Mandible fractures occur more frequently than maxilla fractures. More often only one ramus of the mandible is affected. In foals, the incisors are commonly involved. If the germinal buds were not badly damaged, maturation will be normal.

Maturation of incisors will be normal if the germinal buds have not been damaged.

4.1.1 Etiology

In most cases, fracture follows catching of the teeth in a mesh wire (Fig. F4A) [1]. Occasionally, kicking injuries occur (Fig. F4B) or the animal may injure that part of the face falling or running into an immovable obstacle (Fig. F4C). Pathologic fractures may be seen in progressive severe dental disease with chronic infection and osteolysis. On other occasions, tumors render the mandible fragile, predisposing it to fracture.

Fig. F4A: Fractures of the incisor region most frequently occur when the teeth are caught in a mesh wire fence during playing. Sudden pulling back results in a fracture.

Fig. F4B: Kicking injuries of the jaw may lead to mandible and maxilla fractures.

Fig. F4C: Jaw fractures may also occur when a horse runs into an object.

4.1.2 Diagnosis

In many cases, inanition is the first hint of fracture (Fig. S4A). Excessive salivation is common, possibly associated with asymmetry of the face, and open wounds [2]. Radiographs provide a definitive diagnosis (Fig. X4A). Multiple projections are recommended [3]. For rostral fractures of the mandible V-D intraoral radiographs are indicated. These are best carried out under anesthesia or heavy sedation. Mandibular and maxillary fractures have always to be looked upon as open fractures, since gingival bacteria quickly invade the bone.

Mandibular and maxiallary fractures are open fractures.

Fig. S4A: Fracture of the incisor region in a 7-year-old Arabian stallion. The rostral fragment could easily be displaced through finger pressure.

Fig. X4A: Intraoral radiographic view of a rostral mandible fracture. Several incisor tooth roots are fractured. Some displacement is visible.

4.1.3 Preoperative management

Carry out a detailed examination of the entire animal, with special emphasis on the injured region, prior to surgery. Pay special attention to metabolic disorders such as dehydration, acid base derangements, and nutritional status. The animal may not have eaten for a considerable time. Plan the surgical procedure carefully, and cleanse the mouth thoroughly before intubation. Do not remove any loose teeth prior to fracture repair because the teeth brace each other and can thereby confer stability. If necessary, the loose teeth can be removed at a later stage or at the time of implant removal. Often, such removal proves unnecessary.

4.1.4 Management options

Selected fractures of a single mandibular ramus may sometimes be treated conservatively. Surgical options will vary with the configuration of the fracture. Following repair, the incisors can be rasped down to prevent contact with the opposing arcade, protecting the repair from strain for several weeks.

4.1.5 Surgical procedures

A distinction is made between intraoral and extraoral fixation techniques. In some instances, combined modalities are used.

4.1.5.1 Intraoral fixation techniques

Cerclage wires

Cerclage wires are the most frequently applied fixation devices for dental fractures in the rostral mandible and maxilla [2]. They are very versatile and may also be used in conjunction with other implants. Furthermore, they are quite economic.

These devices are mainly used to fix fractures in the rostral half of the mandible. Several wiring techniques are described in the literature and their selection depends on the preferences of the surgeon [1, 2].

Pass the wire between the teeth from inside to outside. If this proves difficult or impossible, drill holes of 2 mm diameter between the teeth at strategic locations facilitate passage (Fig. S4B). A large needle may be sufficient in younger foals [2] (Fig. F4D).

Fig. S4B: With the help of a 2 mm drill bit a hole is drilled between the incisor teeth to facilitate placement of the wires.

Fig. F4D: Cerclage wiring of a fracture of J2 and J3. A 14-gauge needle is inserted between the teeth and a 1.25 mm stainless steel wire threaded into the needle cannula as it is withdrawn.

Cerclage wiring is the most frequently employed technique in the repair of rostral fractures.

The following techniques are available: wiring of the teeth in a figure-8 fashion from left to right, or including at least two teeth on either side of the fracture [1]. Application of overlapping wire loops [2] allows individual tightening of the loops (Fig. F4E) and results in greater stability than with the sinsuoid wire loop technique mentioned above. The Obgeweser technique [1] involves extruding wire loops from the inside to the outside between each of the teeth (Fig. F4F, Fig. S4C). The wire loops may be prepared with special bending pliers. Feed one end of the wire through each wire loop in front of the teeth and unite it with the other end (Fig. S4D). Then tighten each loop by twisting it with a pair of pliers (Fig. S4E). This type of fixation is extremely stable and may be left in place for several months (Fig. X4B).

Wire loops may be applied in a variety of ways.

Fig. S4C: Wire loops are exited from the lingual side between the incisor teeth.

Fig. F4E: The fracture is treated with two cerclage wire loops; one around J1 and J2 and the other in figure-8 fashion around J2 and the adjacent healthy canine tooth.

Fig. F4F: An alternative method involves exiting wire loops from the lingual side to the labial side, followed by feeding of one end of the wire through each loop. After uniting and tightening the two wire ends, each wire loop is tightened as well, resulting in the most stable of all wire fixations. The twisted ends are directed toward the gingivae.

Fig. S4D: One end of the wire is fed through each of the loops in front of the incisor teeth.

Fig. S4E: The wire ends are united and tightened securely. Then each of the wire loops is tightened individually, resulting in superior stability of the fixation.

Fig. X4B: The fracture shown in Fig. S4A and Fig. X4A was reduced and repaired with the Obwegeser technique. Note, a wire loop was placed around each tooth and tightened. The fixation remained in place for 6 months. No teeth had to be removed.

When the rostral part of the incisors or the diastema is fractured, some type of fixation placed further caudally is indicated. Include the canine teeth in male horses (Fig. F4G) or one or two of the premolar teeth. In the latter case, feed the wire around P2 after prior drilling of a 2.5 mm hole between P2 and P3 (Fig. F4H) and unite the ends of the wire further rostrally [2]. Tighten the fixation by twisting the long wire loop at the diastema with one end of a Steinmann pin (Fig. X4B).

Drill holes in the bone of the diastema to allow cerclage fixation of fractures without encircling the teeth.

Drilling small holes into the diastema on either side of the fracture allows application of wire in a figure-8 fashion through the holes [2] (Fig. F4I). In selected cases, cerclage wires may be applied around the ramus and an oblique fracture (Fig. X4C, Fig. X4D). Apply a tension band involving the incisor and premolar teeth to increase stability.

Fig. F4G: Tension band wiring of a fracture to the canine teeth. Note, an indentation (arrow) was created with a rasp in the nuchal aspect of the canine teeth to anchor the wire.

Fig. F4H: The drill guide is used to protect the cheek and gingiva as a drill bit is used to create a hole for passing the wire between P2 and P3 at the gum line. The wire for inclusion of the first cheek tooth in cerclage wire bridging of the interdental space is passed through this hole.

The advantages of wire are that it is easy to use, versatile, and inexpensive, and it confers a secure fixation. Disadvantages include loosening of the fixation and, in certain instances of molar fractures, exposure. Application may involve several stab incisions through the cheek, with its abundant neurovascular network.

Application of cerclage wires to the molar arcades is facilitated by stab incisions through the cheek.

Fig. F4I: Figure-8 wiring of a transverse fracture of the interdental space. The holes are created with a 2.5 mm drill bit or a Steinmann pin.

Fig. X4C: Long oblique fracture through the diastema of one ramus of a Shetland pony.

Fig. X4D: The fracture in Fig. X4C was repaired with two cerclage wires supported by a tension band wire fixation between the incisor and premolar teeth. The picture was taken 4 months after the surgery at the time of implant removal, which was necessary because of a persistent draining tract.

Fig. X4E: A bilateral mandible fracture in a 3-week-old foal was repaired with a Steinmann pin along each horizontal ramus.

Steinmann pins

Steinmann pins are rarely employed as a sole mode of fixation, except possibly in young foals [1]. They can be used in fractures of the diastema (Fig. X4E), but trauma to the tooth buds may present a problem. In most cases, this fixation is not stable. In suckling foals, the fixation may be adequate but may traumatize the udder of the dam.

Place a screw transversly into the diastema to provide anchorage for wire fixation.

Screws

Screws may be used in fractures of the symphysis or in oblique fractures where good interfragmentary compression may be achieved through cortex screws applied in lag fashion [4, 5] (Fig. F4J). Screws may also be used to anchor cerclage wires in the region of the diastema [ 1] (Fig. X4F).

Fig. X4F: A rostral mandible fracture was repaired with cerclage wires anchored to two cortex screws placed into the diastema.

Fig. F4J: Lag screw repair of a unilateral fracture of the mandible containing a large osseous fragment. The fixation is protected with tension band wiring of the incisors to P2.

Fig. X4G: Laterolateral radiographic view of an unstable mandible fracture in a 1-month-old foal.

The U-bar

An aluminum U-bar, rounded rostrally, and flattened toward the premolars and molars can be used in very unstable fractures of both rami of the mandible [6] (Fig. X4G). It should be fixed with wire loops around the incisors and, further caudally, around the premolar and/or molar teeth on both sides of the cheek (Fig. F4K). Position the animal in dorsal recumbency to allow simultaneous access to both sides of the jaw. U-bars can be cumbersome, requiring several incisions to secure them to the molar arcades [6] (Fig. S4F). To add stability, dental acrylic may be applied as described below.

Fig. F4K: Intraoral splint made from aluminum bar and molded around the contours of the mandible. The bar has a round cross-section in front and a flattened cross-section on either side. The aluminum bar is attached to selected teeth with cerclage wires.

Fig. S4F: An aluminum bar was applied to a very unstable bilateral fracture of the mandible shown in Fig. X4G. The U-bar is attached to the mandible with wires. (Photo courtesy JP Watkins, Texas A&M University.)

Dental acrylic

Dental acrylic may be applied intraorally to serve as a buttress and enhance stability [7, 8]. In its softened state, the acrylic is molded to the contours of the mandible or maxilla. It is important to select an acrylic that does not produce an exothermic reaction during the hardening process. Such a reaction can be harmful to the gingival tissues. In selected cases, wires may be incorporated into the acrylic while it is still soft. When the acrylic hardens, these wires are firmly anchored to the neighboring teeth. This type of fixation has the function of a stent [2, 7, 8] (Fig. F4L).

Enhance stability by the application of dental acrylic.

Plates

Plates may be applied directly to the bone, or attached to the teeth. It may be difficult to identify the ideal location for the plate [9, 10] (Fig. F4M). Underlying teeth may cause a problem and may be traumatized. It is also difficult to apply a plate to the tension side because this tension side is, in fact, the occlusal surface. Therefore, the plate is typically applied in a less than ideal location, in terms of biomechanics, with resultant reduction in stability (Fig. X4H). Care has to be taken to avoid insertion of screws through tooth roots. Plates can be applied in the rostral mandible and possibly on the caudal rim of the ramus if it is large enough to accept the screws [11] (Fig. F4N).

Typically, plates must be placed in a less than ideal location, in terms of biomechanics.

Fig. F4L: Intraoral splinting with dental acrylic (cold curing type) formed around a tension band wire between the incisors and first cheek tooth. Several additional wires are used to unite the splint with the mandible.

Fig. X4H: A rostral mandible fracture was repaired with special plate (PC-Fix) and short screws. The repair was supported with a tension band wire between the incisor and premolar teeth.

Only one report exists of plates being applied to the teeth [12]. With a specially hardened drill bit holes are prepared in the teeth, and short screws are employed to attach the plate. About four to five screws are necessary (Fig. F4O).

Fig. F4M: A 6-hole 4.5 mm narrow DCP is applied to the horizontal ramus of the mandible. The screws are inserted between the tooth roots.

Fig. F4N: Surgical approach for plate application to the vertical ramus of the mandible via a subperiosteal elevation of the masseter muscle.

Fig. F4O: A narrow DCP is applied to the incisor and premolar teeth with short screws. The location of the plate effectively counteracts the developing forces.

Avoid insertion of a screw through a root canal whenever possible. The benefit of this technique is that the plate is applied in a more rostral position of the mandible and closer to the tension side of the bone. After the fracture has healed, remove the screws and fill the holes in the teeth with dental acrylic.

4.1.5.2 Extraoral fixation techniques

Among these techniques external fixators are distinguished from the pinless external fixator.

External fixator

Use a type II external fixator for mandibular fractures.

An external fixator type I consists of one longitudinal bar and four to five Schanz screws or intramedullary screws, being inserted into one ramus of the mandible or maxilla [2, 4] (Fig. S4G). A type II configuration consists of Steinmann pins through and through, involving both rami of the mandible or maxilla and bilateral longitudinal fixation bars. In external fixators mainly Steinmann pins and occasionally Schanz screws are inserted on either side of the fracture and connected to clamps and tubes, cerclage wires, and dental acrylic [2, 4]. Plastic tubes filled with acrylic represent another option (Fig. F4P). With the external fixator, interfragmentary compression of the fracture can be achieved. The integrity of the tooth roots should be preserved. Place the Steinmann pins in such a way as to prevent excessive trauma to the tongue. In the rostral aspect of the mandible, use Steinmann pins with positive threads [2]. Prevent untimely removal of the fixation device by the animal by housing it in a hazard-free environment. If applied properly, good stability may be achieved across the fracture site. It may be necessary to use an alternative feeding technique, such as liquid diet or nasogastric tube feeding. Esophagostomy is also an option, but it is associated with a high complication rate.

Fig. F4P: Type II external fixator across both rami of the mandible. A tension band wire is applied around the pins and tightened to achieve interfragmentary compression of the fracture. The previously open soft tubes are closed with parm bands and the lumen filled with epoxy material, such as PMMA, hoof acrylic, etc.

Fig. S4G: A type I external fixator is applied to a mandible fracture in a 2-year-old Quarter Horse stallion.

Pinless external fixator

The pinless external fixator presents an alternative technique [13]. Several sizes of titanium clamps are currently available. An asymmetric clamp (Fig. S4H) complements the large and small symmetric clamps. The symmetric clamps are applied across the rostral mandible in the region of the diastema, while the asymmetric clamps are applied to a ramus on both sides of the fracture. A minimum of four clamps should be applied and connected to the longitudinal rod (Fig. F4Q). Application involves only minimal trauma, since only small incisions are needed and no transosseous pins are inserted. The clamping force of the fixators persists over a long period, making the devices an attractive alternative. The device can be reused several times. Results so far are excellent, especially in bovine patients [13]. The fact that these animals ruminate should be taken into account. The associated masticatory action causes frequent and powerful cyclic loading. This fixation device must also be protected against inadvertent removal. Good stability can be achieved, leading to good healing. Sequestra may form and require subsequent removal.

Use at least four clamps—two on either side of the fracture.

Fig. S4H: Configuration of the three clamp types of the pinless external fixator. The large and small symmetric clamps are complemented by the asymmetric small clamp. The latter fits ideally around the ramus with the straight arm placed medial of the ramus.

Fig. F4Q: Pinless external fixator applied to a mandible fracture. a) Asymmetric clamp attached to the ramus; b) small adjustable connecting bar; c) single external fixator clamp; d) tubular connecting rod that fits into the clamp (c).

4.1.6 Postoperative management

Monitor the animal and the fixation at least daily during the first 3 postoperative weeks. Delegate the care to the owners as soon as possible, but make them aware of the “danger signs”. Clean the mouth daily with water from a hose and take follow-up radiographs at 6 and 12 weeks. Depending on the fixation technique, it may be advisable to maintain the animal in a box stall until the implants can be removed.

4.1.7 Complications

Infection is the major complication encountered. This becomes especially problematic if instability is present. This instability is occasioned by use, or by trauma to the device. Bone sequestra are not infrequent because these are open fractures. Some teeth may have to be removed in a second operation. Breakdown of the fixation may be an additional complication.

Infection is especially problematic in the presence of instability.

4.1.8 Prognosis

The prognosis is, in most cases, favorable for healing, mainly because of an abundant blood supply. Fractures rostral to the premolars have an especially good chance of healing. If only one ramus is involved, the chances are even better. Generally speaking, foals have a better prognosis than adults do.

4.2 Skull fractures

The prognosis for skull fractures is dependent upon their location. A fissure fracture of the skull may simply cause minor trauma compared with a displaced depression fracture of the skull into the brain, which may be fatal [14]. Most facial and cranial bones are very flat and are readily rendered bereft of a blood supply, predisposing them to sequestration. In many locations the bones are subtended by a hollow cavity, such as a sinus. The brain is also located beneath portions of the bony shell. Rigid internal fixation may not be a prerequisite to healing. The main task involves the reduction of disfiguring fractures and their maintenance in that location until they have healed.

4.2.1 Etiology

Kicks and collisions are the main causes of skull and facial fractures.

4.2.2 Diagnosis

The diagnosis devolves from the anamnesis and observation [14] (Fig. S4I). Assess the extent of the injury by palpation. Some animals may resent this, causing additional, sometimes dangerous, instability. Radiography is indicated but it may be difficult to pinpoint the exact number of injuries and their extent because overlying structures obscure many details [3]. Computed tomography may be the technique of choice, allowing precise identification of the various fragments. Ultrasonography may also be helpful.

Fig. S4I: Palpation of skull fracture. The index finger demonstrates the instability created by the fracture.

Employ computed tomography to precisely define the extent of the pathology.

4.2.3 Preoperative management

Assess the injury in detail, and issue a prognosis, giving due consideration to quality of life. This is important in skull fractures with brain injury or permanent disfigurement. Address the metabolic state of the patient. Some animals will require fluids and correction of acid-base imbalance. If the animal is unconscious or ataxic, tranquilizers and agents such as intravenous DMSO are indicated to help prevent additional damage due to edema. Prepare a surgical plan and check the availability of any devices needed for the surgical intervention [1]. Decide on the approach through which correction of the problem will be attempted well ahead of time to allow expedient correction. Evaluate the animal for gait abnormalities and determine whether the problem is improving or worsening or if there is no change.

4.2.4 Surgical procedures

The following surgical procedures are carried out dependent upon the characteristics of the injury. Either an open or a closed reconstruction, possibly with the aid of a Richards bone hook, can be performed [15] (Fig. F4R). Depression fractures may have to be elevated. This can be achieved with periosteal elevators and hooks or by preparing a hole in an adjacent bone and then inserting an instrument or bent large-gauge wire through the hole and elevating the depressed fragment from the inside [2, 15] (Fig. F4S). Take care to preserve the tenuous blood supply in an effort to avoid sequestration.

Fig. F4R: Use of a bone hook to reduce a depressed zygomatic arch fracture.

Fig. F4S: Insertion of a Steinmann pin through a small drill hole for elevation of a depressed bone fragment. If necessary the fragment is fixed with cerclage wire.

In selected cases, closed reduction is performed and the fragment kept in place by interdigitation of its serrated edges. This would seem to be the ideal situation but it is only applicable to fractures around the zygomatic arch [16]. Insert cerclage wires through small holes prepared in the fragments and in adjacent bones to act as wire sutures (Fig. S4J, Fig. S4K). In cases with large areas of unstable depressed fractures, contour a bone plate and place it over the depressed bones; then apply wire sutures through the plate holes to hold the plate in position. These wire sutures, which are connected to the adjacent bones as well as to the fragments (Fig. F4T), maintain the normal shape of the skull until healing occurs [1, 17]. The fragments are lifted into their normal positions. The bone plate serves as a buttress and bridge, allowing suspension of the bone fragments. If deemed necessary, place a bone graft over the repositioned fragments.

Fig. F4T: A reconstruction plate is contoured to the shape of the head over a comminuted fracture of the skull. Through strategically placed wire sutures the underlying bone fragments are stabilized. It is important that the plate is anchored on the healthy bone on either side of the fractures. Once the fractures are healed the implants are removed.

Fig. S4J: A comminuted fracture of the rostral sinus region was approached surgically. Several small fragments were removed because they were totally devoid of blood supply. The larger pieces were reduced and fixed in place with a wire suture.

Fig. S4K: Closure was uncomplicated after repair of the fracture.

Use a bone plate as a buttress or bridge, from which fragments may be suspended.

If the defect cannot be corrected by reduction, it can be filled with silicone [18] or fluorocarbon implants [19]. These materials appear to be well tolerated.

Reconstructive procedures are indicated in cases of bone defects. With time, some of the bone may slough and leave wide areas of exposed sinuses. Merely closing the skin over these defects proves inadequate because beneath them lies an air-filled cavity. Typically, the skin becomes desiccated and necrotic (Fig. S4L).

Two types of reconstructive procedures can be effective: periosteal flaps and muscle flaps. Periosteal flaps are prepared in the area adjacent to the bone defect with their bases at the edge of the bone defect [20]. The flaps are then inverted, drawn over the bone defect, and sutured either to each other or to the periosteum of the opposite side (Fig. S4M). Apply a cancellous bone graft over the latter, and suture the skin (Fig. S4N). It may be necessary to perform relief incisions and/or transportation flaps to allow adequate coverage of the bone graft [20] (Fig. S4O, Fig. S4P). The other technique involves selection of a special muscle. It is dissected free from the surrounding tissues and transected at its tendon of insertion [21]. Maintain the base of the muscle, then rotate the muscle flap over the defect and fix it in this position. Then close the skin over the area, possibly with the help of relief incisions.

Repair large defects with inverted periosteal or muscle flaps combined with a cancellous bone graft.

Fig. S4L: A foal with a frontocutaneous fistula adjacent to the right eye.

Fig. S4N: A cancellous bone graft was subsequently applied over the periosteal flap.

Fig. S4M: From either side of the bone defect a periosteal flap was dissected free and sutured closed over the bone defect.

Fig. S4O: For tensionless closure of the skin defect, a relief incision was necessary.

Fig. S4P: A good cosmetic result was achieved with this reconstructed approach. An ultrasonographically bony union could be verified 3 months later.

4.2.5 Postoperative management

Take every precaution to prevent trauma during the recovery period. The surgical site should be protected by bandaging and/or a padded hood. Prevent subcutaneous accumulation of fluids by the insertion of drains. Anti-inflammatory drugs and antibiotics are mandatory to control inflammation and prevent postoperative infection. Sutures and any tension reduction devices should be removed 2–3 weeks postoperatively.

Prevent trauma to the surgical site during the postoperative period.

4.2.6 Complications

Complications include breakdown of the fixation through external trauma or selfmutilation. This may lead to disfigurement; possibly to sloughing of vital tissue. Postoperative infection is the only other important complication and should be prevented if at all possible. Both these complications may dictate further revision. Revision may also be indicated in cases in which per primam fixation was not possible.

4.3 References

1. Auer JA (1996) Internal fixation of long bone fractures in cattle/mandibular fractures in the horse. Proc Symp Am Coll Vet Surg; 6:72.

2. Beard W (1998) The skull, maxilla, and mandible. In: Auer JA, Stick JA, editors. Equine Surgery. 2^nd ed. Philadelphia: W.B. Saunders Co, 887.

3. Park RD (1993) Radiographic examination of the equine head. Vet Clin North Am Equine Pract; 9:49–74.

4. Meagher DM, Trout DR (1980) Fractures of the mandible and premaxilla in the horse. Proc Am Assoc Equine Pract; 26:181.

5. DeBowes RM, Cannon JH, Grant BD, et al. (1981) Lag screw fixation of rostral mandibular fractures in the horse. Vet Surg; 10:153.

6. Gabel AA (1969) A method of surgical repair of the fractured mandible in the horse. J Am Vet Med Assoc; 155:1831–1834.

7. Colahan PT, Pascoe JR (1983) Stabilization of equine and bovine mandibular and maxillary fractures, using an acrylic splint. J Am Vet Med Assoc; 182:1117.

8. Dart AJ, Pascoe JR (1987) Treatment of a bilateral mandibular fracture in a mare using an intraoral acrylic splint. Aust Vet J; 64:382.

9. Krahwinkel DJ, Heffernan HJ, Ewbank RL (1969) Surgical repair of fractured maxillae and premaxillae in a horse. J Am Vet Med Assoc; 154:53–57.

10. Wallace CE (1971) Repair by open reduction of fractured mandible in a stallion. Aust Vet J; 47:57–60.

11. Wilson DG, Trent AM, Crawford WH (1990) A surgical approach to the ramus of the mandible in cattle and horses. Case reports of a bull and a horse. Vet Surg; 19:191.

12. Von Saldern FC, Gawaz M (1993) The dental intraoral fixation of mandibular fractures with dynamic compression plates (DCP) in the horse. Proc Ann Meet Europ Coll Vet Surg; 2:29.

13. Lischer CJ, Fluri E, Kaser-Hotz B, et al. (1997) Pinless external fixation of mandible fractures in cattle. Vet Surg; 26:14–19.

14. Turner AS (1979) Surgical management of depression fractures of the equine skull. Vet Surg; 8:29.

15. Blackford JT, Hanselka DV, Heitman JM, et al. (1985) Non-invasive technique for reduction of zygomatic process fractures in the horse. Vet Surg; 14:21.

16. Caron JP, Barber SM, Bailey JV, et al. (1986) Periorbital skull fractures in five horses. J Am Vet Med Assoc; 188:280–284.

17. Burba DJ, Collier MA (1991) T-plate repair of fracture of the nasal bones in a horse. J Am Vet Med Assoc; 199:909–912.

18. Bohanon TC, Gabel AA (1991) Cosmetic repair of a facial deformity by use of a silicone implant in a horse. J Am Vet Med Assoc; 198:1957.

19. Valdez H, Rook JS (1981) Use of fluorocarbon polymer and carbon fiber for restoration of facial contour in a horse. J Am Vet Med Assoc; 178:249.

20. Schumacher J, Auer JA, Shamis L (1985) Repair of facial defects with periosteal flaps in two horses. Vet Surg; 14:235.

21. Campbell ML, Peyton LC (1984) Muscle flap closure of a frontocutaneous fistula in a horse. Vet Surg; 13:185.

4.3.1 Online references

See online references on the PEOS internet home page for this chapter:

http://www.aopublishing.org/PEOS/04.htm

Principles of Equine Osteosynthesis: Book & CD-ROM

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