Fixation of a cat with dislocated jaw.

Re: Fixation of a cat with dislocated jaw.

Evelyn Barbour-Hill — Tue, 16 Dec 2014 21:42:45 GMT

If I may be trivial for a short while......[quote user="John Flynn"]using a bi-gnathic encircling and retaining device.[/quote]

That's a brilliant example of an admittedly not inaccurate description that's one hell of a pompous title for an improvisation!

Re: Fixation of a cat with dislocated jaw.

John Flynn — Tue, 16 Dec 2014 19:28:09 GMT

[quote user="Peter Southerden"]

John

Could you tell me where this was published?

Pete

[/quote]

My awareness of the passage of time is in decline... was a small case series published using nylon-crimp technique 4 years ago!

Nicholson, I. et al (2010) Treatment of caudal mandibular fracture and temporomandibular joint fracture-luxation using a bi-gnathic encircling and retaining device. Veterinary and Comparative Orthopaedics and Traumatology. 23(12), pp. 102-8

Conveniently abbreviated to "BEARD" - catchy

Re: Fixation of a cat with dislocated jaw.

Peter Southerden — Tue, 16 Dec 2014 18:38:58 GMT

John

Could you tell me where this was published?

Pete

Re: Fixation of a cat with dislocated jaw.

Sammy82 — Mon, 15 Dec 2014 23:28:15 GMT

Sounds as invasive as wirering a mandibular, so not too bad but as the non invasive method of bonding the canines leads to better stabilisation I can not see any advantage of nylon and crimps (apart from the material being more readily available in most practices). It might be a useful alternative if canines are missing.

Re: Fixation of a cat with dislocated jaw.

Evelyn Barbour-Hill — Mon, 15 Dec 2014 23:17:34 GMT

Hmmm.

Seems somewhat invasive, is my first reaction.

Re: Fixation of a cat with dislocated jaw.

John Flynn — Mon, 15 Dec 2014 20:41:27 GMT

Did nylon and crimp a few months back and worked a treat.

Need to place an esophagostomy tube first and be prepared to tube feed for 3 weeks.

Then, assess level of injury, if just one TMJ gone then will be able to do by closing jaw over small (eg 3mm) ET tube (saves placing pharyngostomy endotracheal tube) as jaw will not need to be totally tightly closed - overlapping the canines will be fine and a 5-7mm gap between incisors is apparently acceptable.

Wire the mandible in your favoured method.

Slightly bend a 18-20G 1.5" needle (check that your 50lb nylon leader line will pass through it first).

Make a small incision in rostro-caudal direction over the dorsal point of muzzle where expect needle to come out (eases getting needle out in same place from both sides).

Place bent needle from level of premolars or wherever seems appropraite, laterally around maxilla staying close to bone.

Pass nylon leader line down.

Remove needle and repeat for mandible on same side.

Repeat on the otherside.

Close jaw tight as you can (check anatomy of teeth on a normal cat to make sure you've got it right!) while checking will get ET tube out.

place extra 1-2 loose crimps and then place a crimp and crimp tight (the extra ones will give you a fighting chance to recrimp your nylon should you cut it in a few weeks and decide not stable enough).

Have some medetomidine on hand to give iv on recovery to make sure does not freak out etc.

I could do a diagram if it helps but I'll warn you that freehand computer art is not my strength...

Ian Nicholson published a paper on this earlier in the year I think.

Re: Fixation of a cat with dislocated jaw.

Peter Southerden — Mon, 15 Dec 2014 17:57:45 GMT

Tape muzzling a cat is possible though many will not tolerate it well. The technique is similar to a dog but improved by adding an extra tape from the bridge of the nose and running back between the ears and tying with the other tapes at the back of the head. I don't think that this technique would give adequate stabilisation in this case.

Re: Fixation of a cat with dislocated jaw.

Gillian Mostyn — Mon, 15 Dec 2014 11:46:15 GMT

[quote user="David Mills"]Sorry, and Gillian. But how do you tape muzzle a moggy?? Genuinely interested.

[/quote]

Same as with a dog - tie initial loop under chin and then around back of ears. Obviously need the buster collar on though!

I am not suggesting it is the best method of fixation - fixation of the teeth would obviously give a much more stable result. Just an idea though...

Re: Fixation of a cat with dislocated jaw.

joanne mcallister — Mon, 15 Dec 2014 10:03:16 GMT

I have just treated a cat with tmj dislocation and multiple fractures using technique 1 (but with dental composite) for the first time and it worked really well. Placed an o tube first. Borrowed the necessary dental equipment from a friendly neighbouring practice. I did find a reference to buried nylon suture around both jaws somewhere but think it would have been difficult to get good alignment with this technique

Re: Fixation of a cat with dislocated jaw.

Evelyn Barbour-Hill — Mon, 15 Dec 2014 01:21:14 GMT

[quote user="David Mills"] Do either know of some pro-bono charity sympathetic veterinary dentists near south west London??[/quote]

Alas, not since Lisa Milella had to give up.

You could always ask Simone Kirby in Hertfordshire or Rachel Perry in Brighton, you never know.

Re: Fixation of a cat with dislocated jaw.

David Mills — Mon, 15 Dec 2014 00:13:11 GMT

Sorry, and Gillian. But how do you tape muzzle a moggy?? Genuinely interested.

Re: Fixation of a cat with dislocated jaw.

David Mills — Mon, 15 Dec 2014 00:07:33 GMT

Thanks Peter and EBH. I will pester some human dentists tomorrow. Re the nylon fixation, it was something I heard. Equally could not envisage how it would work. Do either know of some pro-bono charity sympathetic veterinary dentists near south west London??

Re: Fixation of a cat with dislocated jaw.

Peter Southerden — Sun, 14 Dec 2014 23:00:06 GMT

I agree with Evelyn. You will have intra- articular fracture(s). Definitely place an O tube. Re-locate the dislocated condyle, bond the canines with about 10mm between the incisors using a light cured composite. Remove the fixation after 10-14 days. You might (though it is unlikely) get ankylosis and this usually presents about 3 months post injury.

Bonding the canines is technically challenging if you've not done it before and so I would try and get help from someone who has. An alternative if bonding is not possible is a condylectomy, though this may/not leave your cat with a malocclusion which would then need treatment.

Re: Fixation of a cat with dislocated jaw.

Evelyn Barbour-Hill — Sun, 14 Dec 2014 21:35:58 GMT

Fix upper and lower jaws together: i.e. yes, bond upper and lower canines, as with many jaw fractures. One great advantage, you know occlusion will be correct when it's healed.

Not with epoxy resin! With dental composite. Your friendly local(ish) veterinary dentist can do this for you or show you how to do it and might not charge if you ask him/her nicely. Failing that, your own actual dentist might have some out-of-date filling material or crown-and-bridge material or even orthodontic bracket adhesive.

Light-cured is practically always used, having the advantage that you can position it just right and zap it, but chemical cure (two pastes you mix together) is also still available. If you are doing this yourself rather than persuading the dentist to do it, you can get light-cure guns extremely cheaply from China on Ebay. Their quality is c**p, but for use once in a blue moon that might not matter.

You will need primer-adhesive as well as the composite material. You will usually need some etch gel as well.

If you use material of a shade substantially different from that of the teeth it helps a bit with the subsequent removal, which to my mind is the really pigging part of the whole process.

It's a matter of nice judgment as to when you remove it. If you leave it too long there's a possiblity of ankylosis.

As for the cause of such persistent dislocation, I'd wager there is a little fracture there, even if it can't be detected on radiography. Not that it makes any difference to treatment.

I always place an oesophagostomy tube. To my mind it's part of the treatment. I know some people don't, because some cats can learn to eat and drink via the comfortable small opening you always leave (i.e. not tightly occluded, but leaving enough opening for the tongue to go out and in). On the other hand, it's a trifle awkward if you decide after fixing the jaws that you want to place a tube after all....

I've never heard of any technique involving fishing nylon and crimping. How would it work? Anybody know about this?

Re: Fixation of a cat with dislocated jaw.

Gillian Mostyn — Sun, 14 Dec 2014 16:13:46 GMT

I'd probably use a bandage muzzle and oesophagostomy tube, with a buster collar obviously. Have done it successfully with a fracture.