Feline head trauma: a CT analysis of skull fractures and their management in 75 cats

Abstract

Objectives: The aim of this study was to describe and evaluate the configurations and management of feline skull fractures and concurrent injuries following head trauma.

Methods: Medical records and CT images were reviewed for cats with skull fractures confirmed by CT that were managed conservatively or with surgery. Details of signalment, presentation, skull fracture configuration, management, re-examination, and complications or mortality were recorded and analysed.

Results: Seventy-five cats (53 males, 22 females) with a mean age of 4.8 ± 3 years met the inclusion criteria. Eighty-nine percent of cats had fractures in multiple bones of the skull, with the mandible, upper jaw (maxilla, incisive and nasal bones) and craniofacial regions most commonly affected. Temporomandibular joint injury occurred in 56% of cats. Road traffic accidents (RTAs) were the most common cause of skull fractures, occurring in 89% of cats, and caused fractures of multiple regions of the skull. RTAs were also associated with high levels of concurrent injuries, particularly ophthalmic, neurological and thoracic injuries. A more limited distribution of injuries was seen in non-RTA cats. Equal numbers of cats were managed conservatively or surgically (47%). Mortality rate was 8% and complications were reported in 22% of cats. Increasing age at presentation and presence of internal upper jaw fractures were risk factors for development of complications. No risk factors were identified for mortality.

Conclusions and relevance: RTAs were the most common cause of feline skull fractures and resulted in fractures in multiple regions of the skull and concurrent injuries occurred frequently. Problems with dental occlusion were uncommon post-treatment. An increased risk of implant loosening and malocclusion was seen with palatine and pterygoid bone fractures and hard palate injuries. This study provides useful additional information regarding feline skull fractures, concurrent injuries and management techniques following head trauma.

Keywords: CT; Skull fracture; complications; computed tomography; conservative; head trauma; surgery.

Figure 1

(a) Transverse 0.75 mm CT slice at the level of the temporomandibular joints. There is fracture of the temporal process of zygoma on the right and a left mandibular condyle (vertical fracture, medial one-third). (b) Three-dimensional volume-rendered CT shows mandibular and maxillary symphyseal separations, bilateral maxillary fractures, right temporal process of the zygoma fracture, bilateral frontal-maxillary suture interface fracture and right fracture of the orbital lamella of frontal bone, with fracture through the maxillary arcade. (c) Lateral projection and (d) ventrodorsal skull radiographs postoperatively showing placement of cerclage wire around the mandible caudal to the canine teeth, K-wire placed across the maxillary bones and the maxilla further stabilised with a figure-of-eight tension band wire. The right zygomatic arch is fractured and there is widening of the maxillary incisors, compatible with the fractures identified on CT. Left mandibular condyle is absent; the mandibular fossa is empty and the retroarticular process is clearly visible