New Study Shows ORIF Outperforms MMF in Feline Mandibular Fracture Healing

Clinical and Diagnostic Imaging Outcomes of Mandibular Fracture Management in 109 Cats

Janny V. Evenhuis, Anna Vincek, Stephanie Goldschmidt, Maria Soltero-Rivera, Mindy A. Nguyen, Boaz Arzi

Background

Mandibular fractures are common in cats following maxillofacial trauma, often resulting from vehicular accidents or altercations. Given the complexity and biomechanical implications of these fractures, optimal treatment is crucial for functional recovery. This study sought to evaluate fracture patterns, treatment methods, and healing outcomes using advanced imaging, with a hypothesis that fracture morphology and fixation method affect healing and functional return.

Methods

A retrospective analysis of 109 cats with mandibular fractures evaluated at the University of California, Davis between 2013 and 2024 was conducted. Inclusion criteria required advanced imaging (CT or CBCT) at presentation and follow-up examination or imaging. Fractures were classified by location, displacement, and fragmentation. Treatment modalities included various forms of fixation such as open reduction and internal fixation (ORIF), maxillomandibular fixation (MMF), cerclage wires, and composite splints. Healing outcomes were scored based on radiologic and clinical findings.

Results

The mandibular symphysis was the most commonly affected site (55.0%), followed by the condylar process (49.5%) and mid ramus (48.6%). Higher pre-operative displacement in the mid ramus and coronoid process correlated with poorer healing. ORIF resulted in significantly better outcomes with higher rates of adequate healing (85.7%) and lower rates of persistent malocclusion (9.1%) compared to MMF (30.4% healing; 53.9% malocclusion). Overall survival rate was 94.5%. Esophageal feeding tube placement did not significantly impact postoperative weight changes.

Limitations

The study's retrospective nature introduced variability in surgical technique and follow-up timing. Imaging modalities varied, and not all cases received follow-up CT, potentially affecting uniformity in outcome assessment. Selection bias toward more severe cases or those referred to tertiary care may limit generalizability. Additionally, blinding was not possible during outcome evaluation.

Conclusions

ORIF demonstrates superior clinical and radiologic healing outcomes compared to MMF for treating caudal mandibular fractures in cats. The findings support ORIF as a preferred approach when feasible. Overall, feline mandibular fractures, when managed with timely diagnostics and appropriate fixation, have a high survival rate and favorable prognosis for functional recovery.

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