# Our experience with Jaw Drop (Trigeminal Neuritis)



## Regulus (Jan 30, 2012)

Background:
Gus was born on 11/20/11. He is an 85 pound, intact male, with less body fat than I had when I did Ironman triathlons. He has what seem to be seasonal skin allergies. They're fair to bad at this time of year (summer) and almost non-existent during the rest of the year. We give him anti-histamines and try to bath him with an anti-bacterial shampoo to manage skin outbreaks (Virbac Etiderm). Those outbreaks are the only health problem he's had to date. We feed him grain free food. Typically we switch between Acana Pacifica and Acana Wild Prairie. He is prescribed Trifexis for heartworm prevention and Vectra 3D for flea prevention. We have used these two drugs since April 2013. He has had no adverse reaction to date (though, after what I've read in a few threads here recently, I may talk to our new vet [we moved recently] about using something different). For anti-histamines, he was on hydroxyzine before we moved. Our new vet suggested that we could use Zyrtec (avoiding D) and supplement with fish oil for Omega 3s. We began giving Zyrtec and Fish Oil supplements the Friday before our current trouble began. While we think they are unrelated, we're only giving him the fish oil for now.

*The Gus story:*

*Wednesday:* My wife texted me to tell me that Gus choked (violently) on a treat. She said that he seem to have coughed it up, and she figured he must be alright since he ate it (again) without further issue. When I got home, I noticed that something about his appearance/behavior was off: his mouth was staying open, and he was licking the air. I didn't think too much of it since he was hopping around, carrying my work shoes and behaving normally otherwise. He ate his dinner fine (Acana Wild Prairie), but when we went outside to play later in the evening, he was having trouble holding onto the size 3 soccer ball that we use to play fetch. He'd eagerly run to the ball, but he'd drop it two or three times on the way back. After his exercise session, we noticed that he wasn't drinking water differently. He was lapping up water, but he was doing so gingerly, rather than forcefully, as is normal. At that point, we were a little worried that something was wrong.

*Thursday:* When I woke up in the morning to get ready for work, he was a little more sleepy than normal; his jaw drop was still there, and he was wet and covered in drool. His jaw seemed flaccid. He didn't have trouble eating his food (still the Acana), but water intake appeared to be more of a struggle, and there was water and drool everywhere. I knew at that point that I had to take him to the vet as soon as I was able. I took leave from work and called his general practitioner. They didn't have an appointment, but they said if I came in and waited, they would see Gus as soon as they were able. As a result, I spent most of the day in the vet waiting for him to be seen, but that's what we do for our fur babies, right? When we were finally called back, the vet was not able to find anything wrong during his preliminary inspection. His temperature was normal; his teeth, gums, 'hard' palate and tongue all looked fine. He wanted to sedate Gus so that he could get a more complete look at his mouth and down his throat. He sedated Gus, inspected his teeth, gums, tongue, hard palate and soft palate down to his esophagus. He also took chest/head x-rays and blood work. He said that his mouth and palate looked fine. There was some redness near the esophagus, but he said it was consistent with the choking episode and wasn't worried. He also said that his x-rays looked normal. He said that he jaw function was normal. It opened and shut like it should, and his tracking and bite were great. Everything was where it was supposed to be, and nothing was there that shouldn't have been. To cover his bases, he gave Gus penicillin and an anti-inflamatory shot with instructions to come back on Friday to follow up. Understandably, Gus was out of it the entire evening. We were only able to wake him up around 20:15 to get him to eat dinner (never underestimate how the cutting of a nail can raise a dog from a dead sleep). The vet suggested chicken and rice, so that's what we gave him. In retrospect, it probably wasn't the best thing to given his jaw drop, as he wasn't able to get much into his mouth. For a while, he didn't do much more than push the rice around with his tongue. He probably managed to eat 80% of what was in the bowl originally; the rest was on the floor or on him. He didn't drink any water after returning from the vet that evening.

*Friday:* No change to jaw drop. I took off again to stay with him. He struggled with his food (chicken and rice again) in the morning, but like the previous night, he finished most of it. While he was back to drinking again, he struggled mightily. Frequently, it seemed as though he ended up with more fluid in his bowl than he did before he approached the bowl to drink (his was drooling that much). His drinking trips would last for 6-8 minutes (no exaggeration), and I was not able to tell that there was a substantial change in the water level. At this point, I started to mark the water bowls around the house so that I'd have a better idea as to the volume of water her was consuming. We took him back to the vet as instructed. Vet acknowledged no change and that he was stumped. All blood work values were normal, and his temperature again, was normal. He wanted to see how Gus was eating, so he grabbed some canned food (Purina EN Gastroenteric Canine Formula), opened it and watched the dog eat it. He was comfortable that the dog would be able to eat it over the weekend, so he suggested that we buy it and feed it to him. It is more nutritious than chicken and rice while still being easy on the throat, so we heeded his advice and bought 12 cans. He told us they'd buy them back from us if we didn't end up using them, so it seemed like a good deal to me. To be safe, he prescribed anti-inflammatory and anti-biotic medication. He prescribed Gus Rimadyl and Cephalexin. When we went home, we fed him another can with his medication. He was able to eat the soft food with some assistance from us (we made the food into small meatballs to aid in his picking them up. My wife and I then went to dinner to try to get a break from the stress of his condition. When we came back, his drinking bowl was slightly tinged red with blood. At that point, we were really freaked out. After taking a look at his mouth, we noticed that his lips (bilateral) behind his lower canines were raw (chapped from the jaw drop and rubbed raw by the licking) and when touched with a tissue left blood. We felt a little bit better, but we took some pictures and video, and we sent it to a friend of ours who is a Vet in San Diego. She didn't think it was an emergency, but asked that we keep sending her pictures and text updates. With her advice, we decided not to take him to the emergency vet. She also suggested that we schedule an appointment with a doctor she knows really well for a second opinion. The soonest we were able to see this doctor was on Tuesday at 10:00.

*Saturday:* No change to jaw drop. We fed him in the morning, and he struggled with the soft food again. The food seem to get stuck to his palate, requiring him to strain to get it off with his tongue. His drinking was still labored; in fact, he'd spent so much time with his head in his bowl overnight trying to drink water that his bowl was tinged a little darker than it had been the night before. He was lethargic/depressed. Most of his activity was limited to making attempts at drinking water. Luckily, the bleeding from the raw lips had ceased. Unfortunately, in the evening, he refused the canned food and didn't seem altogether enthusiastic about drinking. Understandably, at that point, we thought that we were going to lose him, which was obviously pretty tough to take. We resolved to take him to the emergency vet in the morning if he refused food. 

*Sunday:* No change to jaw drop. I tried to feed him the soft food again in the morning, and again, he refused. I was heartbroken. He's never refused food in his life, so I thought something was incredibly wrong. I still needed to give him his meds though, so I went to the refrigerator and got hot dogs to use as pockets for the pills. Suddenly, he was interested in eating. I gave him one after another until he'd eaten 5 hot dogs. When he finished, he ate all of them and trotted off to drink (we read that it'd help if we raised the bowl). It appeared as though maybe, just maybe, he'd turned a corner. We decided to wait on going to the emergency vet until later in the day. He continued to be lethargic, but his energy level seemed better, and he wanted to play. He was able to carry not one, but two tennis balls around (still not the three that's normal, but I'll take it). Also, we could tell that he was able to actually drink water (the elevation of the bowl seemed to do the trick). We switched up his food as well. We bought ground beef, rice and sweet potatoes. We made meatballs with the ground beef and rice and added the sweet potatoes to the bowl. He loved it. We'd also picked up plain pedialyte, and a fried that works at a local hospital got us a couple of small syringes (without needles, obviously). We used those syringes to drip pedialyte into his mouth. While it was a struggle and it took forever, we were able to get almost a half of a liter of 50-50 pedialyte-water mix into his system. 

*Monday:* No change to jaw drop. Gus was still the same in the morning. He was still eating, but he was still having trouble with drinking. He was still lethargic, but like the previous day, he seemed interested in playing, so we were encouraged. Mostly, we were just really worried about his hydration level. The skin test indicated that he was hydrated, or at least not dehydrated, but we were worried nonetheless. My wife and I decided that she'd call to make an appointment, and that I'd take off when necessary to get him there. I went to work, and my wife called to see if we could get an appointment. The only time they had was 10:30. I worked until a little after 0930, and I grabbed my computer so that I could work when we got back. When I got home, he seemed more like his wiggly self. He even tried to pick up one of my shoes. Alas, he wasn't able to keep it in his mouth. I took him to the vet, reported what had happened over the weekend. They took his temperature and did the normal look and listen stuff, but they still could not figure out what was wrong with him. I let the vet know that we had an appointment to see another vet the next day. He said it was a good idea and went ahead with writing up a referral. I asked that they give him a sub cutaneous fluid injection. They gave him the injection, and we were on our way. While we were there, he yawned. This was the first time since the previous Wednesday that I'd seen him yawn. He seemed a little better after getting the fluid, but he slept most of the day, which was fine, as it allowed me to get some work done. He ate his dinner fine, but he hasn't touched water since he got home (understandable as he got fluids at the vet and probably wasn't thirsty). When my wife got home, he was wiggly again, and he grabbed one of her flip flops. This was very encouraging. We also got him watermelon and dog ice cream to try to help the hydration and make up the caloric deficit (respectively), but of course, he didn't like the watermelon and wasn't able to eat the ice cream unless we put it in his mouth in chunks. He didn't really like when we did that, so we didn't try it again. I should note that he never stopped urinating, so I probably shouldn't have been so worried about his hydration levels. Every urination even was at least 6 seconds in length. While that is lower than normal for him, it was clear that he was ingesting and cycling fluid before the injection. 

*Tuesday:* No change to jaw drop. The vet to whom we were referred was able to see him at 10:00 on Tuesday or not until the end of the week. I worked from home in the morning and then took him to the vet. They were very thorough with him, listening to the whole story, from start to finish while taking notes. They reviewed the x-ray and blood work sent by my general practitioner and then did a long exam. Again, temperature, breathing etc. were all normal. She didn't see anything unusual, aside from the jaw drop and what she said seemed to be a bi-lateral abnormality with his tongue movement. She indicated that it may have been a result of the lack of jaw involvement. She then told me that she could sedate Gus and examine him, but she said that her gut feeling was that the issue was neurological and that the test would likely not be worth the expense. Further, she said that it would be possible may want to do testing that would require that he be sedated again, and indicated that it may not be the best thing to have him sedated so many times within a one week period. She referred us to a neurologist, and I made an appointment to see him the next morning. That afternoon, when I let him out, he ran over to his fetch ball, and carried it all the way to me up on the porch. When examined against his inability to carry the same ball back to me the previous Wednesday, I was encouraged. Again, he ate his dinner with gusto. He even went to take a drink afterwards, and he seemed less sloppy. The markings on the bowl proved this to be the case, which was also encouraging.

*Wednesday:* No change to jaw drop. I couldn't miss any more work, so my wife called out and drove him from Suffolk, VA to Richmond, VA to see the neurologist. The neurologist did all of the standard vet pre examination diagnostic stuff. His temperature was normal. His ears were clean. His breathing was were normal, etc. He then proceeded to test reflexes and nerve stuff. I apologize for the lack of specificity, but I wasn't there. My wife is a pediatric physical therapist (neuro), so probably would have been better to have her write this section. All of his eye related and face/lip related reflexes were normal. It was only his mandibular function that was impaired. He diagnosed Gus with trigeminal neuritis. He thinks that it is most likely idiopathic in nature but that the only way to tell for sure would be to do an MRI and a spinal tap. He said that it wasn't necessary to do that at this point. He explained that if it were idiopathic in nature, that it'd go away with time. He asked that we follow up with him by telephone next week and if he wasn't better by the following week, he'd like to see him to perform the MRI and spinal tap. He told us to discontinue the administration of Rimadyl, stating that anti-inflammatories are no longer used to treat trigeminal neuritis. He also suggested that we avoid the Zyrtec too, even though he'd bet there it had nothing to do with Gus' current state. He suggested we continue with the antibiotic and the fish oil. My wife brought him home, and he's been the same way has he's been the last few days. Playful in spots and lethargic in spots. We reintegrated some of us Acana Wild Prairie food. At first, we tried to give it to him after we let it soak in some water. While he was able to get some of it up, he wasn't able to do well enough with the kibble for us to feel great about him continuing, so we put what was left in a food processor and made meatballs out of it. We mixed in some of the remaining rice and beef meatballs, and he ate everything. He also drank water afterwards. It still isn't great, but the markings on the bowl show that he's able to bring in water, even if it's a little messy.

*Thursday (today):* No change to jaw drop. I made Wild Prairie 'meatballs' again. He ate some of them, but wasn't extraordinarily impressed. I took a few of the remaining rice and beef meatballs out, and he gobbled those right up. I fear that he may now be a picky eater. I can't blame him though. If I'd eaten meatballs and sweet potatoes for the last few days, I'd be reluctant to give them up for faux meatballs. I also found a large area of scabbing on the underside of his head, below his right ear. I'm guessing is what was left of a hot spot that may have resulted from him being perpetually damp from the mouth to chest area from Thursday to Sunday. It made me feel really badly, as he'd had to deal with that at the same time as he was dealing with the jaw drop, the poking and prodding from the vet and lethargy/depression from not being able/allowed to play. He's a trooper though.

---

Obviously, this has not been an easy process for my wife an me. Until we saw the neurologist, nobody could tell us what was wrong with Gus. I combed through threads here, and I wasn't able to find anyone with exactly the same experience, which is why I'm posting this here now.

The GP thought it was myositis of the masticatory muscles when we first got to the vet; however, he lack of sensitivity to touch of those muscles and his jaw and his great range of motion without pain led him to believe it wasn't MMM. The blood work was normal; CPKs were not elevated.

He also thought TMJ, but again, he found Gus to present with symptoms after examination.

He checked for a foreign body in the mouth and throat and found nothing; he also found no soft palate trama.

The monday before we got the second opinion, he was slightly worried about laryngeal or pharyngeal issue. Gus had no changes to his bark, growl etc. He wasn't regurgitating food. He wasn't coughing. His concern seemed to be related to a sound he made while excited. I heard the sound as well, but it was the first time I'd heard it, and I've only heard it once since: also when he was very, very excited. I also found it imporant to remember that he's had his mouth open for the better part of 5 days at the point that this sound was heard. I think he'd need to be forgiven being a little dry. The second opinion vet didn't think it was an issue, and the neurologist didn't either.

We suspected starting Friday that it was Trigeminal neuritis, and we mentioned it to our general practitioner at that appointment, but he wasn't really familiar with it.

We mentioned it to the second opinion vet, and she agreed that it certainly seemed to fit, but said that he should see a neurologist.

Now that we finally know what it is, we feel a little better, but there's still some anxiety associated with the "what if it doesn't get better" line of thinking. I'd read in the comments on a blog somewhere that one persons dog seemed to have it. Later they followed up stating that it was trigeminal neuritis, but that it wasn't idiopathic. A tumore was causing the symtoms. I remind myself that Gus is not symptomatic in the face/jowls/lips or eyes (the other two branches). He is only symptomatic the mandibular branch. I know this means nothing, but it helps me feel like everything's going to be alright in a week or two. 

---

I'll work to continue to update this as time passes. 

Feel free to add your thoughts or experiences; I would love to hear from y'all.


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## Hsjwmom (May 29, 2014)

You guys gave really been through the wringer with Gus this past week! I hope you continue to see improvement and he makes a full recovery. Thank you for taking the time to write up your experience, I'm sure it will be a huge help to someone someday.


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## Alaska7133 (May 26, 2011)

I am so glad to see your post. I had always wondered what had was wrong with my Pennie. We put her down back in 2007 because of Trigeminal neuritis. But back then we didn't know what it was and we don't have any specialists in Alaska. So my vet and I were alone in trying to figure out what was wrong. Pennie's condition was far more advanced than your guy's. First we noticed she couldn't close her mouth and her tongue hung out. She could not swallow and also couldn't raise her head above her shoulders. I'm glad your guy can eat and doesn't have too much trouble drinking. Pennie we had to use a turkey baster to get water in her. We did decide to out Pennie down when we found out that a lot of water was going into her lungs from the turkey baster and she was no longer able to cough it up either. It was terrible to watch. We did not drag things out for her. We put her down when she was still able to enjoy life. I do think it is possible hers was a more complex variation of the disease.

I feel for you. I'm so glad you got a diagnosis. Sounds like your guy is stable and not advancing. I hope the antibiotics work. I looked online at Merck the drug manufacturer. They claim it goes away on its own after 3-4 weeks. I really hope the best for you all. Please post back and let us know how it goes.


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## mylissyk (Feb 25, 2007)

I've never heard of this before, so thank you for sharing your experience. You are so diligent with his care, I have to believe he will improve. Please let us know how he progresses.


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## Regulus (Jan 30, 2012)

Hsjwmom said:


> You guys gave really been through the wringer with Gus this past week! I hope you continue to see improvement and he makes a full recovery. Thank you for taking the time to write up your experience, I'm sure it will be a huge help to someone someday.




It was a tough week to say the least; however, it seems as though things are progressing for the better now. I appreciated reading your kind words, and thank you for keeping Gus in your thoughts.
 


Alaska7133 said:


> I am so glad to see your post. I had always wondered what had was wrong with my Pennie. We put her down back in 2007 because of Trigeminal neuritis. But back then we didn't know what it was and we don't have any specialists in Alaska. So my vet and I were alone in trying to figure out what was wrong. Pennie's condition was far more advanced than your guy's. First we noticed she couldn't close her mouth and her tongue hung out. She could not swallow and also couldn't raise her head above her shoulders. I'm glad your guy can eat and doesn't have too much trouble drinking. Pennie we had to use a turkey baster to get water in her. We did decide to out Pennie down when we found out that a lot of water was going into her lungs from the turkey baster and she was no longer able to cough it up either. It was terrible to watch. We did not drag things out for her. We put her down when she was still able to enjoy life. I do think it is possible hers was a more complex variation of the disease.
> 
> I feel for you. I'm so glad you got a diagnosis. Sounds like your guy is stable and not advancing. I hope the antibiotics work. I looked online at Merck the drug manufacturer. They claim it goes away on its own after 3-4 weeks. I really hope the best for you all. Please post back and let us know how it goes.




How awful that must have been. Like you, we felt alone and helpless for the first week he was experiencing trigeminal neuritis symptoms. I am genuinely sorry that you found yourself in such an unenviable position, but given what she was experiencing, I'm certain that you did what was best for your girl.

While it sounds like your girl did have trigeminal nerve involvement, I wonder if there wasn't some other neurological involvement that was causing a couple of the symptoms? Gus' tongue only hangs out when he wants it to hang out, like when he is panting. Oftentimes, his tongue is completely in his mouth. Further, Gus has not had a problem picking his head up. 

Thank you for your kind thoughts and words.



mylissyk said:


> I've never heard of this before, so thank you for sharing your experience. You are so diligent with his care, I have to believe he will improve. Please let us know how he progresses.




Apparently, it's pretty rare. The neurologist that we saw says that me sees maybe 2 to 3 cases a year. 

Thank you for the kind words; I'm a worrier (thanks Mom!), so the only way for me to cope is to be as involved and thorough as I can. Being diligent and thorough are the only things I can control, and the more control I have, the better I feel about facing the things I can't control... if that makes sense.


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## Regulus (Jan 30, 2012)

UPDATE:


Thursday (today): No change to jaw drop. I made Wild Prairie 'meatballs' again. He ate some of them, but wasn't extraordinarily impressed. I took a few of the remaining rice and beef meatballs out, and he gobbled those right up. I fear that he may now be a picky eater. I can't blame him though. If I'd eaten meatballs and sweet potatoes for the last few days, I'd be reluctant to give them up for faux meatballs. I also found a large area of scabbing on the underside of his head, below his right ear. I'm guessing is what was left of a hot spot that may have resulted from him being perpetually damp from the mouth to chest area from Thursday to Sunday. It made me feel really badly, as he'd had to deal with that at the same time as he was dealing with the jaw drop, the poking and prodding from the vet and lethargy/depression from not being able/allowed to play. He's a trooper though.

*Thursday Cont'd*: No change in second half of the day. He ate his dinner and was able to drink sufficient water.

*Friday, Saturday, Sunday*: No change to jaw drop. He ate his food, which is now just plain kibble, and he is able to eat it without an issue. He takes breaks while eating it to drink water, as he still has a decent amount of saliva build up, particularly on his tongue. Behaviorally, he seems to be returning to normal. Starting on Saturday, he's started going after socks and towels like he did before this all started, and he's been pushing to go outside to play and just hang out more. His water consumption is better than it was earlier in the week, even if makes a little bit of a mess. He threw up Sunday morning, but it was mostly-digested food. He's been backed up lately, so I'm guessing there was just too much food in him. When I say he's been backed up, I mean that each #2 session he's had over the last few days has been abnormally large in volume. It's almost like he was a constipated over the past week, and his system is just now sending the food he's eaten on its way. He eagerly ate a small breakfast after throwing up (didn't want to give him his normal 1.5 cups), and he drank water as normally as he's been able to lately, and by 1600, he was begging for his dinner, so again, I'm inclined to think the throwing up wasn't related to anything. It would also be good to mention that I switched his food Thursday evening. Anything he was eating/taking at the time this all started has been phased out of his diet, with the exception of the fish oil. He's now on Acana's Pork and Butternut Squash. He loving it.

*Monday*: No change to jaw drop. I suppose it would be good to clarify that by no change, I mean that it is still there. As you can tell by the updates, he has increased functionality, but the drop itself is still there. Monday was an encouraging day even with the drop still being there. He ate his food and drank a good bit of water over the course of the day. I think his drinking today was more efficient than it's been in a while. There also seemed to be a little less drool. Each bowl had less water and less drool than it would have the previous week after drinking sessions. He also pulled all of his toys out of his toy bin last night, and, what gave me the most pleasure was seeing him chewing on his gummy nylabone. It wasn't with the fervor that he had before the jaw drop, but it's the first time that he's looked to really chew on something.

*Tuesday*: No change to jaw drop. I've started walking him in the morning when I get up. It's not always very far, as I have to drive 40 minutes to work, but I made the decision Friday night that I was going to make it a point to treat him like a dog. I decided that I wasn't going to continue to shelter him. Of course, his ability to drink water more efficiently helped with this decision, but I got to the point emotionally that I decided that even if he's never able to shake the jaw drop, he needs to have a good quality of life; he needs to feel like he isn't punished or quarantined. He's enjoying the walks, and I'm enjoying spending more time with him in the morning. It also works out because it allows me to have more control over what he's encountering outside (bees/wasps, frogs, mushrooms etc.) without him feeling I'm scolding him for being curious.

Tomorrow afternoon will mark 14 days since the onset of the jaw drop. This week has been better than last week. I'm hopeful that the improvements will continue and that we won't have to take him back to Richmond in another week to have a spinal tap/MRI.


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## Regulus (Jan 30, 2012)

*MORE INFO ON TRIGEMINAL NEURITIS*

I probably should have posted this earlier, but here's some info on trigeminal neuritis from vetstream. I don't have the membership, as it is really expensive, but the info is great. As I mentioned, my wife is a PT at a children's hospital and works primarily neuro (most ortho stuff is done as outpatient therapy), so she was able to explain a lot of the nerve related things to me.

*Introduction*
A. Trigeminal nerve branches: ophthalmic, maxillary, mandibular.

B. Most common trigeminal neuropathy is idiopathic mandibular paralysis.

C. *Cause* : inflammation, neoplasia, trauma.

D. *Signs* 
1. Ophthalmic branch: corneal anesthesia, loss of sensation to upper eyelid and eye medial canthus.
2. Maxillary branch: loss of sensation to eye lateral canthus, lower eyelid, face including nostril and palate.
3. Mandibular branch: unilateral or bilateral paralysis of masticatory muscles -- inability to close mouth, difficulty eating and drinking.

E. *Diagnosis* : signs, histopathology, MRI.

F. *Treatment *: supportive care.

*Diagnosis*

A. *Clinical signs*
-1. The ophthalmic branch is sensory to the eye and surrounding skin: 
---a. Can be tested by assessing for a palpebral reflex (afferent - CN V; efferent CN VII), and by assessing corneal sensation.
---b. When the medial canthus of the eye is touched, the animal should blink (palpebral reflex).
---c. If the cornea itself is touched, the animal usually retracts the eye in the globe as well as blinks (corneal sensation).
---d. Normal CN V innervation of the cornea is also needed to maintain the corneal epithelium.
-2. If CN V function is lost to the cornea, a neurotropic keratitis can develop and tear secretion may decrease due to loss of afferent stimulation for lacrimation.
-3. Tear secretion will usually be decreased, but is not absent as CN VII is intact.
-4. The ipsilateral nasal mucosa may become dry.
-5. The maxillary branch of V is sensory to the maxillary area: 
---a. This function is most readily assessed by pricking the medial part of the nasal mucosa as the animal's eyes are covered (to prevent the patient from seeing you).
---b. A direct CN V to ipsilateral CN VII reflex arc is evoked which is manifested as ipsilateral movement of the muscles of facial expression (blinking; wrinkling of the facial muscles) - a subcortical reflex.
---c. The second event is a consciously-mediated movement of the head away from the stimulus.
---d. This requires conscious recognition of the stimulus via pathways projecting to the contralateral parietal cortex.
---e. An animal with a CN V maxillary branch deficit will have neither the reflex or conscious response to this stimulus.
-6. Animals with unilateral involvement of the mandibular branch of V often have atrophy of the temporal and masseter muscles on the ipsilateral side.
-7. Animals with bilateral mandibular nerve disease will present with a dropped jaw and are unable to close the mouth.
-8. Inability to close jaw, except passively.
-9. Accumulation of food between teeth and cheek.

B. *Ophthalmic branch lesion*
-1. Corneal anesthesia.
-2. Loss of sensation to upper eyelid and medial canthus.
-3. Loss of corneal and palpebral reflex from upper lid.

C. *Maxillary branch lesion *
-1. Loss of sensation to lateral canthus, lower lid face including nostril and palate.
-2. Loss of palpebral reflex of lower lid.

D. *Unilateral lesion of the mandibular branch *
-1. Slight deviation of jaw towards normal side.
-2. Loss of sensation to buccal mucosa, with food accumulating between cheek and teeth.
-3. Atrophy of temporalis and masseter muscles and enophthalmus, (sunken eye).
-4. Acute onset hypersalivation.
-5. Coughing.
-6. Dysphagia.
-7. Bilateral absence of tactile and deep pain sensation from face, tongue and oral mucosa.


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From the Merck Manual:

*Trigeminal Neuritis*

Idiopathic trigeminal neuropathy is common in dogs and uncommon in cats. It is characterized by acute onset of flaccid jaw paralysis. Affected animals cannot close the mouth and have difficulty eating and drinking. Horner syndrome, facial paresis, and decreased facial sensation are also possible. The cause is unknown. Histopathologically, there is bilateral nonsuppurative inflammation and demyelination in the motor branches of the trigeminal nerve. Affected animals usually recover spontaneously within 3–4 wk. Fluid and nutritional support may be necessary.


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From PetMD

*Trigeminal Neuritis in Dogs*


Sudden onset of the inability to close the jaw owing to dysfunction of the mandibular (jaw) branch of the trigeminal nerves (one of the cranial nerves) is a treatable medical condition called trigeminal nerve neuritis (inflammation). This is often due to nerve injury, which ranges from neuritis, demyelination (loss of the fatty sheath around the nerve which helps conduct the signal), and sometimes to fiber degeneration of all the branches of the trigeminal nerve and the nerve cell body.

Although it is occasionally seen in cats, trigeminal neuritis is mainly an illness of dogs.

*Symptoms and Types*



Acute onset of a dropped jaw
Inability to close the mouth
Drooling
Difficulty in getting food in the mouth
Messy eating
No loss of feeling in the jaw or face
Swallowing remains normal
*Causes*


The underlying cause of trigeminal nerve neuritis is currently uknown, though it is possibly immune-mediated.

*Diagnosis*


Your veterinarian will perform a thorough physical exam on your dog, taking into account the background medical history, onset of symptoms and possible incidents that might have led to this condition. Your veterinarian will order a blood chemical profile, a complete blood count, a urinalysis and an electrolyte panel to rule out other diseases. Rabies is one of the more important disease conditions that will need to be ruled out. Diagnostic imaging like X-ray will be used to examine the skull and jaw bones, and bone marrow core biopsies and muscle biopsies can be used to rule out other possibilities for disease. 
*Treatment*


The most effective treatment is supportive care. Your dog will need assistance with eating and drinking. If you are able to provide sufficient care at home, your dog may be treated as an outpatient, but if you cannot care for your dog, it will need supportive nutritional care in the veterinary hospital so that it is receiving adequate nutrients. 

If your dog is still able to lap and swallow food that is offered, you can use a large syringe that is placed in the corner of the mouth to feed the dog water and pureed foods, with the dog's head slightly elevated so that it can swallow easily. Fluids can also be administered subcutaneously (under the skin). Feeding tubes are rarely necessary for maintaining adequate food intake, but may be used if your dog is unable to take anything into the mouth or swallow the food that is given. 

*Living and Management*


This disease usually spontaneously resolves after 2-4 weeks. One result of this disease is shrinkage of the muscles used for chewing. Once the condition has stabilized and your dog is able to move its jaws normally again, you can help your dog to strengthen the jaw muscles. Your veterinarian will recommend exercises for doing this based on your dog's overall health and age.


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This article is also really, really good.

http://www.veterinarywebinars.com/assets/NSK_Session2_Notes.pdf

It's call Droops, Tilts and The Head "Stuff"
From Dr Laurent Garosi DVM, Dip ECVN, MRCVS

I won't copy all of it here, as I don't want to hijack someone else's work, but it's definitely worth a read.


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## Alaska7133 (May 26, 2011)

Thank you for posting the information. I do think Pennie had this disease, but with additional neurological problems that will never be diagnosed. It's a sad thing to see no matter how complex. Did your neurologist think it might be a virus that causes the symptoms? Pennie had no trauma, it reminds me of Bell's Palsy (sp?). I hope the best for your boy and he recovers fully and quickly.


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## Regulus (Jan 30, 2012)

Alaska7133 said:


> Thank you for posting the information. I do think Pennie had this disease, but with additional neurological problems that will never be diagnosed. It's a sad thing to see no matter how complex.


Agree wholeheartedly. I didn't mean to give the impression that it wasn't, if that's how my post was perceived.



Alaska7133 said:


> Did your neurologist think it might be a virus that causes the symptoms? Pennie had no trauma, it reminds me of Bell's Palsy (sp?). I hope the best for your boy and he recovers fully and quickly.


No. He referred to it as most likely being idiopathic (unknown cause). Gus had blood work done though, and his white count was normal. His creatine phosphokinase (CPK) count was normal as well. This led the doctor's to believe that he wasn't fighting an infection and that he wasn't experience muscle death. The former should address the virus question, and the latter addresses the myositis concerns.

With respect to Bell's Palsy, it is similar, in a sense. Bell's is a paralysis associated with the facial nerve. The facial nerve is Cranial Nerve No. 7. The Trigeminal nerve is Cranial Nerve No. 5.

Like Bell's Palsy though, Trigeminal Neuritis is a diagnosis of exclusion, meaning that it's diagnosed through the elimination of other reasonable possibilities.

This is why the neurologist wants to know if it doesn't resolve of if Gus isn't significantly better (not sure which will be his determining factor) by next week. The passage of time will either show that he's better or will eliminate the idiopathic diagnosis and move us towards a specific cause.

The thought being that the testing of cerebral spinal fluid and the MRI may give an indication as to whether cancer is causing the problems with the trigeminal nerve.


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## Alaska7133 (May 26, 2011)

Thank you for the information. I'm happy that you were able to find such a competent neurologist with the equipment to do a diagnosis.


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## Ksdenton (Mar 17, 2013)

Any updates?


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## inge (Sep 20, 2009)

Thank you for the very informative way of posting everything, I learned a lot today. Are there any updates ?


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## Alibrat221 (Oct 24, 2016)

Regulus said:


> Background:
> Gus was born on 11/20/11. He is an 85 pound, intact male, with less body fat than I had when I did Ironman triathlons. He has what seem to be seasonal skin allergies. They're fair to bad at this time of year (summer) and almost non-existent during the rest of the year. We give him anti-histamines and try to bath him with an anti-bacterial shampoo to manage skin outbreaks (Virbac Etiderm). Those outbreaks are the only health problem he's had to date. We feed him grain free food. Typically we switch between Acana Pacifica and Acana Wild Prairie. He is prescribed Trifexis for heartworm prevention and Vectra 3D for flea prevention. We have used these two drugs since April 2013. He has had no adverse reaction to date (though, after what I've read in a few threads here recently, I may talk to our new vet [we moved recently] about using something different). For anti-histamines, he was on hydroxyzine before we moved. Our new vet suggested that we could use Zyrtec (avoiding D) and supplement with fish oil for Omega 3s. We began giving Zyrtec and Fish Oil supplements the Friday before our current trouble began. While we think they are unrelated, we're only giving him the fish oil for now.
> 
> *The Gus story:*
> ...


I am really sorry that this is an older thread because I would love to speak with you! Our 4 year old lab has been diagnosed with this illness and we are on our 9th day with him not being able to use his mouth properly! My husband and I have been worried sick but your post has given us great hope that our boy Bandit will begin improving very soon! Our boy cannot get any water into his mouth by lapping at his water bowl,so,we have been syringing water into his mouth, feeding him doggy ice cream by hand and a couple days ago I began making him unsalted chicken broth jello using unflavored gelatin, water and chicken broth. We cut it into strips and hand feed it to him and it is keeping him hydrated. We were told tha this illness which my vet calls,"drop jaw" can last from a couple weeks to a couple months. I would welcome any additional tips from you which you can email me at [email protected] Thank,you for your post on this issue!!! Lisa


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## Prism Goldens (May 27, 2011)

Gus is fortunate he has owners who know to do their own research- sometimes we forget vets can't know everything, and little things we ourselves notice sometimes hold the key. I'm happy that you got a dx and he will be on the mend soon. 've never seen this so reading it was quite interesting to me. Thank you for that!


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## Kkool (Oct 26, 2016)

I read through your all of your posts and this is something I'm confident my pup has now. We have seen one vet who was unsure what the issue was and are going to see a second in two days. My girl is 7 yrs old as of today and going into her 11th day of a dropped jaw. Any updates on Gus?


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## Alibrat221 (Oct 24, 2016)

*Drop jaw*



Kkool said:


> I read through your all of your posts and this is something I'm confident my pup has now. We have seen one vet who was unsure what the issue was and are going to see a second in two days. My girl is 7 yrs old as of today and going into her 11th day of a dropped jaw. Any updates on Gus?


Hello! I too was writing inquiring about Gus because 2 weeks ago our boy Bandit was diagnosed with drop jaw by one vet and was thought to have a fatal neurological disease from another vet when we took him for a 2nd opinion! 
Thankfully our first vet was correct and our dog does have only drop jaw. Today is day 16 and it's only in the last 2 days that I can say he is tremendously improved and actually mostly his mouth is shut rather than hanging open. As of yesterday he is eating on his own though he still needs support drinking. If you have any questions about your dog and your experience maybe I can help since we are currently in the midst of the condition. I would like to say that last week I was scared to death that our beautiful dog was nearing the end of his life and honestly wondered if he would ever improve. Low and behold he did and is going to be fine I believe!!! As I said, ask any questions and I will be happy to answer if I can! Good luck


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## april_1 (Dec 14, 2016)

Hello, Alibrat221, Kkool, - please, any updates? 
I believe my 5 y.o. has it now...


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## jennretz (Jul 24, 2013)

bumping up


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## Kkool (Oct 26, 2016)

Keeping this short my girl is back to normal, I should specify I have a Rottweiler but posted here as I could find no other similar forums. Our vet had no idea, could only suggest steroids which I try to avoid as they are often over prescribed. Sought a second opinion and this was the final diagnosis. She had developed an auto immune disorder that was attacking her masseter muscle which is connected to the jaw. This was final after a blood test, pupil dialation test and some research from the vet. We went the natural route for healing using a Chinese herb called Bu Gan Tang and an anti inflammatory called Traumeel. After two weeks she was back to mouth closed. She has lost some structure around the top of her head due to not using the muscle so we are working on building this back up over time. I would urge people to not stand for an unsure diagnosis and seek an additional from someone with the experience.


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## JHMarco (Jan 5, 2017)

Thank you so much for posting your experience with this. Our dog is in week 6 now, and still has a bit of an open mouth. He is finally able to drink water on his own, although he enjoys it when we give him water with a syringe (just not as often as it was). We have started giving him a Kong toy filled with peanut or almond butter and chopped carrots (his favorite) to help him exercise his jaws/tongue. His forehead muscles have atrophied quite a bit, so we are hoping the Kong will help with that too, although there is no guarantee it will come back.
Our vet had never seen it before, and thought it was something completely different. I did a bit of research and found your article and others (including some YouTube videos that matched our dog's symptoms). He sent us to a neurology specialist, who confirmed what I had found on the internet search. 
Again, thanks for sharing your experience. It really helped us.


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## Lori Omara (Jan 24, 2017)

Thank you for posting this. My 3yr old dog Annie just got diagnosed with, what they think is Trigeminal Neuritis. Came on suddenly, noticed wasn't chewing on Saturday, brought her to vet on Monday, so we are truly in the beginning stages. Hope it leaves as fast as it came. Vet did full exam and x-rays. No other symptoms other that, drooling, not chewing, not closing her moth all the way. Hard to eat and drink, a little less playful, a little more tired. We're helping her with the eating and drinking hopefully this will be a fast process. Keep fingers crossed and pray!!!


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## abatt (Apr 16, 2017)

How is your dog doing now?


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## abatt (Apr 16, 2017)

How is your dog doing now? Mine was diagnosed with this a week ago.


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## Kkool (Oct 26, 2016)

After being unable to get an accurate diagnosis by our regular vet we saw a vet who specializes in integrative medicine. Her diagnosis was an auto immune disorder attacking my dogs masseter muscle which was why her lower jaw was hanging open. We did not feel comfortable moving forward with any steroid use as it was not guaranteed and there can be long term effects. Instead we added a liver cleansing Chinese herb called Bu Gan Tan to her daily meals and she received acupuncture weekly. After 4-6 weeks she was completely healed and we have not had any issues since. I could not find anything on this issue at the time that is why I posted in this forum (though I have a Rottie not a Golden). I would strongly encourage others to do their research and seek a second opinion as your dogs advocate if you feel it has not been accurately assessed.


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## regspeir (Jan 4, 2010)

My Lincoln (3-yr-old Golden) has this now and I am SO grateful to hear the experiences of others. This is taking a toll on me, worrying, figuring out ways to keep him hydrated & nourished. Looks like this is going to be a LONG struggle...


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## Guest (Apr 13, 2018)

Thanks so much for this post! My vet tech saw my video of my dog on Facebook and showed it to the vet who was able to work her in that day. She was diagnosed with Trigeminal Neuritis and I have been struggling to feed her and keep up her water. While searching for help I read your post and it made me feel so much better..thank you! The drinking for long periods and slobbering were right on. Poor pup.


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