TMJ (Bleeding Alveolus)

January 2011
Dr Gerhard Steenkamp

A cat is presented after some unknown head trauma. The patient is stable, however there are some lacerations to the mouth area and the mandible is deviating to the right hand side. On initial examination you find a bleeding alveolus where 404 used to be. There is also a fracture of the 307. No other oral abnormalities are detected.

Which radiographic views do you intend to use for making radiographs in this cat?

The standard lateral and dorsoventral skull views are mostly adequate to diagnose a number of fractures and temporo-mandibular joint (TMJ) luxations/condylar fractures. If the lesions are unclear on these standard radiographic views you may want to incorporate some oblique views of the mandibles. The oblique views of the condyles are notoriously difficult and often wastes time, rather than adding much to the diagnosis. I will discuss these views another time.

From radiograph 1 supplied, what is your diagnosis?

Radiograph 1
TMJ Luxating Cat - bleeding alveolus (1)

There is a luxation of the left condyle in a rostral direction. This is forcing the mandible towards the right hand side. Furthermore there is also a fracture of the right mandible just caudal to where 404 was.

TMJ Luxating Cat - bleeding alveolus (2)










How would you treat this patient?

Since the patient suffered cranial trauma, it is important to do a thorough neurological examination, as well as assessing the airways and circulatory system.

Keeping in mind that if the cat was involved in a fall from a height or a motor vehicle accident, that it may have suffered barotrauma to the thorax. Once the patient is stabilised the condyle can be replaced (see next month). This depends on how long it has been since the trauma. Like any other joint, the prognosis for returning to full function does deteriorate with the amount of time the condyle is situated outside the joint. As trauma forces it out of the socket, blood, joint capsule and even scar tissue may occupy the joint space, therefore making it impossible to replace the condyle in a closed manner.

If it has been some time, usually more than 24 to 48 hours, it may be futile replasing the condyle and a condylectomy is a better option of treating the patient.

Should you be unfortunate to replace the condyle but it reluxates, a condylectomy may also be indicated


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