Surgical Repair and Postoperative Management of a Le Fort I Fracture and Facial Lacerations in a Pediatric Western Lowland Gorilla (Gorilla gorilla gorilla)
A 3-mo-old western lowland gorilla (Gorilla gorilla gorilla) (3.5 kg) was presented for severe traumatic maxillary-facial wounds. Following emergency immobilization, it was determined that a downward force had degloved the nasal planum from the underlying bones and fractured the rostral maxilla and nasal bones, consistent with a Le Fort I presentation.1 Following radiographic assessment of the skull, reconstructive surgery was undertaken. Surgical wire was used to stabilize the primary maxillary fracture, while soft tissue wounds along the nasal bridge and intra-orally were apposed in multiple layers. Bilateral nasal stents were placed and secured to the lateral nasal alar folds to maintain patency postoperatively.
Protracted hospitalization for wound care and hand rearing followed surgical stabilization. Flunixin meglumine (Flunixiject; Butler Schein Animal Health, Dublin, OH, USA; 0.5 mg/kg, IM, SID), famotidine (Baxter Healthcare Corporation, Deerfield, IL, USA; 1 mg/kg IM, SID), cefazolin (West-Ward Pharmaceuticals; Eatontown, NJ, USA; 8.3 mg/kg, SC, TID), amoxicillin trihydrate/clavulanate potassium (Clavamox Drops; Pfizer Animal Health, New York, NY, USA; 15 mg/kg, PO, BID), and topical 50:50 silver sulfadiazine cream (SSD; Dr. Reddy’s Laboratories Louisiana, Shreveport, LA, USA) and Preparation-H ointment (Pfizer; Madison, NJ, USA) were utilized during the recovery period. The infant was fed liquid formula (Similac PM 60/40; Abbott Nutrition; Abbott Laboratories, Columbus, OH, USA) via orogastric intubation every 3 h for the first week postoperatively. Self-feeding with assistance by a spooned-bottle began as continued improvement of superior labial mobility was noted. By 96 h postoperatively, healthy granulation tissue was noted along the laceration repair with subsequent contraction of skin edges. Nasal stents were removed seven days postoperatively, with resolution of surgical swelling and unobstructed nasal breathing both noted.
Controlled interactions with members of the infant’s natal troop were utilized to encourage social development over the following months, with gradual troop reintroduction.3,4 Ongoing monitoring managed concerns associated with dental eruptions over its pediatric years and assessed long-term resolution of the maxillary fracture.2
1. Knoop, K.J., L.B. Stack, A.B. Storrow, R.J. Thurman. LeFort facial fractures. In: Knoop, K.J., L.B. Stack, A.B. Storrow, R.J. Thurman, eds. The Atlas of Emergency Medicine. 3rd ed. New York City: McGraw-Hill; 2010:55–58.
2. Manganello-Souza, L.C., D.F. Pacheco, A.A. da Silva. Dentofacial deformity secondary to a severe trauma of the middle third of the face in infancy. J Oral Maxillofac Surg. 2003;61:1220–1224.
3. Meder, A. Integration of hand-reared gorilla infants in a group. Zoo Biol. 1985;4:1–12.
4. Ryan, S., S.D. Thompson, A.M. Roth, K.C. Gold. Effects of hand-rearing on the reproductive success of western lowland gorillas in North America. Zoo Biol. 2002;21:389–401.