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STAFF

Dr. Bernard Fletcher

templatemo.comBernard Fletcher DVM, is from Bennington, Nebraska. Dr. Fletcher attended veterinary school at Kansas State University, where he also worked as an intern in the equine department. He obtained advanced training in equine surgery through selective continuing education courses. He is certified in acupuncture through IVAS, and has also received advanced training in equine chiropractics. He has had a special interest in equine dentistry and oral surgery since 1984, when he first obtained specialized training in dentistry. In the last decade, he has pioneered techniques in local dental anesthesia that have revolutionized standing surgery and oral extractions – his publications on this subject were first published at the 2004 AAEP conference. He has also developed several radiographic techniques that have been instrumental in formulating proper diagnoses of oral disease in horses. He has been invited to lecture at many major equine dental conferences. Dr. Fletcher isco-owner of the Academy of Equine Dentistry, is also an associate editor for The Journal of Equine Dentistry.

Elizabeth Fletcher

Elizabeth FletcherElizabeth has worked as a veterinary assistant for Equine Medical Services since 2001.  She is certified in Equine dentistry from the Academy of Equine Dentistry, and does the majority of dentistry in the practice. She is currently enrolled in veterinary technical school at Vatterott College in Omaha, NE. She has been involved with horses most of her life and has participated horse 4-H and many other open events showing several different horses. She currently is training a new horse for competition.

FACILITY

The veterinary clinic was built in 1999 and is fully equipped with a surgery suite and a padded induction/recovery stalls. Most of the veterinary work is done at the clinic but we have 2 mobile units to go to farm calls.  We offer digital radiography, ultrasound, and fibro-optic endoscopy to aid in diagnosing our patients.

 

Traumatic Fracture of Mandibular Symphysis

Case History;

A 3-month-old colt had a piece of rebar trau
matically penetrate his lower mandible just
caudal to his incisors. This trauma caused a
compound fracture of the mandibular sym
physis. The rebar entered from the bottom of
the jaw and penetrated through the mandible
into the oral cavity. An attempt to stabilize the
fracture was made by intraoral wiring of the
incisors, but the results were unsuccessful.

Evaluation:

The fracture had not healed, and the incisor
alignment was deviated due to the tension
placed on the intraoral wires. There was a
fistula where the rebar had penetrated the oral
cavity. Radiographs indicated a nonunion
fracture of the mandibular symphysis, with
signs of bone infection.
Treatment:
Our first concern when devising a treatment
plan was the infection in the bone and sur
rounding tissue. We needed to control the
infection and eliminate any further contami
nation to the area. Antibiotics alone, with
out addressing the fistulous tract, would not
work. We surgically debrided the fistula and
cleaned it with antiseptics. The tract could not
be left open because the area would be recon
taminated. There was not enough good tissue
around the tract to use for an oral closure, so
we borrowed a flap of tissue from the cheek
just lateral to the tract. This flap was sutured
to the edges of the freshly debrided fistula so
that it was completely covered. A thin bead
of surgical glue was applied to the suture line
to help seal the tract. To add further support
to the sutured area, the tongue was dried and
glued down over the surgical area. It is impor
tant that this suture line does not dehisce and
allow contamination to reoccur. The mouth
heals very
Case 12
Traumatic Fracture of
Mandibular Symphysis
Figures 82, 83, 84
quickly, and it is only necessary for the sutured
area to hold for 5 to 7 days. Glue used in the
oral cavity, which is a wet environment, is of
questionable benefit, however in this case the
glue did hold the tongue in place over the area
for 4 days. This was obviously long enough
for the suture line to seal, because the tract
healed very well with no signs of infection.
No attempt to stabilize the fracture was done
at this time. The foal was placed on a soft diet
and seemed to get along okay with it. Also,
we prescribed oral antibiotics for 6 weeks post
surgery.

Followup:

The foal was reexamined 3 months post sur
gery. The fistula was filled in and had healed
with no signs of infection. The borrowed mu-
cous membrane flap tore loose eventually, only
leaving a slight scar in the cheek area where it
had been incised. The mandibular symphysis
fracture was stable but had healed in a devi
ated alignment. Radiographs indicated healing
of the symphysis, with no signs of infection. It
was now time to address the misalignment of
the mandible. We decided to use relief cuts to
allow the mandible to grow into a more proper
positioning. The colt is now 6 months of age
and will still have considerable growth of the
mandible. The tooth buds of the lower inci
sors possibly have permanent damage and will
not erupt normally, if at all. However, at a 2-
year followup, all of the teeth had erupted and
were in fairly accurate alignment. The over
bite seen at 3 months of age was almost totally
corrected by 2 years of age.

Supernumerary Causing Displacement

Case History:

A 3-year-old gelding in good condition was
brought to the wet lab for routine dental
evaluation. There was some foul odor
coming from the mouth and the horse seemed
moderately head shy while handling. Oral
examination revealed abnormalities within the
second quadrant. Lateral and dorsal ventral
radiographs were taken of the second molar
quadrant.

Evaluation:

The 206 is displaced rostrally due to pressure
from either a supernumerary tooth or a
deformed 606. It is highly unlikely that a
deciduous tooth would be stabilized enough to
cause this much displacement of an erupting
permanent tooth. However, a supernumerary
tooth would develop at approximately the
same time as the adjacent teeth, thus causing
misalignment as the teeth mature and erupt,
which seems to have occurred in this case.
Also, the size, deformity, and density of this
tooth is more consistent with a supernumerary
tooth than a deciduous tooth.

Treatment:

Extraction of this extra tooth is indicated and
should be accomplished as soon as possible
to allow repositioning of the 206 caudally.
Orthodontic pressure would be difficult to
obtain at this time due to lack of clinical
crown, but may be considered in 6 months if
adequate drifting of the 206 has not occurred.
Also, pressure placed on the clinical crown by
orthodontic wires or rubber bands causes the
tooth to tip and does not move the root and
reserve crown at the same rate, which may be
undesirable in this case. With time this tooth
should reposition itself if care is taken in the
future to remove any protuberance formed
by the opposing 306 as the teeth erupt and
mature.