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Temporomandibular Joint Luxation 961.e3

rapid improvement in clinical signs is noted (chronic uncontrolled qualitative tear Technician Tips
and no concurrent KCS. deficiency) Any dog with a red eye or ocular discharge
VetBooks.ir ○ Cyclosporine 0.2% ointment or 0.5%-2% Recommended Monitoring tear production before other conditions such Diseases and Disorders
• ± Lacrimostimulants
should have an STT to rule out low or decreased
as allergies are considered.
solution q 8-12h usually required for at
• Complete ophthalmic exam with STT,
least 4 weeks and possibly lifelong. May
increase to q 8h if TFBUT < 10 seconds TFBUT, and corneal fluorescein staining SUGGESTED READING
performed every 3-4 weeks initially
after 3-4 weeks of treatment; some advo- • Rechecks performed every 4-6 weeks until Lim CC, et al: Effects of feline herpesvirus type 1 on
cate increasing concentration of solution qualitative tear deficiency and associated tear film break-up time, Schirmer tear test results,
(e.g., 0.2%-2%). May decrease to q 24h disorder(s) (e.g., marginal blepharitis and and conjunctival goblet cell density in experimen-
if TFBUT ≥ 10 seconds and clinical signs meibomianitis) is/are controlled, then every tally infected cats. Am J Vet Res 70:394-403, 2009.
improve/resolve 3-4 months
○ Tacrolimus 0.02%-0.03% ointment ADDITIONAL SUGGESTED
or solution q 8-12h if no response to PROGNOSIS & OUTCOME READINGS
cyclosporine after 3-6 weeks Cullen CL, et al: Tear film breakup times in young
• Antimicrobials if secondary bacterial con- • Varies, depending on underlying cause healthy cats before and after anesthesia. Vet
junctivitis and/or corneal ulceration: • Delayed diagnosis and treatment may result Ophthalmol 8:159-165, 2005.
○ Topical broad-spectrum antibiotic (e.g., in permanent quantitative and qualitative Cullen CL, et al: Keratoconjunctival effects of diabetes
bacitracin-neomycin-polymyxin solution changes in meibomian glands and/or goblet mellitus in dogs. Vet Ophthalmol 8:215-224, 2005.
q 6-8h for 7-14 days or until the corneal cell function. Lim CC, et al: Schirmer tear test values and tear
ulcer has healed) film break-up times in cats with conjunctivitis.
Vet Ophthalmol 8:305-310, 2005.
• Antiinflammatories if severe conjunctivitis PEARLS & CONSIDERATIONS Moore CP, et al: Ocular surface disease associated
and/or corneal vascularization/pigmentation with the loss of conjunctival goblet cells in dogs. J
○ Prednisolone acetate 1% suspension or Comments Am Anim Hosp Assoc 26:458-465, 1990.
dexamethasone 0.1% ophthalmic oint- • Response to lacrimomimetics may occur Singh A, et al: Alkali burns to the right eye. Can
ment q 6-8h if corneal ulceration is ruled after 3-4 weeks; if not, instituting concurrent Vet J 45:777-778, 2004.
out topical lacrimostimulants is advised and may
be required lifelong. RELATED CLIENT EDUCATION
Nutrition/Diet • May take weeks to months of therapy before
Consider L-lysine supplementation for feline determining if there is favorable response to SHEET
herpesvirus type 1 infection. lacrimostimulants. How to Administer Eye Medications
Possible Complications Prevention AUTHOR: Cheryl L. Cullen, DVM, MVetSc, DACVO
• Corneal ulceration Breeds predisposed to eyelid disorders associated EDITOR: Diane V. H. Hendrix, DVM, DACVO
• Vision impairment from progressive corneal with qualitative tear deficiencies: avoid breeding
vascularization/pigmentation/keratinization affected or closely related dogs.

Temporomandibular Joint Luxation Client Education
Sheet

BASIC INFORMATION GENETICS, BREED PREDISPOSITION ○ Caudoventral: rare; usually associated with
Any breed can be affected when associated with fracture of the retroarticular process of the
Definition trauma. Breeds predisposed to TMJ dysplasia temporal bone
The mandibular condyle can be completely (shallow to flat mandibular fossa with flattening • Open-mouth jaw locking (p. 708)
displaced from the corresponding mandibular of mandibular condyle) are at risk for TMJ
fossa of the temporal bone. Subluxation of subluxation/luxation and open-mouth jaw HISTORY, CHIEF COMPLAINT
the temporomandibular joint (TMJ) occurs locking (basset hound, dachshund, Irish setter; Animals are presented for head trauma or
when the mandibular condyle is incompletely Persian cats). inability to close the mouth fully, pain on
displaced. chewing/yawning, reluctance to play or chew
RISK FACTORS on toys, inappetence, and/or an audible click
Synonym Trauma, TMJ dysplasia, increased mandibular when opening or closing the mouth. Depending
Temporomandibular joint displacement symphyseal laxity on the cause, progression may be peracute,
acute, or chronic.
Epidemiology Clinical Presentation
SPECIES, AGE, SEX DISEASE FORMS/SUBTYPES PHYSICAL EXAM FINDINGS
TMJ luxation can occur in dogs and cats of • Subluxation: minimal displacement of the In rostrodorsal luxation, the lower jaw is shifted
any age. TMJ luxation with regional fracture mandibular condyle, which is still situated and tilted ventrally to the unaffected side. This
is more common in younger cats with head in its corresponding mandibular fossa of the malocclusion results in abnormal upper and
trauma. Cats have a higher incidence of TMJ temporal bone lower tooth contact, leading to an acute inability
luxation than dogs due to decreased man- • Luxation to close the mouth fully. Other findings may
dibular symphyseal movement and shorter jaw ○ Rostrodorsal: most common; usually include decreased range of lower jaw motion,
length. unilateral decreased eye globe retropulsion on the affected
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