CT Study Reveals Multifocal Skull Fracture Patterns in Feline Head Trauma—Clinical Implications Uncovered

Assessment of Fracture Distribution and Involvement of Functional Systems Following Craniomaxillofacial Trauma in 48 Cats

Sascha Weichert, Ingmar Kiefer, Lars F.H. Theyse

Background
Craniomaxillofacial (CMF) trauma in cats often results from road traffic accidents or high-rise syndrome and involves a wide range of fractures and functional impairments. While the complexity of CMF injuries is recognized, detailed assessments of fracture patterns and their impact on functional systems—oral, nasal, orbital, and neurocranial—are lacking. This study aimed to systematically characterize fracture distribution and associated functional system involvement in cats using computed tomography (CT).

Methods
A retrospective analysis was conducted on 48 cats with CMF trauma who underwent skull CT scans (1.0 mm slice thickness) at the University of Leipzig from 2006 to 2018. Fractures were classified anatomically, and associated impacts on four functional systems (oral cavity, nasal/nasopharyngeal airways, orbita/eye, and neurocranium) were evaluated. Standard anatomical nomenclature and a modified AO CMF classification were applied. Functional outcomes were assessed based on CT evidence of instability, obstruction, or displacement.

Results
Mandibular fractures were the most common (40/48 cats), followed by TMJ injuries (27/48), and maxillofacial fractures (36/48). Bilateral mandibular or nasal fractures were common. TMJ fractures predominantly affected the condylar process and occasionally occurred without other mandibular fractures. Nasal and oronasopharyngeal airway obstruction was present in 36/48 cats, typically due to palatine and pterygoid bone fractures. Orbital fractures (30/48) were primarily medial and led to airway obstruction. Neurocranial fractures were rare (6/48). Functional system involvement was extensive: 36 cats had concurrent dysfunction in oral, nasal, and orbital systems. Only 10 cats had isolated oral involvement.

Limitations
The retrospective design and limited sample size may restrict generalizability. Trauma etiology (e.g., traffic vs. falls) could not be definitively determined. Functional deficits were inferred from imaging and not confirmed clinically. Soft tissue damage may have been underrepresented due to CT's limited soft-tissue resolution. Outcome data were not evaluated.

Conclusions
CMF trauma in cats commonly results in multifocal fractures with concurrent disruption of multiple functional systems. CT imaging reveals that nearly all affected cats have oral dysfunction, and most also suffer from nasal and orbital impairment. The complexity and overlap of affected systems support a need for a multimodal diagnostic and therapeutic approach in managing feline CMF trauma.

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