Cat with increased jaw tone/not eating

Re: Cat with increased jaw tone/not eating

Emma Middleton — Fri, 18 Jul 2014 21:59:01 GMT

Thanks so much for your help Evelyn, have just been reading up about TMJ ankylosis and looking at the rads again after your advice I think I can see what you mean on one side.

[quote user="Evelyn Barbour-Hill"]Hmmm, the dentition looks a tad unhealthy – reorptive lesions there, and is there one broken upper canine? Not sure. But that's probably nothing to do with the symptoms.[/quote]

Agree not a great mouth and yes it has a broken canine. Owner believes it's been like that for some time and indeed this and the resorptive lesions need addressing.

[quote user="Evelyn Barbour-Hill"]If that doesn't strike you as appropriate, and you reckon it's muscular, then a temporal muscle biopsy might be useful.[/quote]

My feeling is that it's not muscular because there is just no 'give' at all, but I guess I can't rule out a muscular problem on that alone. There is no obvious wasting of the chewing muscles but I suspect I might not notice mild atrophy if it's bilateral.

I like the idea of placing a tube so that at least we can feed the cat and see if stretching is helpful. But as you say, it sounds like surgery would be best in the long run if it is ankylosis.

Re: Cat with increased jaw tone/not eating

Evelyn Barbour-Hill — Fri, 18 Jul 2014 20:11:37 GMT

Nice radiographs.

Hmmm, the dentition looks a tad unhealthy – reorptive lesions there, and is there one broken upper canine? Not sure. But that's probably nothing to do with the symptoms.

Any muscle wasting? Any possible history of trauma?

I really am not sure at all but I think that one TMJ might be abnormal.

The TMJ is notoriously tricky to get a good image of. Could you get a DV view of each? You need a separate exposure for each because you want to position it very precisely so that the centre of the beam goes straight down through the centre of the mandibular condyle. You may have to experiment a little.

The only way I can put it into words is this: with the head lying stretched and flat on the plate (would you call this "mandibular recumbency? ) feel just in front of the pinna and there is a sort of natural hollow that your finger goes in to. That's where your vertical beam should be centred.

Anyway, whatever (if anything) you find, I think my plan (beware, others may disagree) would be to anaesthetise again and forcibly stretch the jaw open until youve got just enough opening to be able to place an oesophagostomy tube. Then you can nourish the cat properly for weeks and weeks if necessary, while you periodically have another GA and another stretch.

If it's muscle contaction then your first session would be a gradual stretching. If it's TMJ ankylosis then it might suddenly go with a crack! (and if its ankylosis it would probably eventually want excision arthroplasty).

If that doesn't strike you as appropriate, and you reckon it's muscular, then a temporal muscle biopsy might be useful.

Re: Cat with increased jaw tone/not eating

Emma Middleton — Fri, 18 Jul 2014 19:19:43 GMT

[quote user="Neil Wheadon"]Was it that you couldn't open the mouth even with a car jack or the cat was resisting because it hurts (unsure from the sedation protocol described) These would mean different approaches.[/quote]

Couldn't open with a car jack. Cat was well sedated and forgot to mention had also been given iso by mask so was pretty much anaesthetised.

[quote user="Evelyn Barbour-Hill"]Would love to see the radiographs.[/quote]

finally got time to add these:

Re: Cat with increased jaw tone/not eating

Evelyn Barbour-Hill — Fri, 18 Jul 2014 18:10:37 GMT

Would love to see the radiographs.

Re: Cat with increased jaw tone/not eating

Neil Wheadon — Fri, 18 Jul 2014 17:58:14 GMT

Only a basic thought

Was it that you couldn't open the mouth even with a car jack or the cat was resisting because it hurts (unsure from the sedation protocol described) These would mean different approaches.

If the mouth will open then I'd try a dose of steroids, if all else normal (myositis)

Neil