedilerin, açık enfekte ve dislokasyonlu symphysis mandibula ayrılmalarının sağaltımında, daha rijit bir stabilizasyon ve komplikasyonsuz bir iyileşme elde edebilmek için, hem dairesel (interfragmenter) hem de canin dişler etrafından '8' şeklinde interdental serklaj teli uygulamasının bir arada kullanılması önerilmektedir. Bunun nedeni, symphysis mandibula üzerine etkiyen craniokaudal ve dorsoventral kuvvetlerin etkisinin ancak bu şekilde karşılanabilecek olmasıdır. Bu durum uygulama ve serklaj telinin uzaklaştırılması için geçen intraoperatif süreyi uzatmakta, aynı zamanda uzaklaştırma esnasında derin bir sedasyon ya da genel anesteziyi gerekli kılmaktadır. Bu çalışmanın amacı, ek bir stabilizasyon gerekmeksizin, sadece serklaj teli kullanılarak tek seferde hem interdental hem de interfragmenter stabilizasyon sağlayabilen yeni bir tekniğin (İVİS-interdental ve interfragmenter stabilizasyon) uygulama aşamalarını ve etkinliğini ortaya koymaktır. Bu amaçla 2007-2015 yılları arasında kliniğimize getirilen ve symphysis mandibula ayrılması tanısı konan 46 hastanın sağaltımında İVİS tekniğini kullandık ve postoperatif haftalık kontroller yaparak klinik iyileşme süresini değerlendirdik. Sonuç olarak bu yeni tekniğin kedilerde dislokasyonlu enfekte olmayan, açık enfekte ve dislokasyonlu symphysis mandibula ayrılmalarının sağaltımında etkin olarak kullanılabileceği sonucuna vardık.

Kedilerde Symphisis Mandibula Ayrılmalarının ve Parasymphiseal Kırıkların Sağaltımında İnterdental ve İnterfragmenter Stabilizasyon (İVİS): Yeni Bir Teknik

In veterinary literature, in order to achieve a more rigid stabilisation and complication-free recovery, both methods of circular (interfragmentary) and 8-shaped interdental cerclage wiring around the canine teeth are recommended in the treatment of open, infected and dislocated mandibular symphysis separations in cats. This is the only way to counteract craniocaudal and dorsoventral forces acting on the mandibular symphysis. However, this prolongs intraoperative time for the application and removal of cerclage wire, as well as necessitating deep sedation or general anaesthesia for removal. The aim of this study is to present the application stages and efficacy of a new technique (IAIS-Interdental and Interfragmentary Stabilisation) achieving both interdental and interfragmentary stabilisation in a single operation using only cerclage wire, with no need for extra stabilisation. For this purpose, the authors used the IAIS technique in the treatment of 46 patients presented to the surgery clinic between the years 2007-2015 and diagnosed with mandibular symphysis separation. Weekly post-operative follow-up examinations were carried out and clinical recovery time was evaluated. In conclusion, this new technique may be used effectively in the treatment of dislocated-uninfected and open-infected-dislocated mandibular sympyhsis separations.

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Verstraete FJM: Maxillofacial fractures. In, Slatter D (Ed): Textbook of Small Animal Surgery. 3rd ed., 2190-2207, WB Saunders, Philedelphia, 2003.
Schacter RI, Furstman L, Bernick S: Postnatal development of the mandible of the cat. Am J Orthod, 56, 354-364, 1969. DOI: 10.1016/S0002- (69)80003-5
Scott JE, Hogue AS, Ravosa MJ: The adaptive significance of mandibular symphyseal fusion in mammals. J Evol Biol, 25, 661-673, 2012. DOI: 10.1111/j.1420-9101.2012.02457.x
Yalçın K, Kaya MA, Arslan A: Comparative geometrical morphometries on the mandibles of Anatolian wild sheep (Ovis gmelini anatolica) and Akkaraman sheep (Ovis aries). Kafkas Univ Vet Fak Derg, 16, 55-61, 2010. DOI: 10.9775/kvfd.2009.385
Harasen G: Maxillary and mandibular fractures. Can Vet J, 49 (8): 819- , 2008.
Scott HW, McLaughlin R: Fractures and disorders of the skull and mandible. In, Scott HW, McLaughlin R (Eds): Feline Orthopedics. 261-271, Manson Publishing, London, 2006.
Johnson AL, Hulse DA: Management of specific fractures. In, Fossum TW (Ed): Small Animal Surgery. 2nd ed., 901-913, Mosby, Missouri, 2002.
Piermattei DL, Flo GL, DeCamp CE: Fractures and luxations of the mandible and maxilla. In, Piermattei DL, Flo GL, DeCamp CE (Eds): Handbook of Small Animal Orthopedics and Fracture Repair. 4th ed., 717- , Saunders Elsevier, St. Louis Missouri, 2006.
Owen MR, Langley Hobbs SJ, Moores AP, Bennett D, Carmichael S: Mandibular fracture repair in dogs and cats using epoxy resin and acrylic external skeletal fixation. Vet Comp Orthop Traumatol, 4, 189-197, 2004.
Dingman RO, Natvig P: Occlusion and intermaxillary fixation. In, Dingman RO, Natvig P (Eds): Surgery of Facial Fractures. 2nd ed., 143, WB Saunders, Philadelphia, 1964.
Farwell DG: Management of symphyseal and parasympheal mandibular fractures. Operative techniques in otolaryngology, 19, 108-112, 2008. DOI: 10.1016/j.otot.2008.06.001
Boole JS, Holtel M, Amoroso P, Yore M: 5196 mandible fractures among 4381 active duty army soldiers, 1980 to 1998. Laryngoscope, 111, 1696, 2001. DOI: 10.1097/00005537-200110000-00004
Lopes FM, Gioso MA, Ferro DG, Leon-Roman MA, Venturini MAFA, Correa HL: Oral fractures in dogs of Brasil - A retrospective study. J Vet Dent, 22 (2): 86-90, 2015.
Wiggs RB, Lobprise HB: Oral fracture repair. In, Wiggs RB, Lobprise HB (Eds): Veterinary Dentistry: Princibles and Practice. 259-279, Lippincott- Raven Publishers, Philadelphia, 1997.
Saglam M, Cetinkaya MA: Clinical studies of orthopaedic treatments of maxillar and mandibular traumatic lesions in cats. Vet Cerrahi Derg, 9 (1-2): 5-10, 2003.
Legendre LF: Management of facial fractures in cats. Can Vet J, (11): 821-825, 1999.
Taylor RA: Surgical repair of mandibular fractures. In, Bojrab MJ (Ed): Current Techniques in Small Animal Surgery, 4th ed., 977-984, Lippincott Williams & Wilkins, Maryland, 1997.
Umphlet RC, Johnson AL: Mandibular fractures in the cat: A retrospective study. Vet Surg, 17, 333-337, 1988. DOI: 10.1111/j.1532- X.1988.tb01028.x
Woodbridge N, Owen M: Feline mandibular fractures a significant surgical challenge. J Feline Med Surg, 15, 211-218, 2013. DOI: 10.1177/ X13477541
Ozer K: Ağız boşluğunun savunma mekanizmaları. In, Ozer K (Ed): Küçük Hayvan Diş Hekimliği. 13, Teknik Yayınevi, İstanbul, 1999.