Jaw-dropping Care
Caramello, a five-month-old goldendoodle, was brought to Cummings School of Veterinary Medicine’s Tufts at Tech Community Veterinary Clinic through a referral from a former Tufts emergency and critical care doctor, Annie Wayne. He was unable to close his mouth after an accidental encounter with another dog in his home, and an initial visit to a different hospital produced an estimate for care that was beyond the owner’s means.
Dog owner Smiling Jose Santiago (he/his) explains, “A piece of food dropped on the floor and Caramello went after it by crawling over our six-year-old Staffordshire Terrier, who was home recovering from surgery for cancer and she reacted with two quick snaps, which were unfortunately in Caramello’s face.”
After initial assessment at a local emergency clinic, Carmello’s injuries to his jaw “were assumed to be a potential luxation of the temporomandibular joint (TMJ), but we couldn’t really tell without doing diagnostics,” says Dr. Yuki Nakayama (she/her), V14, assistant clinical professor for community medicine, who led Caramello’s care team. She was assisted by many, including Stephanie Boisvert, V23; Eva Guerin, V23; and Edward Wong, V23, who supported procedures, client relations, and case management.
Treated at Tufts at Tech, in addition to traditional x-rays of his skull, dental x-rays from inside the mouth were taken. “We are fortunate to have Kate Zukowski, a certified vet tech who is also a veterinary technician specialist in dentistry,” Nakayama explains. “The diagnostic images inside the mouth helped us diagnose a fracture on both sides of the jaw.” The team was fortunate to have this information without the need of a CT scan, but this meant securing the jaw would be a significant challenge, especially because of Caramello’s age and lack of adult teeth. He also had a lacerated tongue.
Following consultation with several dentists and surgeons, the team devised a plan, and fixed his tongue and inserted a feeding tube, as he was unable to eat due to his broken jaw.
To help the jaw heal, the team placed a few wires across the fracture sites, and then attempted to stabilize it by performing a technique to essentially suture his mouth closed in order to use the upper jaw as a splint for the broken lower jaw, and allow bone to regrow at the fracture sites.”
Caramello was able to open his mouth slightly, allowing his tongue to lick liquid food, but extensive home care was required. “I give a lot of credit to his owners for the care they did at home. This included feeding him through the feeding tube for quite some time, administering several medications, and keeping an energetic puppy quiet,” says Nakayama.
During a return visit four weeks after the surgery, the team was thrilled with the results. “We were pleased that the jaw healed well, and he is able to use his mouth now,” Nakayama beams, but some complications arose. “Some of Caramello’s baby teeth were traumatizing his lips, so we had to extract those and one of the back teeth turned inward and injured his tongue, so we repaired that as well,” she says.
One more procedure will be a full evaluation of Carmello’s teeth to ensure that his baby teeth will come out correctly and his adult teeth will arrive in a way that is comfortable for him, according to Nakayama. “He responded so well that just one week after the jaw procedure he was licking food on his own and was eating fine,” she says.
“As a means-tested subsidized clinic, Tufts at Tech provided this care at a cost that was a fraction of what it would be anywhere else. The owners said it was like nothing ever happened to him. Caramello didn’t need a feeding tube after three weeks, and we removed all the gear in his mouth after four weeks and he was like new again.”
Santiago is so thankful for the care Caramello received at Tufts at Tech. “I’m 100 percent satisfied with how they treated me and Caramello. He’s healing, back to using his mouth and eating kibble that I soften a bit with water. He is running around and playing like he did before.”
Nakayama credits the collaboration with several veterinarians for such a positive result. “I’m thankful to be a part of a strong community of veterinarians. We couldn’t have gotten through this case without several people pitching in to help. This case was a great success. If the family wasn’t all in, this puppy could have ended up euthanized, so I applaud them for advocating for his care.”
Tufts at Tech Turns 10
For 10 years, the Cummings School veterinary clinic at Worcester Tech has provided low-cost services to pets from underserved household
