# Surgical Approaches to the Mandible and Maxilla


## Key Takeaways

- Mandibular fractures are significantly more common than maxillary fractures in dogs and cats, with the molar region and symphysis/parasymphysis being the most frequent sites for mandibular injury. Maxillary fractures most commonly involve the maxillary bone itself.
- Approach selection is dictated by fracture location, prioritizing adequate exposure for reduction and implant placement while meticulously preserving critical neurovascular structures (inferior alveolar nerve, mental nerves, facial artery and vein) and tooth roots.
- Biomechanical principles favor lateral plate application on the mandible's tension surface (ventrolateral aspect) for optimal load distribution, necessitating approaches that expose this bone region. The maxilla's buttressed structure often allows for less invasive stabilization.
- Subperiosteal elevation is the preferred dissection technique for mandibular approaches to preserve the periosteal blood supply and osteogenic potential, crucial for fracture healing. Oral approaches must preserve gingival attachments to maintain vascularity.
- Patient positioning is critical for surgical access, with dorsal recumbency commonly used for mandibular body and rostral fractures, and sternal or lateral recumbency for maxillary fractures, depending on the specific bone segment involved.
- Implant selection, including locking plates, reconstruction plates, cerclage wire, and interfragmentary screws, is guided by fracture configuration, bone quality, and mechanical demands, with screw placement requiring preoperative imaging to avoid vital structures.

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This article details the surgical approaches used to expose the mandible and maxilla in dogs and cats for fracture repair and tumor resection. The intended reader is a practicing veterinarian who already manages oral trauma or maxillofacial disease and requires a structured reference for exposure planning, patient positioning, and implant placement. The clinical questions addressed are which approach provides adequate access for a given fracture location or lesion extent, how to position the patient for each exposure, and how the approach influences subsequent fixation choices.

Mandibular fractures account for the majority of jaw injuries in dogs, with the molar region, symphysis, and parasymphysis most frequently affected. Maxillary fractures occur less often and are commonly confined to the incisive and maxillary bones. The distribution of fracture locations directly determines which surgical approach is appropriate, because each exposure is designed to reach a specific anatomic region while preserving neurovascular structures and dental roots. A retrospective study of 100 dogs with jaw fractures reported that the molar region was affected in 47.1% of mandibular fractures, followed by the symphysis and parasymphysis in 30.6%, and the premolar region in 17.4%. The same study found that the mandibular first molar tooth was involved in 85.9% of mandibular body fractures, and the canine teeth were involved in 67.5% of symphyseal and parasymphyseal fractures. These figures illustrate why approach selection must account for dental structures that lie directly within the surgical field.

The principles governing approach selection are exposure, preservation, and stability. Exposure must be sufficient to visualize the fracture ends, apply reduction forces, and place implants without undue soft tissue retraction. Preservation concerns the mental and inferior alveolar nerves, the parotid duct papilla, the facial vessels, and the tooth roots. Stability is achieved through the implant construct, but the approach determines which bone surfaces are available for plate application. The surgeon must decide before incision whether the intended fixation will be applied to the lateral, ventral, or medial aspect of the bone, because this decision dictates the dissection plane.

## At a Glance

| Parameter | Clinical Consideration |
|---|---|
| Most common mandibular fracture sites in dogs | Molar region, then symphysis and parasymphysis |
| Most common maxillary fracture site in dogs | Maxillary bone, then incisive bone |
| Key neurovascular structures at risk | Inferior alveolar nerve, mental nerves, facial artery and vein |
| Primary approach for mandibular body fractures | Lateral approach via subperiosteal elevation |
| Primary approach for rostral mandible | Oral or combined oral-cutaneous approach |
| Primary approach for maxillary fractures | Dorsal or oral approach depending on fracture location |
| Positioning for mandibular approaches | Dorsal recumbency with maxilla secured, or lateral recumbency |
| Positioning for maxillary approaches | Sterna recumbency with head elevated, or lateral recumbency |
| Implant options | Locking miniplates, reconstruction plates, cerclage wire, interfragmentary screws |

## Biomechanical Basis for Approach Selection

The mandible functions as a curved beam under masticatory load. Tension forces develop along the dorsal (alveolar) border during biting, while compression forces develop along the ventral border. This biomechanical pattern explains why plate application to the tension surface, the lateral or ventrolateral aspect of the mandibular body, provides the most favorable load distribution. The approach must therefore expose the lateral surface of the mandible from the ventral border to the alveolar margin to allow plate placement along the tension band.

The maxilla is a buttressed structure that transmits masticatory forces through the facial buttresses to the skull base. Fractures of the maxilla are often minimally displaced because of the multiple bony buttresses and the splinting effect of the nasal septum and palatine bone. This inherent stability means that many maxillary fractures can be managed with conservative treatment or minimal exposure. When surgical stabilization is required, the approach must expose the specific buttress involved while avoiding the infraorbital neurovascular bundle and the nasolacrimal duct.

## Applied Surgical Anatomy

The mandible receives its principal blood supply from the inferior alveolar artery, a branch of the maxillary artery that enters the mandibular foramen on the medial aspect of the ramus. The inferior alveolar nerve accompanies the artery through the mandibular canal and emerges at the mental foramina. The middle mental foramen lies ventral to the premolar teeth, and the caudal mental foramen lies near the level of the fourth premolar. Surgical approaches to the mandibular body must preserve these neurovascular structures to avoid denervation of the lower lip and chin.

The maxilla is supplied by branches of the maxillary artery, including the infraorbital artery, which exits through the infraorbital foramen ventral to the orbit. The infraorbital nerve provides sensation to the nose, upper lip, and rostral maxilla. The nasolacrimal duct runs within the medial wall of the maxillary sinus and can be injured during approaches to the dorsal or lateral maxilla. The parotid duct papilla lies on the buccal mucosa adjacent to the upper fourth premolar and must be identified and preserved during oral approaches to the caudal maxilla.

## Fracture Classification and Approach Planning

Fracture location is the primary determinant of approach selection. The mandible is divided into the symphysis, parasymphysis, body, angular process, and vertical ramus. The maxilla is divided into the incisive bone, maxillary body, palatine bone, and nasal bone. A retrospective study of 299 human patients with alveolar process fractures found that these injuries occurred most frequently in the maxilla at 74% and involved only two teeth in 57% of cases. While this human data does not transfer directly to veterinary patients, it illustrates the principle that alveolar fractures are often limited in extent and may be approached through a localized oral incision instead of a wide exposure.

Mandibular fractures in dogs are classified by location, displacement, comminution, and the presence of open versus closed components. Fractures of the mandibular body require a lateral approach for plate application. Fractures of the symphysis and parasymphysis can often be approached through the oral cavity, with the incision placed directly over the fracture line. Fractures of the vertical ramus and condyle require a more caudal approach, and some condylar fractures are managed conservatively. A review of the literature on diacapitular fractures of the mandibular condyle identified specific indications for open reduction and internal fixation, including fractures affecting the lateral condyle with reduction of mandibular height and fractures where the proximal fragment dislocates laterally out of the glenoid fossa. The same review noted that undisplaced fractures, fractures without shortening of condylar height, and comminuted condylar head fractures are managed conservatively. These criteria guide the surgeon in deciding whether a surgical approach to the caudal mandible is indicated at all.

## Biologic Considerations in Approach Design

The soft tissue envelope surrounding the mandible and maxilla provides the blood supply that supports fracture healing. The periosteum is a critical source of osteogenic cells and vascular ingrowth. Approaches that preserve the periosteal attachment to major fracture fragments maintain this biologic advantage. Subperiosteal elevation is preferred over extraperiosteal dissection because it preserves the periosteal blood supply to the bone surface and creates a clean plane for implant placement.

The oral mucosa provides an additional blood supply to the mandible through the gingival and submucosal plexuses. Approaches that combine oral and cutaneous incisions must preserve the gingival attachment to the bone to maintain this supply. The decision to extract teeth in the fracture line is based on the degree of periodontal disruption, root fracture, and the ability to achieve a stable reduction. A case series of six dogs with critical-size mandibular defect non-union fractures described staged repair in which tooth extraction was performed during the initial procedure, followed by delayed reconstruction with a locking titanium miniplate and a compression-resistant matrix infused with recombinant human bone morphogenetic protein-2. All dogs healed with intact gingival coverage over the defect, demonstrating that a well-vascularized soft tissue envelope supports even complex reconstructive procedures. The same series reported that hard-tissue formation was observed clinically within 2 weeks and solid cortical bone formation within 3 months, with one dog showing 92% of the bone density of the contralateral side on computed tomography at 3 months. These outcomes support the principle that approach design should prioritize preservation of the soft tissue envelope.

## Patient Positioning and Preparation

Positioning follows the fracture location and planned approach. For most mandibular body, ramus, and temporomandibular joint exposures, place the patient in dorsal recumbency with the maxilla secured to a padded frame or table attachment. This position allows bilateral access and facilitates intraoperative assessment of occlusion. For symphyseal and rostral mandibular fractures, dorsal recumbency with the head elevated 20 to 30 degrees provides excellent access. Lateral recumbency suits unilateral ramus or condylar approaches and permits simultaneous access to the opposite side if needed.

Maxillary fractures, particularly those involving the incisive or nasal bones, are best approached from dorsal recumbency with the hard palate perpendicular to the table surface. This orientation allows direct visualization of the dental arcade and simplifies reduction maneuvers. For caudal maxillary or palatine fractures, lateral recumbency with the affected side uppermost improves access to the pterygopalatine region.

Secure the endotracheal tube to the mandibular canine or the contralateral maxillary canine using wire or heavy suture. This fixation must not obstruct the surgical field or distort the dental arcade. In patients with concurrent nasal or sinus involvement, consider pharyngotomy intubation to free the oral cavity entirely. [Verstraete and colleagues described pharyngotomy intubation combined with temporary maxillomandibular fixation for staged mandibular reconstruction](https://pubmed.ncbi.nlm.nih.gov/24410723/), a technique that provides unobstructed access to the entire mandible while maintaining occlusion.

Clip and aseptically prepare the entire hemiface or the full face, including the eyelids, ear canals, and oral commissure. The oral cavity itself cannot be sterilized, so copious lavage with dilute chlorhexidine or saline before incision reduces bacterial load. Drape so that the eye, ear, and nares remain visible for monitoring. For intraoral approaches, a self-retaining retractor or stay sutures through the tongue and lips maintain exposure without excessive traction on neurovascular structures.

## Approach Selection by Fracture Location

The table below summarizes approach selection based on fracture location, patient size, and surgeon preference. These guidelines apply to both dogs and cats unless noted.

| Fracture Location | Recommended Approach | Positioning | Primary Implant Options | Special Considerations |
|---|---|---|---|---|
| Symphysis/parasymphysis | Intraoral, direct | Dorsal recumbency | Cerclage wire, interfragmentary wire, plate | Preserve mandibular canine roots, avoid penetrating alveolar mucosa |
| Mandibular body, rostral | Intraoral or extraoral lateral | Dorsal recumbency | Miniplate, locking plate, external fixator | Molar region most common site in dogs, protect inferior alveolar neurovascular bundle |
| Mandibular body, caudal | Extraoral lateral | Dorsal recumbency or lateral | Locking plate, reconstruction plate | Masseteric attachment preservation, staged approach for non-union defects |
| Mandibular angle/ramus | Extraoral lateral, angular | Lateral recumbency | Plate, lag screw | Identify and preserve facial vessels and parotid duct |
| Condylar process | Preauricular or submandibular | Lateral recumbency | Conservative or ORIF depending on fracture type | Diacapitular fractures often managed conservatively |
| Maxilla, incisive/nasal | Dorsal midline or intraoral | Dorsal recumbency | Microplate, wire | Avoid nasal cavity contamination, monitor nasal airflow |
| Maxilla, body/palatine | Intraoral or lateral rhinotomy | Dorsal recumbency | Miniplate, reconstruction plate | Concurrent dental injuries common, assess occlusion carefully |

Mandibular fractures in dogs most frequently affect the molar region, followed by the symphysis and parasymphysis, with the mandibular first molar involved in a large proportion of cases [as documented in a retrospective study of 100 dogs with jaw fractures](https://pubmed.ncbi.nlm.nih.gov/16149386/). Maxillary fractures occur less commonly and most often involve the maxillary bone itself, followed by the incisive bone. This distribution influences approach selection because the surgeon must anticipate dental root proximity and neurovascular structures at each site.

## Step-by-Step Approach Checklists

### Extraoral Lateral Approach to the Mandibular Body

1. Position the patient in dorsal or lateral recumbency with the affected side accessible.
2. Palpate the mandibular body and mark the planned incision along the ventral border, curving dorsally over the fracture site.
3. Incise skin and subcutaneous tissue parallel to the mandibular ventral border.
4. Identify and preserve the facial vein and artery where they cross the masseter muscle.
5. Incise the deep cervical fascia and reflect the platysma muscle dorsally.
6. Elevate the masseter muscle from the lateral surface of the mandible using periosteal elevation, preserving the muscle attachment where possible.
7. Expose the fracture site by subperiosteal dissection, taking care to protect the inferior alveolar neurovascular bundle emerging from the mental foramina.
8. Reduce the fracture and apply the selected implant.
9. Close in layers, reapproximating the masseter muscle to its origin and closing subcutaneous tissue and skin separately.

### Intraoral Approach to the Symphysis and Parasymphysis

1. Position the patient in dorsal recumbency with the head elevated.
2. Place stay sutures through the tongue to retract it caudally and laterally.
3. Incise the gingiva along the fracture line, extending the incision into the alveolar mucosa as needed.
4. Elevate a mucoperiosteal flap to expose the symphyseal surface.
5. Reduce the fracture by aligning the incisive dental arcade.
6. Place interfragmentary wire or a small plate across the symphysis, ensuring the implant does not penetrate the alveolar sockets of the canine teeth.
7. Close the gingiva with absorbable monofilament suture in a simple interrupted pattern.

### Approach to the Condylar Process

1. Position the patient in lateral recumbency with the affected side uppermost.
2. Make a curvilinear incision starting at the dorsal aspect of the zygomatic arch and extending ventrally along the caudal border of the ramus.
3. Identify the facial nerve branches and retract them gently.
4. Incise the masseter muscle along its dorsal attachment and elevate it ventrally.
5. Expose the condylar neck and the temporomandibular joint capsule.
6. Open the joint capsule only if direct visualization of the articular surface is required.
7. Reduce the fracture and apply implants if open reduction is indicated.
8. Close the joint capsule, masseter muscle, subcutaneous tissue, and skin in layers.

For diacapitular fractures of the mandibular condyle, the literature supports conservative management in most cases, with open reduction and internal fixation reserved for fractures that shorten condylar height or dislocate laterally out of the glenoid fossa [according to a review of open versus closed reduction for these injuries](https://pubmed.ncbi.nlm.nih.gov/22842852/). This decision framework applies to both dogs and cats, although feline condylar fractures are less common.

## Implant Selection and Placement

Implant choice depends on fracture configuration, bone quality, and the mechanical demands of the location. Locking plates provide angular stability and are preferred for comminuted fractures, non-union defects, and osteopenic bone. Non-locking plates require precise contouring to avoid displacing the fracture during screw tightening. Cerclage and interfragmentary wires remain useful for symphyseal fractures and simple oblique fractures in small patients.

For mandibular reconstruction of critical-size defects, a staged approach with initial debridement and tooth extraction followed by delayed bone grafting or regenerative techniques may be necessary. [A case series describing mandibular reconstruction using locking titanium miniplates and rhBMP-2 in a compression-resistant matrix reported successful healing with return to normal function and correct occlusion in all treated dogs](https://pubmed.ncbi.nlm.nih.gov/24410723/). This technique requires a soft tissue envelope capable of covering the implant and graft material.

Screw placement must avoid dental roots and neurovascular structures. Preoperative imaging, ideally cone-beam CT or conventional CT, provides the spatial information needed to plan screw trajectories. Intraoperative radiography confirms implant position before closure.

## Monitoring and Documentation

Postoperative monitoring focuses on occlusion, implant stability, and soft tissue healing. Assess occlusion daily by examining the dental arcade and observing prehension and mastication. Malocclusion detected within the first week may be correctable by adjusting or replacing implants. After that period, malocclusion may require orthodontic intervention or acceptance.

Radiographic follow-up at 4, 8, and 12 weeks evaluates bone healing and implant integrity. Loss of implant position, screw loosening, or progressive lucency around implants indicates failure and warrants revision. CT is reserved for cases with suspected non-union, implant failure, or where clinical assessment is inconclusive.

Document the fracture classification, approach used, implants placed, and intraoperative findings in the medical record. Include postoperative imaging and a clear description of the occlusion achieved. This documentation supports continuity of care and provides a baseline for assessing complications.

Feline patients present specific challenges. Their smaller mandibles limit implant size, and their thinner cortices reduce screw purchase. Microplates and 1.5 mm screws are often the largest implants that can be placed safely. Cats also have a higher incidence of mandibular fractures secondary to dental disease, so concurrent oral examination and treatment of periodontal disease are essential.

## Complications and Failure Modes

The most frequently encountered complication after mandibular or maxillary fracture repair is malocclusion. This occurs when reduction is imperfect, when fixation loosens before bone healing is complete, or when the contralateral temporomandibular joint undergoes adaptive remodeling under an altered bite. Detection requires systematic postoperative assessment. Evaluate occlusion at each recheck examination, beginning 2 weeks after surgery. Compare the preoperative dental occlusion photographs with the postoperative bite at the canine, premolar, and molar positions. Subtle rostral shifts are best appreciated by examining the incisor relationship from a rostral viewpoint. If malocclusion is identified within the first 2 weeks, early intervention with elastic traction or revision of fixation is more likely to succeed than delayed correction.

Implant loosening is the second most common failure. Screw pullout occurs when a screw is placed into a fracture line, when the bone is osteopenic, or when the plate is not contoured precisely to the underlying bone surface. A plate that stands off the bone by even 1 mm transmits excessive torque to the screws during mastication. Early detection relies on serial radiographs. Compare the immediate postoperative study with the 4 week study. Look for a radiolucent halo around a screw, widening of the fracture gap, or migration of the plate position. Palpation of the plate through the skin or mucosa is not a reliable indicator of loosening because soft tissue swelling masks early motion.

Surgical site infection presents with local swelling, wound dehiscence, or draining tract formation. The risk is highest when the fracture communicates with the oral cavity, when teeth in the fracture line are compromised, or when the patient has concurrent periodontal disease. In the case series describing mandibular reconstruction with rhBMP-2 and internal fixation, all dogs healed with intact gingival coverage, but the authors emphasized that staged procedures and extraction of teeth in the fracture line were performed to achieve a clean soft tissue envelope before implantation [Verstraete et al., Regenerating Mandibular Bone Using rhBMP-2: Part 2](https://pubmed.ncbi.nlm.nih.gov/24410723/). This principle applies equally to routine fracture repair. If a tooth root is exposed in the fracture gap, extraction is usually preferred over retention because the tooth acts as a portal for bacterial ingress.

| Observation | Likely Cause | Discriminating Check |
|---|---|---|
| Malocclusion at 2 week recheck | Inadequate reduction or fixation loosening | Compare occlusion photographs, obtain orthogonal radiographs to assess fracture gap and implant position |
| Radiotranslucent halo around screw at 4 weeks | Screw loosening from poor bone purchase or plate contour mismatch | Assess plate-bone interface on radiographs, consider CT if available |
| Wound dehiscence over plate | Infection, excessive soft tissue tension, or plate prominence | Culture the wound, evaluate soft tissue closure tension, assess plate contour |
| Persistent draining tract | Deep infection or foreign body reaction | Sinus tract study or CT, culture and susceptibility testing |
| Delayed union at 8 weeks | Inadequate stability, infection, or compromised vascularity | Radiographic assessment of callus, consider bone scan or CT |

## Common Errors and Corrective Actions

The most common error in approach selection is choosing an intraoral approach for a fracture that requires plate application on the lateral cortex. The intraoral approach provides excellent exposure of the alveolar margin and the medial cortex but poor access to the ventral and lateral mandibular body. A surgeon who begins with an intraoral approach and then attempts plate application will struggle with implant placement and will often accept a plate position that is too dorsal, placing screws into tooth roots. The corrective action is to plan the approach from the intended implant position. If a plate is planned on the lateral surface, use the extraoral lateral approach from the outset.

A second error is failure to identify and address teeth in the fracture line. The retrospective study of 100 dogs with mandibular fractures found that the mandibular first molar was involved in 85.9% of mandibular body fractures and the canine teeth were involved in 67.5% of symphyseal and parasymphyseal fractures [Lopes et al., Oral fractures in dogs of Brazil](https://pubmed.ncbi.nlm.nih.gov/16149386/). Students and less experienced clinicians often attempt to preserve these teeth to avoid creating a communication with the oral cavity. The more reliable approach is to extract compromised teeth during the initial procedure, as described in the staged reconstruction protocol, and to close the alveolar defect primarily or with a local mucosal flap.

A third error is inadequate soft tissue handling during the extraoral approach. The facial vein and the parotid duct are at risk during dissection of the caudal mandibular body. The marginal mandibular branch of the facial nerve runs with the facial vein and can be injured by aggressive retraction. The corrective action is to identify the vein early, ligate it if necessary, and retract the soft tissues with a Langenbeck retractor placed directly on bone instead of on the overlying muscle.

## Limitations of the Evidence

The veterinary literature on mandibular and maxillary fracture repair consists largely of retrospective case series and expert opinion. Prospective comparative trials are scarce. The available data on fracture distribution in dogs come from single-center retrospective studies, and the reported frequencies vary with the referral population [Lopes et al., Oral fractures in dogs of Brazil](https://pubmed.ncbi.nlm.nih.gov/16149386/). The human literature on condylar fractures is more extensive, but the indications for open versus closed reduction described in that literature, such as lateral condylar displacement with loss of mandibular height, have not been validated in dogs and cats [Chrcanovic, Open versus closed reduction of diacapitular fractures](https://pubmed.ncbi.nlm.nih.gov/22842852/).

Expert opinion differs on several points. Some surgeons advocate closed reduction for all symphyseal fractures, while others prefer open reduction with wire or plate fixation to achieve anatomic alignment. The choice of implant, specifically whether to use miniplates or larger reconstruction plates, also remains contested. The rhBMP-2 reconstruction series demonstrates that critical-size defects can be managed successfully with a staged approach, but the technique requires specialized equipment and materials and is not universally available [Verstraete et al., Regenerating Mandibular Bone Using rhBMP-2: Part 2](https://pubmed.ncbi.nlm.nih.gov/24410723/). The volumetric changes reported for bone grafting in the atrophic mandible, with graft resorption of 29% to 35% during healing, suggest that similar resorption should be anticipated when grafting mandibular defects in dogs [Barone et al., Early volumetric changes after vertical augmentation](https://pubmed.ncbi.nlm.nih.gov/28705523/).

## Referral and Escalation Criteria

Referral to a veterinary dental and oral surgery specialist is warranted when the fracture involves the condylar process with displacement, when the fracture is comminuted or involves a critical-size defect, when the patient has concurrent maxillofacial trauma affecting the orbit or nasal cavity, or when the surgeon lacks experience with plating of the mandible. The American College of Veterinary Surgeons maintains a directory of board-certified surgeons and provides client-facing summaries of surgical conditions and expected outcomes [ACVS Animal Health Resources](https://www.acvs.org/small-animal/). Early referral is preferable to attempted repair with inadequate equipment or experience, because a failed repair with malunion or nonunion is more difficult to salvage than a primary repair performed by an experienced surgeon.

Laboratory involvement is indicated when a pathologic fracture is suspected. Submit a biopsy of the fracture margin for histopathology if neoplasia is considered. If the patient has clinical signs suggestive of metabolic bone disease, such as hyperparathyroidism or renal secondary hyperparathyroidism, measure serum calcium, phosphorus, and parathyroid hormone concentrations before surgery. The MSD Veterinary Manual provides species-specific guidance on the diagnosis and management of these conditions [MSD Veterinary Manual](https://www.msdvetmanual.com/).

Regulatory reporting is rarely required for mandibular or maxillary fractures in companion animals. However, if the fracture is suspected to result from non-accidental injury, the clinician has an obligation to document the findings thoroughly and to report suspected animal abuse to the appropriate authorities. The American Veterinary Medical Association provides practice resources on the recognition and reporting of animal abuse [AVMA Practice Resources](https://www.avma.org/resources-tools). Documentation should include photographs of the injuries, a detailed description of the fracture pattern, and a statement of the consistency between the reported history and the clinical findings.

## Frequently Asked Questions

### How Do I Choose Between Intraoral and Extraoral Approaches When Equipment Is Limited?

When locking plates, computed tomography, or power equipment are unavailable, approach selection shifts toward what can be achieved with basic instruments. Intraoral approaches to the symphysis and parasymphysis require only a periosteal elevator, bone-holding forceps, and a pin driver or wire passer, making them feasible in most general practices. Extraoral approaches to the mandibular body demand more soft tissue dissection and retraction but allow direct visualization for plate application. If only cerclage wire or Kirschner wires are available, favour fracture configurations that are geometrically stable, such as simple short oblique fractures, and avoid comminuted or defect fractures. For defect non-union fractures, reconstruction without appropriate implants and bone grafting materials carries a high failure risk, and referral is the safer recommendation. The [ACVS small animal surgical resources](https://www.acvs.org/small-animal/) provide guidance on when specialist referral is indicated.

### What Is the Role of Maxillomandibular Fixation in Mandibular Fracture Repair?

Temporary maxillomandibular fixation aligns the dental arches and restores occlusion before definitive internal fixation. It is particularly useful for comminuted fractures, bilateral body fractures, and defects where the occlusion cannot be maintained manually. The technique involves placing screws or wires on the maxillary and mandibular canine teeth or premolars and connecting them with orthodontic elastic or wire. In one described staged protocol for defect non-union fractures, pharyngotomy intubation and temporary maxillomandibular fixation were performed before extraoral plate application, allowing accurate reduction before definitive fixation. Fixation is released once the bone is stabilized, and the patient is monitored for malocclusion during recovery. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) offers additional guidance on perioperative airway management and patient monitoring during maxillofacial procedures.

### How Does Mandibular Fracture Management Differ Between Dogs and Cats?

Cats have thinner mandibles, smaller medullary canals, and a higher incidence of symphyseal separation and condylar fractures compared with dogs. The feline mandible accommodates smaller implants, and 1.0 to 1.3 mm plates or wires are often the maximum that can be applied without compromising the tooth roots. Symphyseal fractures in cats are typically repaired with a single cerclage wire passed around both mandibles rostral to the canine teeth, whereas dogs may require two wires or a small plate. Condylar fractures in cats are more often managed conservatively because of the small fragment size and the difficulty of stable screw placement. In both species, preservation of the tooth roots and the inferior alveolar neurovascular bundle is critical during approach and implant placement. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) provides species-specific guidance on feline oral anatomy and fracture considerations.

### What Records Should I Maintain for Mandibular and Maxillary Fracture Repairs?

The medical record should document the fracture location and classification, the surgical approach used, implant type and size, and the method of occlusion verification. Preoperative and postoperative radiographs or advanced imaging should be stored with the record, including at least two orthogonal views of each fracture site. Photographs of the occlusion before and after repair are valuable for medicolegal purposes and for client communication. Record the method of postoperative analgesia, feeding plan, and activity restrictions, and schedule a recheck examination at 4 to 8 weeks with imaging to assess healing. If complications such as implant loosening or malocclusion occur, document the findings and corrective actions. The [AVMA practice resources](https://www.avma.org/resources-tools) provide general standards for medical record keeping in veterinary practice.

### How Should I Explain the Surgical Plan and Prognosis to a Client?

Explain that the goal of surgery is to restore normal occlusion and allow the bone to heal in a functional position. Describe the approach in plain terms, for example that the incision is made either inside the mouth or through the skin over the jaw, depending on where the fracture is located. State the expected recovery timeline, including soft food for 4 to 6 weeks, restricted chewing, and a recheck examination with radiographs. Be honest about the risk of complications such as implant loosening, infection, or malocclusion, and explain that a second surgery may be required in a small percentage of cases. For complex fractures, including defect non-union fractures, explain that referral to a surgical specialist may offer a better outcome. The [ACVS small animal surgical resources](https://www.acvs.org/small-animal/) include client-oriented summaries that can supplement your discussion.

### When Should I Refer a Mandibular or Maxillary Fracture to a Specialist?

Refer when the fracture is comminuted, involves a critical size bone defect, or extends into the condylar process with displacement that cannot be reduced closed. Refer also when the ideal implants are unavailable, when the patient has concurrent maxillofacial trauma that compromises the airway, or when the fracture is pathologic and requires biopsy and reconstruction. Defect non-union fractures of the mandible have been successfully reconstructed using locking miniplates and bone morphogenetic protein implants, but this requires specialised equipment and experience. If you do not have access to locking plates, computed tomography, or a power drill with small burrs, referral is appropriate for any fracture that is not a simple, stable, single-site fracture. The [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) do not address surgical referral, but professional judgment and local specialist availability should guide the decision.

## Related Clinical & Scientific Guides

* [Perioperative Antibiotic Prophylaxis: Timing and Selection](/knowledge/veterinary-medicine/veterinary-surgery/perioperative-antibiotic-prophylaxis-timing-selection)
* [Surgical Approaches to the Femur and Stifle](/knowledge/veterinary-medicine/veterinary-surgery/surgical-approaches-femur-stifle)
* [Fracture Healing Assessment: Radiographic and Clinical Evaluation](/knowledge/veterinary-medicine/veterinary-surgery/fracture-healing-assessment-radiographic-clinical)


## References and Further Reading

- [Regenerating Mandibular Bone Using rhBMP--2: Part 2-Treatment of Chronic, Defect Non-Union Fractures.](https://pubmed.ncbi.nlm.nih.gov/24410723/). 2015.
- [Alveolar process fractures in the permanent dentition. Part 1. Etiology and clinical characteriztics. A retrospective analysis of 299 cases involving 815 teeth.](https://pubmed.ncbi.nlm.nih.gov/26411777/). 2015.
- [Open versus closed reduction: diacapitular fractures of the mandibular condyle.](https://pubmed.ncbi.nlm.nih.gov/22842852/). 2012.
- [Sports-Related Maxillofacial Injuries.](https://pubmed.ncbi.nlm.nih.gov/26468794/). 2015.
- [Oral fractures in dogs of Brazil--a retrospective study.](https://pubmed.ncbi.nlm.nih.gov/16149386/). 2005.
- [Early volumetric changes after vertical augmentation of the atrophic posterior mandible with interpositional block graft versus onlay bone graft: A retrospective radiological study.](https://pubmed.ncbi.nlm.nih.gov/28705523/). 2017.
- [American College of Veterinary Surgeons Animal Health Resources](https://www.acvs.org/small-animal/). American College of Veterinary Surgeons.
- [MSD Veterinary Manual, Professional Edition](https://www.msdvetmanual.com/). MSD Veterinary Manual.
- [American Veterinary Medical Association Practice Resources](https://www.avma.org/resources-tools). American Veterinary Medical Association.

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> This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.