UC Davis Veterinary Oral Surgeons Repair Dog’s Crushed Skull
February 3, 2016
UC Davis veterinary oral surgeons reconstructed Ziba's skull and jaws after her head was crushed by a car.
Case of the Month – February 2016
Ziba, an 8-month-old female Rottweiler, was accidentally hit by a car and suffered extensive injuries to her head four months ago. Her skull and jawbones were fractured in several areas, and brain damage was feared. Thanks to surgeons at the UC Davis veterinary hospital, however, she is on the road to recovery, and her outlook is promising.
Like all maxillofacial trauma cases brought to UC Davis, Ziba was seen by the Dentistry and Oral Surgery Service (DOSS). While she was alert and responsive, Ziba had a sunken appearance to her right eye, a clear misalignment of her jaws, generalized facial swelling, was bleeding and had decreased airflow from both nostrils, had blood-tinged saliva from the mouth, and had an increased effort to breathe with loud snorting sounds. Cerebrospinal fluid was also leaking from her nostrils, a clear indication of potential brain damage and a reflection of the severity of the trauma. Even if Ziba’s skull fractures could be repaired, the potential brain damage could lead to secondary systemic problems like seizures or diabetes throughout her life.
Initial CT scans from her referring veterinarian determined many fractures to her skull, coupled with brain swelling and a lack of oxygen to the brain. As with all catastrophic head injuries, DOSS consulted with the hospital’s Ophthalmology and Neurology Services to examine for further damage. Luckily, Ziba had relatively few neurological abnormalities given the extent of her injuries – the biggest exception being that her right optic nerve was compromised, which ophthalmologists determined was causing blindness in her right eye.
The hospital’s Diagnostic Imaging Service was also brought in to perform further skull CT scans, as well as thoracic and abdominal radiographs. The radiographs revealed no evidence of thoracic or abdominal cavity trauma. The CT, however, revealed to true extent of the damage to her head: numerous maxillofacial and bilateral mandibular fractures, C1 vertebra fracture, depressed fractures of the brain case, mild intracranial hemorrhage, partial dislocation and fracture of the right temporomandibular joint (TMJ), changes to the bones of her hyoid apparatus (which holds the larynx in place and supports the pharynx and tongue) and the neck muscles that support it, and complicated crown root fractures of the right upper fourth premolar and first molar teeth.
Due to Ziba’s young age and current overall condition, DOSS determined that reconstructive maxillofacial surgery was possible, and she could recover with proper follow-up treatment. The Anesthesiology Service prepared Ziba for surgery (and would continue to play an important role in management of pain throughout her stay). The nearly five-hour surgery was performed by DOSS faculty members, assisted by resident veterinarians and dedicated staff. The team’s reconstruction of Ziba’s skull, jaws and TMJ involved closing the fractures with specialized titanium mini-plates and screws which were contoured and placed to reestablish the normal anatomy of the bones and joints.
Following surgery, a large gauge wire was placed around Ziba’s bottom jaw, behind her canine teeth, in order to align her two mandibles to facilitate appropriate healing. The team also bonded her upper and lower canine teeth together on each side with a specialized biocompatible restorative composite to achieve a temporary maxillary-mandibular-fixation, which allowed the fracture of her TMJ and other mandibular bones time to heal. Ziba recovered in the Intensive Care Unit, where she remained overnight and received individualized postoperative monitoring and care.
Two weeks following the surgery, Ziba returned to UC Davis for suture removal and an ophthalmic examination. Unfortunately, the blindness in her right eye persisted and appeared to be permanent. As she had been since the surgery, Ziba was to remain and strict crate rest and be fed through a tube.
A month later, she returned for another follow-up examination where veterinarians removed the composite and wiring, as well as the two fractured molar teeth. Ziba was able to successfully eat food by her mouth for the first time since the injury. She remained on crate rest, but was allowed short walks.
In another two weeks, Ziba’s condition improved enough for her to start utilizing soft chew toys to exercise her jaws and joints. Finally, three months post-surgery, a CT scan of Ziba’s skull showed that the fractures were healing appropriately, and there is no evidence of implant failure or infection. Although there may be potential long-term issues associated with the trauma, Ziba’s veterinary care team is pleased with her progress and hope for many years ahead.
# # #
About the Veterinary Medical Teaching Hospital
The William R. Pritchard Veterinary Medical Teaching Hospital at the University of California, Davis—a unit of the #1 world ranked School of Veterinary Medicine—provides state-of-the-art clinical care while serving as the primary clinical teaching experience for DVM students and post graduate veterinarian residents. The VMTH treats more than 51,000 animals a year, ranging from cats and dogs to horses, cows and exotic species. To learn more about the VMTH, please go to www.vetmed.ucdavis.edu/vmth. Timely news updates can be received on its Facebook (www.facebook.com/ucdavisvetmed) and Twitter (www.twitter.com/ucdavisvetmed) pages.
VMTH Communications & Marketing Officer