Plus-Hex CLINICAL
Patient signalment
Species Breed Age Sex Weight
Dog
Presentation
Tibetan Mastiff 1 year Female, entire 31 kg
The patient( Figure 1) presented to the referring veterinary practice with a 2 – 3-day history of lethargy and hyporexia, along with excessive ocular discharge. After an initial assessment and radiographic investigation showed extensive facial trauma, the patient was referred to a dentistry and maxillofacial surgery department with multiple mandibular and maxillofacial fractures. The left globe was also ruptured. The cause of injuries was a road traffic accident( RTA) involving an articulated lorry.
Figure 1. The patient, pictured shortly after referral.
Patient assessment
The patient ' s temperature was not taken on admission, but was 37.7 ° C before the first anaesthetic. Pulse was 140 beats per minute, with no obvious murmur or arrhythmia. Panting was observed during respiratory checks. Mucous membranes were pink and moist, and capillary refill time was < 2 seconds.
Initial assessment at the referring veterinary practice noted a possible maxillary fracture, with the left incisors and palate hanging lower than the right. The mandible was found to be angled towards the right. Moderate blepharospasm was noted along with significant discharge from the eyes and nares. Lateral, dorsoventral and oblique radiographs of the skull were obtained, revealing a segmented fracture of the right mandible and left maxillary and zygomatic arch fractures. No visible skin wounds were noted and no further tests were performed at the referring practice.
Veterinary investigation
On arrival at the referral practice, an intravenous( IV) catheter was placed in the right cephalic vein. The patient underwent a first general anaesthetic for imaging and initial dental extractions, followed by a second anaesthetic 1 day later for reconstructive surgery and enucleation of the left globe. On pre-anaesthetic assessment, no significant comorbidities were discovered except referred upper respiratory noise on thoracic auscultation, which was likely due to the extensive facial injuries impacting on the upper respiratory tract. The patient was assigned an American Society of Anesthesiologists( ASA) physical status grade of II, with an advisory note not to perform any form of intermittent positive-pressure ventilation until computed tomography( CT) images had shown that the lungs were free of injury.
For the first procedure, an IV premedication consisting of 0.007 mg / kg medetomidine( Sedator, 1 mg / ml, Dechra) and 0.2 mg / kg methadone( Comfortan, 10 mg / ml, Dechra) was administered. The patient was induced with 2.9 mg / kg propofol IV( Propofol-Lipuro Vet, 10 mg / ml, Virbac) and 0.001 mg / kg ketamine( Anesketin, 100 mg / ml, Dechra), administered by the intramuscular route. The patient was maintained at a suitable depth of general anaesthesia using inhalational isoflurane( Isoflurane-Vet, Boehringer Ingelheim). Intraoperative IV fluids consisted of lactated Ringer ' s solution( Hartmann ' s solution, Carelide UK Ltd) at a rate of 5 ml / kg / hour. Vital parameters including heart rate, respiratory rate, end-tidal carbon dioxide, non-invasive blood pressure( NIBP) and temperature were monitored continuously and recorded every 5 min.
A CT scan was performed of the head and thorax, and confirmed multiple fractures across the rostral aspect of the head( Figure 2, page 36). Widespread fractures were located across the maxillary, palatine, orbital and zygomatic bones, as well as the rostral and caudal right mandible. Fractures of the left maxillary fourth premolar were also noted. Instability of the maxilla was found bilaterally, with the left side hanging lower and rostrally, causing a malocclusion. On further investigation, the left globe was found to have been ruptured in the collision. Two extractions, of maxillary teeth 208 and 110( Figure 3, page 36), were performed.
Overnight, the patient was maintained on a combination of IV analgesia consisting of 0.1 mg / kg meloxicam( Metacam, 1.5 mg / ml, Boehringer Ingelheim), 0.1 – 0.2 mg / kg methadone( Comfortan, 10 mg / ml, Dechra)
Volume 41( 4) • August 2026
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