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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 24471
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My dog holding s mouth open. Not to breathe. He eats &

Customer Question

My dog holding his mouth open. Not to breathe. He eats & drinks, but is messier & he can't chew. He barks & runs around outside as normal. What is wrong?
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
Aloha! You're speaking to Dr. Michael Salkin
I believe that you're describing a trigeminal nerve (cranial nerve V) disorder. This is tested for by palpating the muscles of mastication (chewing) for denervation atrophy, checking the palpebral reflex because the sensory branch of this nerve innervates that part of the eyes, and opening the mouth to assess muscle tone and range of motion.
Here's a synopsis of trigeminal neuritis taken from Clinical Veterinary Advisor, 3rd Ed., Cote', 2015:
Basic Information
Definition
An idiopathic, self-limiting inflammatory condition that involves the motor and sensory branches of the trigeminal nerve and (on occasion) the sympathetic innervation to the eye (i.e., Horner's syndrome)
Synonym
Dropped jaw
Epidemiology
Species, Age, Sex
Dogs most commonly affected; rare in cats
Genetics and Breed Predisposition
No sex or breed predilection; golden retrievers may be overrepresented.
Risk Factors
Other immune-mediated disease
Associated Disorders
Possible paraneoplastic association
Clinical Presentation
Disease Forms/Subtypes
Bilateral paralysis of the masticatory muscles that primarily affects the mandibular branch of the trigeminal nerve
History, Chief Complaint
Acute or subacute onset of an inability to close the mouth. The dog cannot prehend food, may hypersalivate, and has difficulty drinking water.
Physical Exam Findings
Bilateral paralysis of the masticatory muscles
Affected dogs are bright and alert and do not appear as though they are in pain. Most have no other detectable neurologic abnormalities.
In some cases, there is decreased facial sensation bilaterally, and Horner's syndrome may be observed.
Trismus/inability to open the mouth does not occur with trigeminal neuritis.
Etiology and Pathophysiology
Most common neurologic cause of an inability to close the mouth in the dog
Etiology is unknown, but extensive bilateral nonsuppurative inflammation, demyelination, and, in some cases, axonal degeneration of all portions of the trigeminal nerve and its ganglion, with no brainstem lesions, have been reported at necropsy.
Complete recovery is observed in 2-3 weeks (rarely, may take several months), with no drug therapy being reported as useful.
Facial sensation is usually preserved. Occasionally, Horner's syndrome may be observed, presumably because the postganglionic sympathetic axons course with the ophthalmic branch of the trigeminal nerve.
Diagnosis
Diagnostic Overview
The diagnosis is based on characteristic clinical signs, absence of other neurologic deficits, and elimination of the possibility of orthopedic (mandibular, temporomandibular joint) disorders. Advanced diagnostic testing is generally reserved for cases showing additional or unusual neurologic deficits, when spontaneous resolution does not occur, or if rabies is possible (quarantine/euthanasia).
Differential Diagnosis
Rabies
Traumatic mandibular injury
Inflammatory or infectious central nervous system (CNS) disease
Initial Database
CBC, serum chemistry profile, urinalysis: usually within normal limits
Screening for infectious diseases such as protozoal, fungal, and viral diseases is recommended, as clinically and geographically appropriate.
Advanced or Confirmatory Testing
Unnecessary in most cases
Cerebrospinal fluid (CSF) analysis may be normal or show mild increases in protein concentration. Lymphocytic pleocytosis is rarely observed.
Electromyography may reveal increased insertional activity and other mild changes.
Computed tomography or magnetic resonance imaging of the brain: within normal limits
trigeminal nerve biopsy: not recommended
trigeminal NEURITIS: trigeminal neuritis patient exhibiting the classic dropped jaw appearance and partial Horner's syndrome.
Treatment
Treatment Overview
Spontaneous resolution usually occurs in 2-3 weeks with no treatment.
Acute General Treatment
Maintenance of hydration and alimentation is critical.
Percutaneous gastrostomy may be helpful in severe cases.
Chronic Treatment
Signs will typically resolve spontaneously in 2-3 weeks but in some cases will take months to fully normalize.
Nutrition/Diet
Will most likely need a slurry or canned food gruel in the immediate period since the patient is unable to close the mouth but the tongue is still functional
Clinical signs should resolve in 3 weeks.
Behavior/Exercise
Encourage strengthening of the muscles by using a tennis ball to chew on.
Possible Complications
Dehydration
Weight loss
Recommended Monitoring
Hydration status
Food intake
Prognosis & Outcome
Excellent for recovery
Pearls & Considerations
Comments
If signs do not resolve in the 2-3-week period, other differentials should be considered.
If sensory deficits are observed, the recovery period may take longer.
Prevention
Make sure that the patient maintains adequate hydration and is eating well.
Client Education
Signs are typically self-limiting and should resolve in 2-3 weeks. Please respond with further questions or concerns if you wish.
Expert:  Dr. Michael Salkin replied 1 year ago.
Hi Jodie,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin

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