Another pug, another problem...

RE: Another pug, another problem...

Steve Leonard — Mon, 11 Jan 2021 10:58:24 GMT

Thank you both for your input - it is like having little guardian angels on our shoulders. Very much appreciated.

RE: Another pug, another problem...

Evelyn Barbour-Hill — Mon, 11 Jan 2021 01:12:58 GMT

For information – the images are excellent.

Essentially: wot Norman said.

But I'd just like to add: the fracture has no chance whatever of healing if the teeth whose periodontal disease is responsilbe for the fracture are still there. Whereas once the teeth are removed the fracture will quite possibly heal with no specific surgery, and if by chance it doesn't then a fairly simple internal fixation will do it.

If you are not confident with extractions, there's no shame in asking a colleague to do them.

Personally I would usually do all the indicated extractions, both sides, in one fell swoop: but that's opinion, not a strong recommendation. The decision has to be made according to individual circumstances. I think it most unlikely, looking at the images, that the left mandible would break during the extractions, assuming reasonable care. It's quite possible that the small amount of new bone that has formed at the right mandible fracture site will give way again, but that woul not be of great importance. Curette the site and flush copiously with saline – never forget the value of copious flushing. Then a little soft tissue surgery to close up the site, if possible;

Soft diet until all healed, yes. But it's a mistake to make it too soft and pasty. Anything straight out of a sachet will be fine, as will most tins of stuff for little dogs. Mash it into a paste and it is actually more difficult for the dog to eat; it also tends more to work into nooks and crannies

As a completely incidental note: one occasionally sees, invariably in Pekinese or Pomeranians or Shih Tzus, what I can only describe as permanent fractures where a pathological fracture (yes, I know, all fractures are pathological, but let's not go into that now) has been un-noticed or neglected, the guilty teeth have been shed, the soft tissues have healed but there has been no bony union. The patient, having adapted, seems perfectly happy. I'm not suggesting, of course, that this is an acceptable outcome to aim for.

RE: Another pug, another problem...

Norman Johnston — Sun, 10 Jan 2021 17:29:55 GMT

Hi Alex.
This is a common problem in small brachy breeds. First of all I would not be hugely concerned by the symphysis. It’s a fibrous union/joint and not a solid structure

The teeth in areas of bone loss have to go or the inflammation and infection continues. That includes your fracture site as a priority. If you are considering referral, send now. If this is not an option, do full mouth rads and then make a treatment plan based on priority. The fracture site can be dealt with first once teeth are all cleaned. A filthy mouth won’t heal well. The fracture may well heal without fixation if the soft tissues are closed well and the dog eats soft paste for 3-4 weeks and avoids toys etc. Muzzling is not easy in this breed.

Use clindamycin post op and a combo NSAID and opiate. Once the mandible has healed, go back and do the left side and anything else that has excessive bone loss, pockets and/or overcrowding