case report

Tusk fissure treatment

Place: 

Date: 2019

Data provided by: Willem Schaftenaar

History

A 22-yrs old bull elephant developed a longitudinal crack (fissure) in its left tusk, presumably due to excessivly hitting the tusk against the steel door of his enclosure during musth. The fissure had a length of 20 cm and was located at the dorsal side of the tusk, extended below the sulcus. The fissure was getting longer all the time. It was not known whether the pulp tissue was exposed.

Treatment

A standing sedation was performed using detomidine and butorphanol. The eyes were covered by cotton gauze patches. Radiographs were taken to determine whether the fissure was in contact with the pulp tissue. Unfortunately it was not possible to visualize the fissure in the proximal part of the tusk. 

Radiograph of the left tusk, showing the pulp cavity (white dashed line) and the fissure (yellow dashed line). 

The depth of the fissure was carefully explored by grinding the borders away using a hand grinder (Dremel). It became clear that the fissure had not reached the pulp tissue.

Consequently the fissure was etched with a hypochloride solution for bonding and the proximal 8 cm was filled with glass-ionomer cement.

Following the procedure described before (https://www.youtube.com/watch?v=Do13hcb8wJI), a 30 cm long fiberglass-reinforced carbon cast was made around the tusk in order to prevent the fissure to get larger.

When after grinding it became evident that the pulp tissue was not exposed, the proximal 8 cm of the cleaned-out crack was filled with glass-ionomer cement  

The carbon cast is being positioned. Note that the plastic tube is placed to make the cast vacuum durig the drying process. 

Treatment results

During the months following the treatment, the tusk continued to grow. The proximal end of the cast was partly damaged when he was rasping the tusk on hard objects. It was provisionally repaired with a 2-component resin. After 10 months the distance between sulcus and proximal end of the fissure was 5 cm. Assuming that a normal tusks grows approximately 1 cm per month, the fissure must have been at least 5 cm inside the sulcus at the time of treatment. The fissure did not increase in size during the following 20 months. 

10 months after the treatment, the distance between the sulcus and the fissure is 5 cm.

References:

  • https://www.youtube.com/watch?v=Do13hcb8wJI

  • Sim R.R. et al. 2017. Use of composite materials as a component of tusk fracture management en an Asian elephant (Elephas maximus) and an African elephant (Loxodonta africana). Journal of Zoo and Wildlife Medicine 48(3): 891–896.