Winston the Westie battles Craniomandibular Osteopathy

Winston the WestieWinston is an 8-month-old, intact male, West Highland White Terrier who presented to our hospital for lethargy. He was the first puppy owned by this family. Everything was normal and he seemed in good health until the day after he went to see his family veterinarian. After his visit, he was lethargic and reluctant to eat, which was cause for concern for his owners. At the time of admission to NorthStar VETS, he was eating small amounts of soft food with some effort. Labwork done by his family veterinarian showed mild anemia and an increase in ALP and phosphorus which was considered normal in a puppy. A 4DX test was negative. He had seemed painful when eating for the past few days.

Upon examination, he was reluctant to move, but the most dramatic finding was reluctance to open his mouth. He cried if his mouth was opened more than 2 inches. He also had soft tissue swelling on the top of his head.

The technicians who took care of Winston overnight noted his painful state while they kept him on IV fluids, antibiotics and pain medication. By the next morning, his fever had resolved.

Winston's RadiographRadiographs showed changes consistent with craniomandubular osteopathy, a congenital disorder common in the Westie breed, that is an excessive and abnormal bone growth on the skull (cranium) and lower jaw (mandible) causing pain and discomfort. It is inherited as an autosomal recessive trait in West Highland White Terriers. It can be seen in other breeds as well. It occurs in growing puppies (3-to-10-months of age). In this disease, normal bone is replaced by fibrous bone. It most commonly affects the mandible, but in Winston, the bones of the head were severely affected. If the temporo-mandibular joint (TMJ) is affected, then difficulty grasping, chewing and swallowing food is seen. Fever occurs frequently and there is pain associated with palpation on petting the head and pain upon opening the mouth. Weight loss and progressive loss of the muscle of chewing can be seen. Prognosis depends on the areas affected and the ability to provide supportive care.

Winston with his familySupportive care includes treatment with anti-inflammatory drugs and analgesics (pain medications). Dogs on chronic therapy should be monitored closely and will require therapy adjustments based on clinical course and monitoring of labwork (chemistry and cbc). In some cases, feeding tubes can be used to help maintain nutrition.

Prevention of this disease can only occur if affected animals carrying this recessive gene are not bred.

Winston responded very well to anti-inflammatory doses of prednisone for 6 weeks. Unfortunately, after 8 weeks off of prednisone, his signs recurred and the prednisone needed to be resumed. He will need monthly rechecks and in a few months he will be taken off of the prednisone once again. He is becoming more puppy-like now that he is feeling better. It is a benign disease, that Winston should grow out of as he gets bigger, so the prognosis for this adorable little guy is favorable at this time.

Tammy Anderson, DVM, DACVIMTammy Anderson, DVM, DACVIM
Dr. Anderson is a New Jersey native who received her veterinary medical degree from Ohio State University in 1995. She completed her small animal internship at Michigan State University in 1996, and her residency in small animal internal medicine at the University of Tennessee in 1999. She remained at UT as an assistant professor of small animal medicine until 2001, when she returned to New Jersey and entered private practice. Dr. Anderson joined NorthStar VETS in 2004.

The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

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