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  Discussion on Facial Paralysis and "Lumpy Jaw"
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New Member:
Kinesis4

Posted on Wednesday, Nov 2, 2005 - 5:24 pm:

I bought a 10 year old Thoroughbred mare about 3.5 weeks ago, and she is now suffering from facial paralysis and something else?? - perhaps lumpy jaw. I'm going to try and detail what has happened over the last two weeks:

Friday 10/21 - I had the horse a little over a week, and I ground DrOve her, because like I said, I know very little about her past, including her training, and the first time I tried to get on her she bucked me off. I'm giving her the benefit of the doubt at this point, and blaming myself for not properly warming her up before I got on. Anyways, while ground driving her, as I was asking her to stop, she threw a fit and while tossing her head, turned to the left and hit the side of her face on the round pen. I gave up because I didn't feel like I was getting anywhere with the mare that day, so I hosed her off and put her away. That evening, there was a little bit of swelling in her lower lips on both sides, and she wasn't very interested in her dinner.

Saturday 10/22: Her face is even more swollen, and she still doesn't really want to eat. I tried feeding her mashed up senior feed, thinking that her lips hurt and she didn't want to chew hay. She is somewhat interested, but not enough to finish half the 8qt bucket I made.

Sunday 10/23: Pretty much the same as Saturday. I also gave her some bute paste, hoping that would help with the pain. I didn't see any change.

Monday 10/24: The vet came out first thing and looked in her mouth as far as she would let him. He noticed a slight tweak in her nose, and commented that she had very slight facial paralysis. He gave her banamine and cortisone, and instructed me to give her 5cc banamine IM 2x a day for the next two days, as well as Dexamethasone orally once a day for the next two days. Monday evening, she ate all the mashed up senior food I made her, and the swelling in her lips had gone down slightly.

Tuesday 10/25: The swelling continued to go down, and tuesday morning when I brought her mashed up senior feed, she looked great. She was alert and hungry, but still a little bit more mellow than normal. Tuesday evening though, she was not as interested in her food, and had a little bit of yellowish discharge in her nose.

Wednesday 10/26: In the morning, more discharge, and at this point, we are done with the initial two days of meds. The vet had warned me that although the dexamethasone was the best as far as reducing inflammation, it also weakens the immune system. So i figured she was just getting a cold. I checked her temp - 100.5. Wednesday evening, her lip is now tweaked to the right, with the left side showing signs of paralysis. I made another appointment with the vet for the next morning.

Thursday 10/27: Her lip is even more tweaked to the right, the right side of her lower lip is extremely tight, and the underside of her chin is hard and tight. She also continues to have yellowish discharge in both nostrils, as well as mucous in her stool. When the vet arrived, he sedated her to get a better look inside her mouth. He noticed a laceration underneath her tongue. As for the nasal discharge, because she still had no fever, he thought that it was brought on by the trauma, but said it could also be a secondary bacterial infection. He even suggested that because of the tightness underneath her chin, it looked like possibly the beginning signs of "Lumpy Jaw" (which i can't find very much info on but I understand is usually contracted from cows?). He gave me tocaprim (sp?), banamine paste, and told me to give her two bute in the am. He told me to call him monday if there was no improvement, and we'd treat her for Lumpy Jaw. She ate her medicine over a different kind of sweet feed I bought with no problems.

Friday 10/28: The paralysis has moved from just the left lip to her eye and ear on that side. I began putting eye ointment in that eye because I didn't want it to dry out. Of course, my vet was gone that day and I couldn't ask him what to do. I continued with the eye ointment, though. She also only ate half her medication in the sweet feed, and left the rest of it, despite the fact that it is the only thing I offered for her to eat all day.

Monday 10/31: (I skipped the weekend because nothing changed really) At this point, the mare doesn't eat much, nibbles on alfalfa, and will not touch the mashed up senior anymore. However, her digestive system is all working, which I take as a good sign. Also, there is a little bit of puss coming out of her chin, which has become extremely itchy to her in the last 24 hours, making me think strangles. I asked the vet when I talked to him if that was a symptom with Lumpy Jaw, and he said it wasn't uncommon. The vet came out in the evening and gave her a bottle of Sodium Iodide intravenously, treating the "Lumpy Jaw." I asked if he was sure that this is what she had, and he said that although he wasn't, Sodium Iodide would take care of pretty much any sort of bacteria infection she had. He told me to continue with the tocaprim, bute and banamine, and call him in 2 days with a progress report - if she was doing better, he'd give her another bottle of Sodium Iodide on Thursday.

Wednesday 11/2: (today) No improvement. I called the vet - haven't heard back yet. Her face seems incredibly itchy, and the eye that is paralysed is bugging her as well. She keeps trying to rub it on everything. I am also having an incredibly hard time getting her to take her medicine. I have been mixing it with apple sauce and, using a dosage syringe, getting it as far back in her mouth as possible. However she just holds it there, and lets it DrOol out the paralyzed side of her mouth, and then rubs her lips on the ground to get the rest out. The vet recommended mixing it with orange jello powder and mixing it with sweet feed. She seems interested and will eat some if I offer it to her, but wont eat it by herself.
However, despite all that, I'm wondering if we're even treating the right thing? If anyone has any ideas about giving the medication, or about something i can do for her eye so she wont scratch at it anymore, please let me know. Any other suggestions about possible causes/solutions would be much appreciated.
Sorry about the incredible length of this, but I was trying to be as detailed as possible.
Moderator:
DrO

Posted on Thursday, Nov 3, 2005 - 8:55 am:

Welcome Sarah,
With the history I would concentrate of the fact this horse has smashed her face and find it likely that this accounts for all your symptoms. However it would take an exam to confirm this. The question is how much damage has been done and I think it is going to take a radiograph to determine that. One of the important questions to be answered is if there is a fracture that leads from the oral cavity to the nasal sinuses.

Certainly with evidence of infection, secondary to the trauma, antibiotics should be continued but sodium iodide would not be my choice. If the horse eats I think your trimethoprim-sulfa is OK to try first but be sure your dosages are adequate, see Equine Medications and Nutriceuticals » Antibiotics and Antimicrobials » Trimethoprim -Sulfa. For the damage to the nerves I do think antiinflammatory therapy makes it more likely they will return to function but am uncertain what would be best: the NSAID's (like bute and Banamine) or the dexamethasone. The dex is stronger but if the infection is a big concern not the best choice. I would not give both the antibiotic and NSAID together in the feed because the bute is bitter. If the medication cannot be given orally careful injections would be best.
DrO
New Member:
Kinesis4

Posted on Thursday, Nov 3, 2005 - 9:49 am:

Thanks Dr. O
The vet is coming out again today, and we're going to arrange radiographs. There are no obvious signs of fracture, but at this point, that seems to be the most likely cause. With this kind of evidence of nerve damage (facial paralysis), is a fracture in her face the most likely cause? or could there be problems in her spinal cord in her back? I don't understand that much about how the nervous system works.

Thanks
Sarah
Moderator:
DrO

Posted on Friday, Nov 4, 2005 - 8:33 am:

Swelling and dysfunction are the 2 primary signs of fracture however nerve damage can occur with just bruising along with swelling. The progressive nature suggest a secondary ongoing progressive process like infection though progressive swelling from the original trauma could be responsible without infection. Has your horse's temperature remained normal?

Since you don't describe any spinal nerve dysfunction this is almost certainly confined to the cranial nerves. The cranial nerves all exit the brain directly through the skull. The facial nerve (which is motor to the ear, lid, and lip to that side) exits the skull just behind the jaw and just below the ears. There it immediately divides to go to the ears and then to the face. Since the lips were effected first then it spread to the ears, I believe the injury was just in front of this place and the inflammation has spread backward to involve the motor nerves to the ears. Because the jaws joint (temporomandibular joint) is just deep to this area the difficulty eating could be 2 fold, neurological and acute traumatic arthritis.
DrO
New Member:
Kinesis4

Posted on Friday, Nov 4, 2005 - 10:34 pm:

Dr. O

Thanks for the explanation of the facial nerves. It helps me very much to understand what is going on.

Do you have any information on Lumpy Jaw? I found lots of info about how it affects cows, and the treatment for them, but nothing really specific to horses. Any info you have would be great, as my vet feels this is still what we're dealing with, secondary to the trauma.

An update on my mare...
The vet came out Thursday 11/3, prepared to do facial x-rays to figure out what is going on. However, both he and I saw improvement in her attitude and a slight improvement in the swelling of her lower lip as opposed to the night before. We decided to continue with the treatment that we're doing now (Antibiotics and bute) until Monday, and do a recheck then. Today (Friday 11/4), she seems about the same.

Just as a side note to anyone having problems giving antibiotics or medication in powder form, Orange jello powder, mixed 1:1 with the meds works (at least for my picky horse)!

Thanks again!
Moderator:
DrO

Posted on Saturday, Nov 5, 2005 - 12:12 pm:

No I cannot find a case of lumpy jaw like infection in the horse. It is true there are some members of the genus Actinomyces can be found in the normal flora of a horses mouth and I guess such a secondary infection is possible. I am unaware of any such cases however and the normal infections found in the mouth following trauma usually respond to wide spectrum antibiotics that also cover anaerobes. There are a few cases of Actinomycosis causing infection in horses in other locations:

J Am Vet Med Assoc. 1991 Feb 1;198(3):457-9.
Skin pustules and nodules caused by Actinomyces viscosus in a horse.

Specht TE, Breuhaus BA, Manning TO, Miller RT, Cochrane RB.
Department of Food Animal and Equine Medicine and Surgery, College of Veterinary Medicine, North Carolina State University, Raleigh 27606.

A 12-year-old Arabian stallion was evaluated for a refractory skin problem of 2 years' duration. Skin nodules and pustules, which would rupture, had developed over the right lumbar muscles. Anaerobic culturing from the pustules yielded Actinomyces viscosus, and histologic examination of biopsy specimens revealed globular eosinophilic structures. Concomitant treatment with isoniazid (8 mg/kg of body weight, q 24 h for 8 weeks), trimethoprim-sulfadiazine (30 mg/kg, q 24 h for 8 weeks), and sodium iodide solution (66 mg/kg, every 1, 2, or 4 weeks, for 32 weeks) resolved the condition.

DrO
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