Treatment of an Occipital Fracture by Esquillectomy

골편적출술을 적용한 후두골 골절 치료

  • Park, Jin-Uk (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University) ;
  • Cho, Ki-Rae (Department of Veterinary Nurse and Pet Science, Seojeong College University) ;
  • Chang, Dong-Woo (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University) ;
  • Choi, Seok-Hwa (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University) ;
  • Kim, Gon-Hyung (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University)
  • Accepted : 2010.07.08
  • Published : 2010.08.30

Abstract

A 4-year-old male Yorkshire terrier was referred to us with signs of vomiting and unconsciousness due to a blunt head trauma. Gross examinations detected facial edema, subcutaneous hemorrhage and hypersalivation. A survey radiograph located an occipital fragment which was displaced caudally. A three-dimensional computed tomographic reconstruction demonstrated that the ventral portion of the fragment was attached incompletely. Because of the instability of the fragment, it was decided to perform an esquillectomy. After removing the fragment, the defect was reinforced with a muscular flap originating from the splenius muscle. The patient's condition gradually improved except for a slightly ataxic gait. At 20 months follow-up, there was no evidence of ataxia. The neurological status did not deteriorate before starting surgical intervention, although the patient sustained a skull fracture with severe intracranial hemorrhage. It is likely that the fragment being displaced outwardly played an important role in preventing an increase in intracranial pressure which could have led to neurological deterioration.

4년령의 수컷 요크셔테리어가 두부의 둔상에 의한 구토와 무의식을 주증으로 내원하였다. 육안검사에서 안면 부종, 피하 출혈, 과유연을 확인하였다. 방사선 검사에서 후두골편이 뒤쪽으로 변위되어 있음이 확인되었다. 3차원으로 재구성한 컴퓨터단층촬영 영상에서 골편의 배쪽 부분이 불완전하게 부착되어 있음을 보여주었고, 골편의 불안정성 때문에 골편적출술을 실시하기로 결정하였다. 골편의 제거 후, 결손부는 널판근을 이용한 근육판으로 보강하였다. 환자 상태는 약간의 실조성 보행을 제외하고, 점차 개선되었다. 술 후 20개월째 추적조사에서 운동실조는 더 이상 관찰되지 않았다. 심한 두 개 내 출혈과 두개골 골절에도 불구하고, 수술적인 중재를 시작하기까지 환자의 신경학적인 상태는 심하게 악화되지는 않았다. 이는 바깥쪽으로 변위된 골편이 신경학적 악화를 야기할 수 있는 두개내압의 증가를 방지하는데 주요한 역할을 했기 때문이라고 사료된다.

Keywords

References

  1. Armitage-Chan E, Wetmore LA, Chan DL. Anesthetic management of the head trauma patient. J Vet Emerg Crit Care 2007; 17: 5-14. https://doi.org/10.1111/j.1476-4431.2006.00194.x
  2. Bruns J, Jr., Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia 2003; 44 (Suppl) 10: 2-10.
  3. Dewey CW. Emergency management of the head trauma patient. Principles and practice. Vet Clin North Am Small Anim Pract 2000; 30: 207-225.
  4. Hopkins AL. Head trauma. Vet Clin North Am Small Anim Pract 1996; 26: 875-891.
  5. Phillips IR. A survey of bone fractures in the dog and cat. J Small Anim Pract 1979; 20: 661-674. https://doi.org/10.1111/j.1748-5827.1979.tb06679.x
  6. Siesjo BK. Basic mechanisms of traumatic brain damage. Ann Emerg Med 1993; 22: 959-969. https://doi.org/10.1016/S0196-0644(05)82736-2
  7. Siesjo BK, Siesjo P. Mechanisms of secondary brain injury. Eur J Anaesthesiol 1996; 13: 247-268. https://doi.org/10.1097/00003643-199605000-00004
  8. Stocchetti N, Longhi L, Zanier ER. Intracranial pressure monitoring for traumatic brain injury: available evidence and clinical implications. Minerva Anestesiol 2008; 74: 197-203.
  9. Syring RS, Otto CM, Drobatz KJ. Hyperglycemia in dogs and cats with head trauma: 122 cases (1997-1999). J Am Vet Med Assoc 2001; 218: 1124-1129. https://doi.org/10.2460/javma.2001.218.1124