Internal Fixation of Severe Maxillofacial Fractures in Dogs Boaz Arzi, DVM Diplomate AVDC & EVDC, and Frank J.M. Verstraete, DrMedVet MMedVet Diplomate AVDC, ECVS & EVDC Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California Corresponding Author Dr. Boaz Arzi, DVM Diplomate AVDC & EVDC, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis One Shield Avenue, Davis, CA 95616. E‐mail: barzi@ucdavis.edu Submitted August 2013 Accepted December 2013 DOI:10.1111/j.1532-950X.2014.12161.x Objective: To describe internal fixation for maxillofacial fractures using titanium miniplates and report outcome in 7 dogs. Study design: Prospective case series. Animals: Skeletally mature dogs (n ¼ 7) with maxillofacial fractures. Methods: After CT evaluation of fracture configuration, using a combination of extraoral and intraoral approaches as needed, non‐locking titanium miniplates were contoured to match the normal anatomy of the fractured bones. Plates were secured using non‐locking titanium screws and then covered with a soft‐tissue envelope followed by routine intraoral and extraoral closure. Results: Fractures healed rapidly after reconstruction with immediate return to normal function and occlusion. Follow‐up time of up to 94 months indicated excellent long‐ term function and general lack of complications. One dog developed nasal aspergillosis 1.5 years after surgery and the miniplates were removed without adverse consequences. Conclusion: Internal fixation for maxillofacial reconstruction using titanium mini- plates is an excellent solution for the treatment of comminuted and displaced maxillofacial fractures in dogs. The maxillofacial complex in the dog is the most prominent part of the skull rendering it vulnerable to severe injuries. 1,2 Indeed, most maxillofacial fractures result from traumatic insult such as blunt trauma from vehicular accident, horse kick, or impact forces. The term “maxillofacial” refers to structures involving the incisive, palatine, zygomatic, lacrimal, frontal, and nasal bones as well as the maxillary bone proper. 1,3 This anatomic region is located between 2 strong craniofacial bony structures, the cranial base and the mandibles. 4 Biomechanically, the maxillofacial structure can be thought of as a strong, but lightweight, frame made of thin bones and large airy spaces of the nasal cavity and paranasal sinuses. 4 The maxillofacial frame is strengthened by the buttresses, or projecting support, that maintain the position of the maxilla in the appropriate relationship with the base of the skull and the mandibles. 1,4,5 These buttresses in the dog and their importance in maxillofacial reconstruction have been characterized. 1,5 Miniplates have been used for maxillofacial osteosynthesis in people as a part of orthognathic surgery since the 1970s. 6–8 These specialty plates are ideally suited for comminuted or simple maxillofacial fracture repair because of their size and ease of contouring. Plates are typically applied using a tension‐band principle and provide buttress support in maxillofacial fracture repair. 9 Moreover, the transition from using stainless steel plates to titanium has advanced the field of reconstruction as titanium miniplates are lightweight, possess and elastic modulus and density similar to bone, and have great biocompatibility. 9 They are also not typically removed after fracture healing because of their excellent osteointegration. 7,10,11 Advanced maxillofacial reconstruction is uncommonly performed in animals. Boudrieau used miniplates for maxillo- facial fractures achieving excellent functionality and cos- mesis, 5,12 and has reported important considerations in miniplate application in dogs. 9 However, short‐, medium‐, and long‐term data from a larger number of cases are necessary for wider acceptance of the use of miniplates for maxillofacial reconstruction in dogs. Thus our purpose is to report our technique, experience, and follow‐up on 7 dogs that had internal fixation of maxillofacial fractures using titanium miniplates. MATERIALS AND METHODS Case Recruitment Dogs with severe maxillofacial trauma that were considered suitable candidates for internal fixation were included in this study. Comminuted and displaced maxillofacial fractures were defined as “panfacial” if 3 bones were affected and “localized” if 1–2 bones were involved. All dogs had a multidisciplinary approach for systemic stabilization after trauma. Specifically, dogs were evaluated by emergency medicine, ophthalmology, and neurology clinicians and were assessed to be of low anesthetic risk. All dogs were re‐ evaluated 2 weeks after surgery and several times throughout follow‐up. Dr. Arzi and Dr. Verstraete contributed equally to this study. Veterinary Surgery 44 (2015) 437–442 © Copyright 2014 by The American College of Veterinary Surgeons 437