Osteosynthesis of bilateral, displaced incisive bone fracture in a horse

A nine-year-old Trakehner mare was presented three days after an episode of severe epistaxis, showing intermittent foul-smelling nasal discharge with feed material and rostral displacement of the upper incisor teeth. Radiographic and computed tomography examinations revealed a complete comminuted fracture of the right side and an oblique complete fracture of the left side nasal processes of the incisive bone and maxillary bone, as well as open fractures of the nasal septum and palatine bone with displacement of the incisor part rostrally and development of an oronasal communication. The fracture was treated by osteosynthesis using a locking compression plate on the left side of the incisive bone and cerclage wire connecting incisors and premolars of the upper jaw on both sides. Pressure on the fracture line during mastication was reduced by adjusting incisor length. Soft tissues of the hard palate were closed with sutures and managed with daily flushing of the oronasal communication. The mare showed good clinical condition during the whole treatment period. 9-week follow-up examination showed good upper jaw stability and cosmesis. CT-examination confirmed proper bone alignment and complete soft tissue healing.