Masticatory muscle myositis

Re: Masticatory muscle myositis

Evelyn Barbour-Hill — Wed, 06 Mar 2013 16:27:00 GMT

[quote user="Rob Davis"]

[quote user="Evelyn Barbour-Hill"] I can't locate any readymade chlorhexidine mouthwashes that are not flavoured.[/quote]

What about hexarinse?

[/quote]

Last time I looked it seemed to have vanished. Must have been my mistake.

(Opportunity to cite last line of "Some Like It Hot".......)

Re: Masticatory muscle myositis

Evelyn Barbour-Hill — Wed, 06 Mar 2013 16:11:20 GMT

Not at the dilutions and frequency involved.

Wasn't there a thread about this a couple of years ago? Vague and uncertain memories.

Here we are:

www.vetsurgeon.org/.../20829.aspx

Re: Masticatory muscle myositis

Niall Taylor — Wed, 06 Mar 2013 16:04:39 GMT

[quote user="Evelyn Barbour-Hill"]Another thought that occurs for your problem case is that xylitol solution would be logical if you want something more than water. Aquadent is one brand name. (It's sold for putting in the drinking water, where it does sweet FA as far as I can see. But as a mouthwash it's logical).[/quote]

You wouldn't worry about toxicity then?

www.aspcapro.org/mydocuments/ze-vetm0207f_095-100_.pdf

http://www.healthypet.com/PetCare/PetCareArticle.aspx?title=Xylitol_toxicity_in_dogs

Niall

Re: Masticatory muscle myositis

Rob Davis — Wed, 06 Mar 2013 15:56:27 GMT

[quote user="Evelyn Barbour-Hill"] I can't locate any readymade chlorhexidine mouthwashes that are not flavoured.[/quote]

What about hexarinse?

Re: Masticatory muscle myositis

Evelyn Barbour-Hill — Wed, 06 Mar 2013 15:48:43 GMT

[quote user="Rob Davis"]

Also from their website: "Many home care dental products contain chlorhexidine. Published veterinary dental research has demonstrated that regular chlorhexidine use can increase the rate of mineralization plaque (calculus formation), stain the teeth brown, and decrease the patient’s sense of taste. MAXI/GUARD Oral Cleansing Formula does not contain chlorhexidine and does not have these side effects."

What are your thoughts on this?

[/quote]

The Mandy Rice-Davies quote, probably! Using dilute chlorhexidine solutions at the sort of frequency that's going to be likely, I doubt if there are any significant adverse effects. I'm no special Maxiguard fan. The problem for me is that with the disappearance of certain products, I can't locate any readymade chlorhexidine mouthwashes that are not flavoured. Human products invariably seem to be flavoured with things that are obnoxious to dogs like mint or cinnamon. So we have to devise home-made solutions.

Another thought that occurs for your problem case is that xylitol solution would be logical if you want something more than water. Aquadent is one brand name. (It's sold for putting in the drinking water, where it does sweet FA as far as I can see. But as a mouthwash it's logical).

Re: Masticatory muscle myositis

Rob Davis — Wed, 06 Mar 2013 15:35:47 GMT

[quote user="Evelyn Barbour-Hill"]With Maxiguard or something,[/quote]

I've not used maxiguard before - I usually go for something chlorhexidine-based. Do you rate it? (I'm sure you don't agree with the claim on their website "works without brushing"!)

What are your thoughts on this?

Re: Masticatory muscle myositis

Rob Davis — Wed, 06 Mar 2013 15:31:43 GMT

[quote user="Evelyn Barbour-Hill"]

Could you get the owner to sluice the mouth with a suitable syringe or nozzle? With Maxiguard or something, or just plain water? It might make all the difference.

[/quote]

Good idea, I will suggest it.

Re: Masticatory muscle myositis

Evelyn Barbour-Hill — Wed, 06 Mar 2013 15:00:20 GMT

Could you get the owner to sluice the mouth with a suitable syringe or nozzle? With Maxiguard or something, or just plain water? It might make all the difference.

Re: Masticatory muscle myositis

Rob Davis — Wed, 06 Mar 2013 14:50:45 GMT

[quote user="Evelyn Barbour-Hill"]I expect you agree that heavyweight surgery is hardly justified.[/quote]

Absolutely![quote user="Evelyn Barbour-Hill"]

It looks on the radiograph as if a lot of the periodontal attachment has vanished (could be deceptive though). If you can reach the tooth with any sort of instrument, does it have a waggle at all? If so, you can probably break down the attachment with improvised instruments and persuade it out. What do you think?

Maybe you could put right-angle bends in a couple of your best luxators? (They'd be ruined for further use though......)

What about using the Crossley rabbit molar luxator and forceps?

[/quote]

As far as I could tell it feels more solidly attached that the radiograph would suggest. I did consider attempting extraction, but I was worried about doing half a job and failing, leaving more of a mess that there was to start with! Crossley rabbit instruments may work, but I don't think I would be able to get any luxators near it even if they were severely abused (which would break my heart to do!)

[quote user="Evelyn Barbour-Hill"]If that's not possible, I wouldn't feel too bad about leaving it, in the circumstances, regrettable though it be. If the pulp's dead, the tooth is no longer sensitive.[/quote]

I think I probably will end up leaving it and monitoring for now, though I am concerned about the possibility of apical abcessation. There was a whole load of foul-smelling nectrotic gubbins packed over the tooth remnant which I am sure will accumulate again fairly quickly. It will require further scaling and polishing in 6-12 months, so I can recheck it and repeat the radiograph then, by which time it may be loosening further (and, to look on the bright side, we may find the same happening with 210...)

Many thanks, as always, Evelyn for your thoughts - always helpful.

Re: Masticatory muscle myositis

Evelyn Barbour-Hill — Wed, 06 Mar 2013 14:17:21 GMT

[quote user="Rob Davis"]

I have just had the CKCS I started this thread with in for a dental - slightly scary few minutes trying to intubate with tracheostomy tube at the ready! Although there was not surprisingly lots of calculus build up due to his inability to masticate, once scaled the teeth were generally surprisingly ok, however there appears to be an advanced caries lesion in 110. It is very difficult to see the tooth well, let alone access it for extraction. Even getting a radiograph was tricky - the film had to be fed in between the incisors and worked caudally with forceps! The tooth is just visible in the photograph and the radiograph is also attached below. I can't see any easy way of dealing with this tooth, and I am uncomfortable with leaving it alone. Any suggestions?

[/quote]

Interesting challenge.

I expect you agree that heavyweight surgery is hardly justified.

Maybe you could put right-angle bends in a couple of your best luxators? (They'd be ruined for further use though......)

What about using the Crossley rabbit molar luxator and forceps?

If that's not possible, I wouldn't feel too bad about leaving it, in the circumstances, regrettable though it be. If the pulp's dead, the tooth is no longer sensitive.

Re: Masticatory muscle myositis

Gerry Henry — Tue, 05 Mar 2013 19:56:12 GMT

Biopsies will commonly come up negative (section of muscle, pinned onto card etc) however clinical signs and response to IS doses pred diagnostic; GA and open mouth by increments, repeat monthly if necessary; both cases I've seen recently presented with exopthalmos.

Re: Masticatory muscle myositis

Rob Davis — Tue, 05 Mar 2013 12:30:14 GMT

Re: Masticatory muscle myositis

Evelyn Barbour-Hill — Tue, 04 May 2010 22:59:59 GMT

[quote user="jamie winstone"]

On a personal note I have had Psoriatic arthritis of both temporo-mandibular joints for many years leaving me with an ability to eat Kit-Kats but nothing higher than a Mars Bar!

The only relevence is the consultant surgeon has offerred aTMJ replacement or an Excision Arthroplasty of the affected joints. No amount of the jaw stretching spatulas have ever made any difference and I fear this is the same end stage result in MMM.

Jamie

[/quote]

Yes, but the difference is that the TMJs are the problem in your case, whereas MMM is nothing to do with the TMJ.

The analogy would be with TMJ ankylosis in the cat following a fracture. That needs an excision arthroplasty.

(Wow! a TMJ replacement! I'd go for that!)

Re: Masticatory muscle myositis

jamie winstone — Tue, 04 May 2010 22:52:41 GMT

I am also treating a CKCS with a presumed diagnosis of MMM. A biopsy was discussed with the owner but again was declined. The dog was only 6 months old when first presented and so restriction of jaw opening has not become an issue. After complete control of the symptoms for the last 6 months, the owners have requested treatment to reduce the low daily dose of steroids as the dog`s voracious appetite was getting them down, so I have now started concurrent treatment of Azathioprine.

As the dog you have mentioned is 6y.o. I would suggest there is chronic fibrosis within the temporal muscles and I would suspect no treatment will increase the mouth opening.

On a personal note I have had Psoriatic arthritis of both temporo-mandibular joints for many years leaving me with an ability to eat Kit-Kats but nothing higher than a Mars Bar!

Jamie

Re: Masticatory muscle myositis

Clive Ansell — Tue, 04 May 2010 18:28:33 GMT

The last 2M sample I submitted, which indeed did go to the US, took just over a week, so still worth doing both, or still an option for clients not keen on biopsy.

Re: Masticatory muscle myositis

Rob Loxley — Tue, 04 May 2010 18:18:31 GMT

[quote user="Clive Ansell"]Ideally it is best to do both the 2M antibody assay and the muscle biopsy[/quote]

I believe all the UK labs send 2M to the USA so turnaround of a muscle biopsy may be much quicker.

Re: Masticatory muscle myositis

Clive Ansell — Sun, 02 May 2010 10:50:28 GMT

I had a case in a 18 month old entire male working Springer Spaniel about a year ago, diagnosis was made with a positive 2M antibody test and no biopsy. Responded well to initial immunosuppressive doses of prednisolone. he is currently on a eod maintenance dose and is doing fairly well.

The 2M antibody test is an ELISA based test and is very sensitive and specific. A negative antibody titer may occur in end-stage masticatory muscle myositis or after corticosteroid therapy, thus a muscle biopsy would be the only way to achieve a diagnosis.

Ideally it is best to do both the 2M antibody assay and the muscle biopsy. The 2M antibody assay will provide the diagnosis (in the absence of corticosteroid therapy or end-stage disease) but does not provide information about the degree of myofiber destruction or fibrosis which are important in determining a prognosis.

Comparative neuromuscular laboratory

Re: Masticatory muscle myositis

Niall Taylor — Sat, 01 May 2010 16:38:32 GMT

You're working in the dark until you get that biopsy - why the resistance from the owner, it's only a minor procedure, surely?

Probably re-radiographing the head and neck wouldn't be a bad idea either.

Niall

Re: Masticatory muscle myositis

Evelyn Barbour-Hill — Sat, 01 May 2010 15:01:53 GMT

Anderson, J.G. and Harvey, C. E (1993) Masticatory Muscle Myositis Journal of Veterinary Dentistry 10 pp6-8

The mouth-opening procedure consists of wedging tongue-depressors incrementally one at a time, first between the incisor teeth and later between the carnassial teeth.

In this case, it achieved an "opening of five centimetres". After that the owner was instructed in manipulating the mouth three times a day.

The paper is quite a good overview and discussion.

Rob, if you want a copy, send a private message with your address.