Craniomandibular Osteopathy

Re: Craniomandibular Osteopathy

Fiona French — Fri, 07 May 2010 22:36:40 GMT

Saw a case recently in a Westie X. Started when dog was around 4 months old; was still eating but very painful. One of it's litter mates had already been euthanased because the pain from it's CMO had been uncontrolable. It has been on metacam for a few months now and is doing well, just about able to control the pain. I must admit to not radiographing, as funds were limited and I was very confident of the diagnosis as everything seemed to fit.

Have told the owner that things should be fairly well settled by the time the dog is about 10 months old - does this sound about right or can they go on much longer?

Re: Craniomandibular Osteopathy

Vikki Halliday LLB — Wed, 05 May 2010 09:04:54 GMT

[quote user="jenny overton"] love tramadol although i'm stuck dosing wise for small dogs as our smallest capsule is 50mg and this dog was 4.5kg, although it was going to be my back up option if it was larger[/quote]

Some of the Vet School pharmacies will reformulate capsulated drugs for you into smaller capsules, not sure if they would do it for Tramadol, but have had it done for another human prep, Enterocort, for a cat which needed about 1/3 of a capsule dose.

You will have to pay for the service, and I had the Enterocort done at Edinburgh, mainly as they had seen the cat for a referral, but it may be worth invesigating.

I usually find NSAIDs to be effective enough in CMO, but have also used oral buprenorphine in addition where pain is severe.

Re: Craniomandibular Osteopathy

jenny overton — Tue, 04 May 2010 21:57:47 GMT

I have given my owner the option of x-ray if we don't control it well on meds but if he starts to improve we'll probably continue in the same direction.

I love tramadol although i'm stuck dosing wise for small dogs as our smallest capsule is 50mg and this dog was 4.5kg, although it was going to be my back up option if it was larger.

Re: Craniomandibular Osteopathy

Holly Lee — Tue, 04 May 2010 21:22:30 GMT

The one I was treating did respond well to just meloxicam when the pain flared up which got less frequent as she got older (happily now mature and CMO free!). From everything that's been said and read I'm not convinced there's any indication for pred - did consider tramadol although not familiar with use in immature animals. I radiographed for 100% diagnostic confidence - think I would be reluctant not to.

Re: Craniomandibular Osteopathy

jenny overton — Tue, 04 May 2010 21:03:05 GMT

Recently I've treated a 13 week old westie with quite severe CMO and he has partly responded to carprofen but we moved onto meloxicam as he still had a couple of bad episodes, but generally NSAIDs seem to be working. I am reluctant to give him preds at his age and not convinced they would be better. Should we x-ray dogs if the diagnosis is clear?? Just curious?

Re: Craniomandibular Osteopathy

lenny cooper — Sun, 30 Nov 2008 12:59:39 GMT

[quote user="Niall Taylor"] The degree of pain was high enough for me to think that NSAIDs wouldn't have been enough to control the pain. [/quote]

I am curious about this statement. I would consider the analgesic properties of NSAIDs (especially for musculoskeletal discomfort in a condition such as CMO) to be better that corticosteroids.

Certainly the couple of patients we have seen with this condition in the last few years have been managed satisfactorily with meloxicam or carprophen.

Slightly off-topic but I would be interested to hear anyones' thoughts.

Re: Craniomandibular Osteopathy

Niall Taylor — Thu, 09 Oct 2008 15:53:27 GMT

Glad to hear things are going well.

Niall

Re: Craniomandibular Osteopathy

Holly Lee — Tue, 07 Oct 2008 09:56:17 GMT

Thanks for all the replies. Have kept her on metacam for time being as this has been very effective in controlling her pain prior to having her radiographs, have also been recommended that Tramadol may help if the pain becomes uncontrolled with metacam alone so will see how things progress...

Re: Craniomandibular Osteopathy

rahul udehiya — Tue, 07 Oct 2008 07:57:31 GMT

Craniomandibular osteopathy (CMO) is a non-cancerous disorder that almost exclusively affects the bones of the head in dogs. It is also called mandibular periostitis, temporomandibular osteodystrophy or "lion jaw.

The cause of CMO is believed to be hereditary. Terriers are prone to the disorder. West Highland white terriers are the most commonly reported breed to be affected with CMO, with Scottish terriers, cairn terriers, Boston terriers and bullterriers also having a higher than normal incidence. It has been reported in non-terrier breeds, but this is uncommon.

The age of onset of clinical signs is usually three to eight months. There is no sex predilection, with males and females affected equally. Neutering and spaying seems associated with reduced risk of the disorder.

The disorder is usually self-limiting, but may require medication to make the dog comfortable.

Re: Craniomandibular Osteopathy

Richard Allport — Mon, 06 Oct 2008 23:19:07 GMT

Acupuncture can be very helpful in controlling pain and discomfort while waiting for the condition to resolve and avoids the risk of side effects to NSAIDs and/or steroids

Richard

Re: Craniomandibular Osteopathy

Sandra Milburn — Mon, 06 Oct 2008 20:59:13 GMT

Hey Holly

Haven't had too many cases through. But yes, thinking back to when I was reading up on it, newer reports seem to suggest NSAIDs as a first line of Rx. My case was a young Westie as well, which got really quite unwell with it. NSAIDs were the most effective Rx in that case.

Hope you get on ok, keep us posted on the progress.
Sandra

Re: Craniomandibular Osteopathy

Philip Lhermette — Mon, 06 Oct 2008 20:05:05 GMT

Craniomandibular osteopathy (CMO) is a proliferative disease of the bones of the head and especially the mandible and sometimes the tympanic bullae. The condition is inherited as an autosomal recessive trait in West Highland White terriers.

Normal lamellar bone is resorbed and replaced by enlarged fibrous bone that proliferates beyond the normal periosteal margin. This fibrous bone may be permanent or may spontaneously regress as the dog matures. It is not an inflammatory process.

The bone changes result in dysphagia with resulting weight loss and progressive atrophy of the temporal and masseter muscles. Affected dogs may often exhibit pyrexia with pain on palpation of the head, jaw or on opening the mouth. If the temporo-mandibular joint is badly affected the prognosis is more guarded although clinical signs may improve with skeletal maturity.

Treatment is limited to controlling fever and pain, with NSAID's being the drugs of choice. NSAIDS are helpful in reducing fever as well as pain control. Since it is not primarily an inflammatory disorder corticosteroids are often unhelpful and maybe contraindicated. If one NSAID does not seem affective, it is worth switching to another as some individuals seem to respond better to one drug than another, In the olden days, large doses of vitamin C were given but since many cases resolve spontaneously anyway, credit previously given to this treatment has since been disproved.

Neutering may decrease the incidence in siblings and it is best not to breed from affected animals anyway.

Philip

Re: Craniomandibular Osteopathy

Niall Taylor — Mon, 06 Oct 2008 15:49:07 GMT

Hi Holly,

The last one I treated was a few years ago (a Westie inevitably) but it extremely well on prednisolone at anti-inflammatory doses and time. The degree of pain was high enough for me to think that NSAIDs wouldn't have been enough to control the pain. After a few months we were able to reduce the dose of preds on a trial and error basis and by the time he was about 12 months of age the signs had stopped. He's been fine ever since.

A small note of warning, according to Dunn's textbook of small animal medicine in some cases the pain can be so severe as to be uncontrollable.

Let us know how the case progresses.

Niall

Re: Craniomandibular Osteopathy

Philippe Michon — Mon, 06 Oct 2008 13:02:40 GMT

I just remember some cases resolving without any treatment...