fused temporomandibular joint help

RE: fused temporomandibular joint help

John Flynn — Tue, 14 Jul 2015 13:56:41 GMT

they sometimes stick at the bit where the zygomatic arch meets vertical part of mandible also.

RE: fused temporomandibular joint help

grumpyoldman — Mon, 13 Jul 2015 18:58:07 GMT

[quote user="Martin Atkinson"]... and despite my best efforts the owners are extremely unrealistic [/quote]

We have had this situation a few times recently : there is a whole generation of people out there now between 40-50 years old who have both parents and grand parents surviving to a very ripe old age. They have extremely regular ordered lives where nothing bad ever happens. They are totally unable to cope with the loss of their pet and cling on for grim death . I had one at Christmas ,8 yo diabetic schnauzer with hypercalcaemia , a game of hunt the tumour found Histcytic sarcoma in lungs spleen and kidneys. Pulmonary effusions etc , We recommended euthanasia ,they refused ,it was referred and had lomustine etc repeat drains ,force feeding , End of jan referral centre insisted on euthanasia on humane grounds, the client then refused and went for a tertiary referral where the dog died in the midst of yet another thoracocentesis. It weighted 3.5kg . Had not voluntarily eaten for several weeks ,had constant uncontrolled vomiting and diahorrea. Sometimes an unlimited pet plan has a lot to answer for too , i am sure had they been paying they would have sensibly pulled the plug when they were told too.

RE: fused temporomandibular joint help

Martin Atkinson — Mon, 13 Jul 2015 13:10:45 GMT

[quote user="Andrew Mellor"]

I feel that is a little harsh Martin. Do you force caring clients to put their animals to sleep, do you call the RSPCA yourself?

[/quote] Your previous statements: "8 weeks on cat is brain damaged and until this point not wanted to eat on his own. owners have been feeding through a oesophagostomy tube ....... and despite my best efforts the owners are extremely unrealistic ". Am I really being harsh? Some home truths are needed IMO if the cat is so brain damaged it can't exist without being force fed, These are not caring owners indeed the opposite they are selfish unrealistic and not considering the main factor in this case - the welfare of the cat. If you were to tell me that it is perfectly normal and capable of sustaining itself in the future and the only problem left was the inability to open its mouth it might be different.

RE: fused temporomandibular joint help

Andrew Mellor — Mon, 13 Jul 2015 12:56:01 GMT

I feel that is a little harsh Martin. Do you force caring clients to put their animals to sleep, do you call the RSPCA yourself?

RE: fused temporomandibular joint help

grumpyoldman — Sat, 11 Jul 2015 20:39:14 GMT

[quote user="Evelyn Barbour-Hill"] hemimandibulectomy when you could do excision arthroplasty.[/quote]

Its an easier surgery ,or, at least one i am familiar with that gives good long term outcomes particularly with lower jaw neoplasia. Referral is ideal but the money has run out. Your probably right to treat it as a unilateral TMJ dysplasia.

RE: fused temporomandibular joint help

Evelyn Barbour-Hill — Sat, 11 Jul 2015 20:07:51 GMT

I don't pretend to have all the answers but I can't see the point of hemimandibulectomy when you could do excision arthroplasty.

RE: fused temporomandibular joint help

grumpyoldman — Sat, 11 Jul 2015 17:50:07 GMT

If they are determined not to pull the plug ,some people just won't. You could jack it open slowly ,the best tool i can think of for this are small rib spreaders ,the type with a wheel and thread ,spreads the torque evenly, hook the jaws over the incisors. Then loads of pred and keep your fingers crossed , if it scars up and fuses again , just by pass it with a PEG tube. The other possibility with a cat is some kind of post traumatic sarcoma. If just one side is scarring you could also consider hemi-mandibulectomy, cats and dogs tolerate that surprisingly well

After deciding what we can do its still difficult to know if we should sometimes.

RE: fused temporomandibular joint help

Martin Atkinson — Fri, 10 Jul 2015 17:30:03 GMT

I think this is close to an RSPCA cruelty case and you are condoning it Andrew. The cat should be euthansed,

RE: fused temporomandibular joint help

Evelyn Barbour-Hill — Fri, 10 Jul 2015 17:23:30 GMT

[quote user="Andrew Mellor"] I feel he has very severe brain damage and despite my best efforts the owners are extremely unrealistic and obviously hugely emotionally involved.[/quote]

Yes...............................................

RE: fused temporomandibular joint help

Andrew Mellor — Fri, 10 Jul 2015 17:08:14 GMT

the other problem is that even after a few weeks with good healing going on and no obvious pain anywhere the cat never wanted to eat or drink, and seemed to have difficulty coordinating tongue movement , I feel he has very severe brain damage and despite my best efforts the owners are extremely unrealistic and obviously hugely emotionally involved.

they have no money either now 500 pound per condition insurance policy! WHAT USE IS THAT! maybe referral for another opinion to explain to them just how bad things are!

RE: fused temporomandibular joint help

Evelyn Barbour-Hill — Fri, 10 Jul 2015 15:36:23 GMT

It would be perfectly respectable to refer to a veterinary oral/dental surgeon.......

Otherwise: lots of radiographs of course to try to get as much information as possible about the TMJ area. It sounds pretty likely that there were fractures of one bit or another of each TMJ and now ankylosis is very likely.

Excision arthroplasty (excision of mandibular condyle) would be indicated. As they say, not a surgery for the fainthearted (a suitably vague description!).

If you are pretty sure there is no ankylosis and each TMJ looks normal on Xray, you could try stretching; probably in repeated sessions. GA, (being at least prepared to do emergency tracheostomy) and, to be crude, jack the jaws apart. Realistically the only good way I know of doing this is by successively sliding lolly sticks or tongue depressors between the incisor teeth to build a stack. Take it slowly, give the fibres time to tear. The main hazard is that you may break something again. Lots of pain relief may help.

You would probably need to do this as well as the arthroplasty, if you go down that route.

Results could be disappointing, but I'd be happy with enough improvement to allow eating.

Want to post some radiographs?