HELP - New to Forum

[dladd]

Sorry for the length but it's been a 4 month ordeal....

I have a 10 year old Basset named Bebe. She has always been healthy with no problems. 4 months ago she developed a swollen lump under her left eye. We immediately took her to the vet. When he raised her lip/jowel, she had a hole in her upper gum from an abscessed molar. This same tooth had abscessed about a year earlier and we treated it with an antibiotic and the swelling went down and everything was normal. This time we decided to have the tooth removed since it seemed that it was going to be a recurring issue. We were referred to an oral surgeon and we made the appointment.

The oral surgeon removed the offending molar along with 3 other teeth that he found problems with during the examination and procedure. She had stitches and had to be put on soft food for two weeks. She was also prescribed Rimadyl for the inflamation. After the procedure, her mouth was very sore and she was unable to fully open it. This was to be expected.

After three weeks, her soreness had gone away but she still couldn't open her mouth fully and when she tried to yawn she would let out a seal barking type of moan. It was better when on the Rimadyl but when we took her off of that, she would lose ground rapidly until after 2 days, she was in severe pain. We took her back to the oral surgeon and he stated that under sedation when he opened her mouth that he saw one of her bottom teeth move. His explanation was that the tooth root was touching the ligament in her jaw. He extracted that tooth at that point. Back on the Rimadyl for two to three weeks after which time, still can't open her mouth fully without severe pain.

At this point the surgeon diagnosed her with arthritis of the jaw, I guess due to her age. She didn't have any problems before the surgery but apparently the arthritis set in overnight (I'm being sarcastic.) My wife and I told him repeatedly that she didn't have arthritis of the jaw before the surgery but he continuted to tell us that it couldn't be anything else.

After about two weeks of continuing the Rimadyl to help ease the pain and symptoms,I was scratching her on the left ear and noticed that she was really pushing her ear into my hand. We took her to the vet and discovered that she had an ear infection. The is significant because at that point the oral surgeon thought that it made sense that if she had an ear infection that it could make it painful if opening the mouth due to the proximity of the ear canal to the mandible in a Basset. We were hopeful. She was given a cortizone shot and an antibiotic. She was better for about a week and then we descended back down the hill with all of the same symptoms.

After another couple of weeks managing the pain and symptoms, we decided to take her to another clinic to get a fresh perspective. The doctor there sedated Bebe and attempted to open her mouth. She cried out even under sedation. The doctor instantly thought that she had masticatory myositis. She started her on Pred and she has gotten marginally better. Two days after starting her on Pred, we noticed that she lost muscle mass on the left side of her head. While this would be consistent with MMM, it typically affects both sides. We've continued on the elevated dose of Pred for 3 weeks now with no new results. Her pain seems to be less but she can still only open her mouth about 2 inches and howls if you try to open it further.

We are taking her to the Mississippi State College of Vetenary Medicine on Monday to have her evaluated completely.

After talking to several other vets over the months, the symptoms don't seem to be consistent with any one thing. Whatever it is, it was obviously triggered from her first tooth extraction.

Possibilities:
MMM typically affects younger dogs. It should affect the 2M fibers in the jaw muscles of both sides.

Dislocated Jaw would typically cause her to display an misaligned bite. But since the specialist saw a tooth move from touching the ligament when opening her mouth, that tells me that everything wasn't in the same place as it was before the first surgery.

Cracked Mandible seems like it could explain all of her symptoms except the atrophy of the muscles. Although if she hasn't chewed on the left side for 4 months, I guess the muscles could waste.

Does anyone on this board have any ideas or possibilities? While I am taking her to the Vet school on Monday, I would appreciate any other ideas that I could bring up to them once we get there.

Thanks in advance for any thing you guys can add.

[Wworm]

Oh, sorry to hear about your ordeal, Bebe.
glad you get a full eval on Monday.

what about some nerve issue that's causing pain after the surgery?

here's an example: trigeminal neuralgia (i'm not sure that's what your dog has, because you didn't mention blinking symptoms and maybe the nerve is not close to where the dental extraction is.)

Trigeminal Neuritis in the Dog: TN is a Neurological Condition Impairing a Dog's Eating and Drinking | Suite101.com

but this would be an example of a painful nerve condition. i'm more familiar with it in people. it can be very painful & people don't want to move their face for fear of triggering the pain. here are the symptoms in people:

Trigeminal neuralgia: Symptoms - MayoClinic.com

[dladd]

She hasn't had any blinking problems and she has experienced no skin sensitivity to the touch. She has also never lost mobility of her mandible. The degree to which she can open her mouth is solely dependent upon whether she is on meds or not. If she is on meds, she can open her mouth about 2 to 3 inches before she has pain. If she is off the meds, she can open her mouth about 1 inch before acute pain.

I've read that with MMM, which is the current diagnosis, the jaw physically over time will physically lock up. The immune system attacks the 2M fibers in the jaw and the muscle is literally eaten away to be replaced with scar tissue. This causes the muscle atrophy and sunken spots on the head. Well, scar tissue does not stretch like muscle tissue so the jaw is locked shut.

While she the current diagnosis is MMM, the more the pieces are fit together, I am becoming more and more convinced that the left side of the jaw suffered some kind of trauma during the first surgery. Whether that be a fracture, a torn ligament, a torn muscle, or whatever. All of these could have been caused by the mouth being overextended during the surgery.

It just doesn't make any sense to me that MMM would occur the very next day after this surgery and on the same side as the abcess.

It's just too much coincidence for me. Thoughts?

[Mikey T]

Managing TMJ in companion animals

Unable to open the mouth
» Craniomandibular osteopathy
» TMJ ankylosis
» Fracture of the zygomatic arch
» Osteoarthritis (too painful to open)
» Masticatory muscle myositis
» Tetanus
» Retrobulbar abscess or cyst
» Neoplasia
Additional associated presenting clinical signs could be pain on mastication, resulting in a reluctance to chew, audible "click" with jaw movement, pain on palpation of the TMJ or surrounding soft tissues, swelling of the TMJ area, malocclusion of teeth, decreased range of motion and/or enophthalmos/exophthalmos. A good otic examination (and possibly imaging of the inner ear) should be included on initial work-up to rule out ear disease as the cause for pain in the region of the TMJ.

[Herzo]

That is just horrible. It sure does seem to me that something in the surgery made this happen. I do hope you get to the bottom of it . Poor Bebe I hope she gets better.

[Boomer's Mom]

Oh no, what an awful ordeal you and your Bebe have to go through. I have no suggestions personally, but do wish you and your girl the best and hope you get a definite answer on Monday.

[dladd]

UPDATE: Bebe went to MSU yesterday and they pretty much ruled out Masticatory Myositis. The asymetrical atrophy is not consistent with that disease. They feel that she does have a dislocated or fractured jaw. (They noticed that while panting, her front teeth slope down to the left indicating that the left hinge point is lower than the right which would be consistent with a dislocation). They indicated that it would be very hard for an oral surgeon to do this kind of damage during a tooth extraction unless there was some underlying issue that had weaken her bone or joint. That typically a dislocation is a result of severe trauma like being hit by a car.

So in addition to radiographs of the jaw and joint, she will most likely be undergoing an MRI today which would show any tumor activity that may not be readily apparent from an x-ray.

While to the casual observer, this may seem insanely expensive (and it is), you can not skimp or cut corners when it comes to diagnostics. The more information you have, the better the decisions are concerning treatment.

[Princess Buttercup]

Poor lil thing!!! My heart aches for you watching her in pain for so long. Sounds like you'll get to the bottom of it soon & begin treatment. Hugs & Belly Loves.

[dladd]

Update: Well, it looks like the worst case scenerio is coming true. Bebe ended up having a CT scan instead of an MRI based on the results of the x-rays. It turns out that she has a bone tumor that has engulfed the mandible and TMJ. The tumor has significantly eaten away at the involved bones to the point that her jaw is unstable. So what started out an abscessed tooth has turned into end-of-life decisions. This has been a real devastating turn of events. She has been a true and faithful member of our family for over 10 years (since she was a puppy) and while you always know that this time will come with any pet, it doesn't ever get any easier....especially when it is so sudden and unexpected. We are heart broken.

Thanks to all of the replys above. I appreciate the input.

[Lightning&Stomps]

I'm so horribly sorry about the diagnosis. Who would have thought it would be a tumor? Ten years is just too young. I hope during her remaining time you can keep her comfortable.