Galina!

Galina is a happy contented 18 month old kitty that had as part of her morning routine, racing up and down the steps of her two story home after her ball.  One owner would stand at the top of the stairs and catch a little ball her other owner would throw up from the kitchen, and back and forth she would go.  It was great exercise and totally fun for Galina, until one morning, two weeks ago…

Galina’s owners heard a loud thump as she was bounding up the stairs.  Galina stopped short when they came over to see what had happened, and then quietly walked over to her bed and laid down.  Her owners made sure she was breathing, looked alert, seemed not to be in pain, and let her rest.  When afternoon arrived and she had still not come out to the kitchen for her breakfast, nor moved much from her spot from the morning, they brought her to the hospital to have us check her out. 

Outwardly, Galina seemed to be fine. There was no evidence of bruising or soreness anywhere.  She didn’t have a fever.  Her heart and lungs sounded normal and her mucus membranes were pink.  No signs of a broken tooth, but wait.  Her front teeth looked a little askew, as if they didn’t fit into each other normally.  The lower teeth seemed to be shifted a little to the right.  She could still close her mouth but was reluctant to open it.  With a little more investigation, we noticed a mild swelling over her left jaw and wondered if the loud thump could have been her head hitting the step and causing injury to her jaw.  We weren’t sure if there was a fracture or dislocation, but her lower jaw seemed to be the problem.

We referred Galina to a specialist to be sure that we would only need to anesthetize her once, to both diagnose the problem with xrays, and treat it simultaneously should there be a fracture or more complicated repair.  It turned out that she had dislocated her left TMJ (temporomandibular joint).

Note the slight rotation of the lower jaw/teeth to the right as compared to her upper teeth (red arrow), and the larger space at the left TMJ (white arrow) vs. the right in this “before” xray:

 The surgeon was able to perform a “closed reduction” under anesthesia and reset the jaw:

 Notice how the canine teeth fit together symmetrically now (red arrow), and the TMJ’s are also symmetrical now (white arrows).

A closed reduction refers to a procedure whereby the joint is reset without opening the site surgically.  In order to prevent the joint from slipping out of position again, while the ligaments that normally hold it in place healed, the surgeon opted to place a large gauge non-absorbable suture across the bridge of  her nose, through her mouth inside her upper and lower lips, and secured under her chin.  She could open her mouth a little bit to lap up water and soft food, but could not open her jaw fully.  She also had to wear a plastic Elizabethan collar to prevent her from pulling out the suture.  As you might imagine, this was quite an adjustment for Galina!
After a few days at home it became clear that she was not going to eat on her own, nor would she drink water.  She became dehydrated, and constipated, and then started vomiting.  Her supportive care during her recuperation became difficult to manage at home, so Galina spent several days in the hospital so that our nurses could syringe feed her and keep her hydrated until the suture could be removed. 

After 10 days we removed the suture and while she was still on soft food for another week, she returned to quite the happy kitty again, able to clean herself, and open her mouth freely.  In about 3-4 more weeks, we can be pretty comfortable that she will not risk dislocating her TMJ without another serious impact. 

Her owners have learned a lot about cats through this experience:  how much they do not like “hats”, or having their jaw sutured closed, how they vomit sometimes when constipated, how finicky they can be about food, and how appreciative they are for attention when they want it.  Thankfully her ordeal is now behind her.  Good luck Galina!