Budja's has a complicated jaw abscess case anyone have experience with jaw abscesses

[Cassie119300]

Hello everyone,
I've posted on here before... on my prior thread My rabbit Budja's jaw abscess came back for the third time after 2 surgeries about Budja's. I'm basically updating on this. Another X-Ray was done, when I returned back from the UK to the US to do my visa from the USA and get Budja's a check up as she is with my parents. The X-ray was quite difficult to interpret and even the vet at Cornell could not interpret it 100%. There does appear to be jaw bone changes, a possible ear infection which cannot be confirmed, and 3 teeth shifting. The last kind of surgery performed was to flush out the abcess cavitity when the abcess had burst and manuka honey was instilled inside, the opening was allowed to close over. Budja's remained abcess free for 6-7 months as I was giving her Penicillin G injections every other day for 3 months along with Azithromycin the past 6 months and currently, however, where the lance had been done there remained some very thickened feeling tissue under her jaw even after it was well healed which never went away but didn't quite feel like an abscess. I believe this is because the abscess capsule was left intact, which I've read in several cases was not a good idea. The vet told me that the abscess capsule must have resorbed as it was not seen on the x-ray but this I don't believe. There is a weird sharp/bony point at the very bottom of her jaw which I'm thinking is some kind of bone fragment/tooth material. The vet doesn't believe any jaw pieces/bone fragments have broke off but couldn't confirm nor deny possible lysis/infection of jawbone but said it wasn't that serious, but really that not much could be said from the x-ray except there was jaw bone changes/possible thinning and shifting teeth. In addition to this mass feeling material under her jaw, which felt somewhat fluid like/like hard tissue/ and a piece that feels like a sharp bone point... there was a small dense bubble that remained directly on the corner of the jawbone/cheek area. This bubble recently grew a little denser/thicker and then shifted and moved up onto the cheek area and moved further down so it is now directly above the side of the jaw and now on the cheek literally just above the underside of her jaw with all the other matter. We will be going to Cornell on October 12th as my vet referred me to another vet there who can do a C-T scan and try and get to the bottom of what exactly is continuing to be an issue. There must be some foreign object/issue with a tooth.... every time Budja's teeth were looked at and x-rays were done, and when she had a dental trim... nothing was ever found wrong with her teeth apart from her teeth now shifting due to the mass structure under her jaw. This abscess is also not showing so much on the outside this time as her other ones had, it can only be felt when touching her cheek, so these are more hidden within muscle. Her current medications are Azithromycin, Meloxicam, and Benebac. She continues to eat well, drink well, is shedding still a bit, going to the bathroom good, seems to have a lot of growling stomach noises, but still chews on her wood toys a lot, even binkies at times, and seems to be relaxed but she does still do the constant jaw chewing motion at times. She does also have sore hocks which I put bag balm on, it seems under control, and I have a lot of blankets and padded areas she relaxes on for this. I have read here on the forums that there is someone named Randy who has experience with rabbit abscesses and I was wondering if anyone knew a way to get in touch with that person, as any additional insight at this point would be great, I fear osteomyelitis could be at play here... at this point in time, I don't want to jump to conclusions but no foreign object has ever seemed to be found, even though the first two abscesses were completely and entirely removed, and despite doing antibiotics long term and injections for 3 months... it still continues on. Any insight would be much appreciated. Thanks everyone.

 

[JBun]

Randy isn't on here anymore. Hasn't been since I started 11 years ago. I don't know if you're still looking for info, but I'll share the experience I've had with my rabbit.

Only experience I had with a head abscess, was a retrobulbar acscess. The eye couldn't be saved, so was removed. Abscess developed in the empty and healing eye socket, and it burst. Was cleaned out, then I had to keep the pus cleaned out and wound from closing over, so flushed it out thoroughly every day.

She was started on Bactrim, then moved to enrofloxacin (or vis versa, can't remember). They were ineffective, and I requested azithromycin be started. First course, was 30mg/kg for 10-14 days (can't remember exactly). The infection in her eye socket was visibly stopped within 3 days. Antibiotics stopped at 10-14 days. Infection returned a few days after.

Azithromycin at 50mg/kg for 3-4 weeks was started. Infection didn't return. Eye socket healed normally. She lived another year + and died of old age at 10.

So maybe ask your vet about trying a different rabbit safe antibiotic or a stronger dose.

Medirabbit: facial abscesses

Medirabbit: skin abscesses

Medirabbit: abscess management

With some very difficult infections, I've read of rabbits needing to be on an antibiotic the remainder of their life. Some infections in rabbits can be extremely difficult to get rid of, and it becomes just managing it as best you and your vet can.

 

[Cassie119300]

Hello,
So I have an update regarding all of this. Budja's went to Cornell on Oct. 12th to receive a C-T scan and a subsequent surgery. They had to remove 3 of her teeth on the affected side, as all three of these teeth had disintegrated. There was two abscess capsules found. The specialist was going to remove a fourth tooth, but because of the fragility of Budja's jaw she did not want to chance it and injected a gel antibiotic behind the tooth. As much infected tissue/bits of necrotic bone were removed and Budja's had a marsupiliazation done on her jaw/cheek area. The C-T scan did indeed show osteomyelitis as well as advanced dental disease they believe to be heriditary. She will need a check up done for her teeth at our normal vet every 6 months as well as a yearly C-T at Cornell to make sure there is no other occurances of abcesses. Unfortunately not all of the two abcess capsules could be removed entirely due to the involvement with the bone but as much diseased/affected tissue were removed. I have been flushing the marsupilization site twice a day with a saline solution and packing it with a hydrogel. She is going for her re-check on Monday as well as making sure two superficial ulcers she developed on her eye's after surgery are healing ok. The marsupilization area's really do heal up too quickly so they did talk about having to re-open that for continued flushing. She is currently on eye drops and an eye lubricant for the ulcers, Metronidazole, Enrofloxacin, Gabapentin, and Meloxicam. We are still waiting on the abcess culture results, but they should be in very soon. She is healing very well and is back to eating/pooping/peeing and drinking fine and is loving cuddle time. There is no certainty right now that the abscess won't return but we're hoping to manage it and stay on top of it all as much as possible. I did have Budja's on Azithromycin for quite a long time and I do believe it did help in slowing the growth of the abcess for a while, but it did not stop the destruction unfortunately, not even when it was combined with the Penicillin G for a while. I do believe however though, if the abscess had been removed a lot earlier entirely, it would not have probably caused so much destruction to the bone/teeth but at the time the C-T scan had been quoted at a much higher price and we were trying to do our best to manage it. It's really great to hear that the Azithromycin helped your bunny and did solve her issue, the positive stories are so hard to find, but they are indeed there! I was told there have been cases seen even worse than Budja's.... which is hard for me to imagine, I did reiterate as long as she has a good quality of life, I will do everything I can. They had her in for the C-T and Surgery that day. Fingers Crossed, and I will continue to update on her progress.

 

[Cassie119300]

Budja's marsupilization area is taking longer than expected to close and heal, last tuesday they opened it up a little further and stitched around it, I continue to flush it twice a day. Has anyone ever encountered bone when flushing a jaw abcess area? There is now thick brown bone in the actual marsupilization hole that I can hardly even flush around, unfortunately this is emitting pus which now makes sense why I was seeing some pus before the area was opened up more last tuesday. I'm continuing to flush it as best as I can meanwhile waiting for a callback/some advice from the veterinarian's her next appointment to get her sutures removed isn't until the 30th next Thursday.... I'm literally just dealing with the uknown and continuing to put wound gel on it after the flushing. I think either 1. This brown bone that looks like it's pushing itself, is going to end up pushing itself out.... or b. this thing is unfortunately going to fester until I can get her in, and hopefully I get a call back so I can get her in sooner.

 

[JBun]

I only dealt with a big hole in the eye orbit, no visible bone.

That doesn't sound like a good thing to me. I would think that it would be essential to keep the bone covered and from drying, with some sort of moist wound dressing. But I honestly really have no idea what to do when there's exposed infected bone. It doesn't sound good though. I hope the vet can get back with you soon.

 

[Cassie119300]

That's what I was thinking too, thankfully I do put wound gel on it everyday twice a day. I no longer think this is bone.... I know this sounds gross, but it literally looks like a rabbit poop in a tube like form that is quite dense, pushing itself out of her marsupilization area and I have to flush with the syringe around this thing and the pus that it is emitting. Unfortunately no on ever did get back to me before thanksgiving yesterday, i've sent emails, pictures etc. I've done everything to get a hold of them. I went to call again today and it's emergency calls only. I believe I'm dealing with a foreign object that is encapsulated in this dark brown material trying like mad to push itself out of this hole. Check out this picture....

 

[JBun]

That is odd. Can't imagine what it would be, unless it's some dried pus, which can have a very strange appearance, or debris stuck in there. Hopefully you can get a response from the vet soon.

 

[Cassie119300]

The vet emailed me back on Saturday actually and I was informed this is the antibiotic gel that was used during the initial surgery that is now coming out and turns brown/black. There is still a bit more coming out but the one I posted in the picture came out on its own after a few days of flushing. Budja's will be going back this Thursday to have the stitches removed around the area and for a good flushing to get more of this debris out. There is a tiny bit of pus here and there still which I imagine is coming from this stuff being all blocked up in the tiny tunnel that is still open due to the debris, to me it looked like critical care/pellets that dried up and got stuck in there, since during her initial surgery 3 teeth had to be removed and the gums were stitched but there was a possibility that food could possibly get in there until the gums were entirely healed. At least I'm not panicking anymore thinking it's bone, my god that was scary. She's not a fan of these marsupialization flushes 2x a day anymore, but she does stomp and eventually lets me wrap her in the towel and do what I have to do lol

 

[Cassie119300]

She is also being treated with a medicine called vancomycin and metradonizole currently, I guess they cultured over 5 different bacteria, yikes.

 

[Cassie119300]

Hello everyone, I just wanted to update this thread so anyone else looking for information knows how everything went. The stuff that was coming out of Budja's marsupialization area was indeed old matter/debris and the wound did successfully heal over after it all came out. It just took a little more time to do so. There's just a tiny pit/scar where it was but my continued flushing did help. She has been doing really good since and eating hay like a champion, she will get right up on your lap just about for any sort of treat all of the time, she is back to binkying again, cuddling with her plush toys, so her quality of life I would say has improved greatly since the surgery. She has not been on any medicine for several months now. She is going back to Cornell at the end of this month to have a repeat C-T done to make sure everything is still ok in her mouth as well as a spay surgery. The antibiotics vanomycin and metradonizaole did really seem to help her and the abcesses as well as the marsupilization procedure. I guess sometimes a C-T scan can only see what the x-rays were not seeing, which in her case was that her three teeth had to be removed.

 

[JBun]

It's so great to hear she healed up and is doing well! Thanks for keeping us updated.

 

[Cassie119300]

Hello everyone, I just wanted to provide some updates on Budja’s. She had her C-T and routine bloodwork done on 5/28 followed by her Spay Procedure on 5/29. She has recovered exceptionally well from her Spay Procedure, she seemed a little more sleepier than usual the first couple of days with small poops which gradually increased but her poops have been a little weird since the spay, they have been all different sizes, moist, and I think she is leaving what is called “Cecal Juice” on her mat at night ever since, her stomach also makes growling noises at times, this isn’t the first time she has had growling noises but generally I don’t see small poops mixed in with the others. Every year she also gets flaky scales and fur that kind of falls off her ears, I don’t think it’s mites but she is scratching her ears/jaw/and eye areas a lot, I would think if there was any ear issues the C-T would have picked it up.
The C-T findings were as follows, it was done without contrast.

” Diagnostics 5/28:
PCV/TS: 45/6.5 – Within normal limits
Chemistry: Within normal limits
Head CT: Below is the CT report from our radiologists:
SUMMARY OF FINDINGS:
Mildly improved (since 10/12/23), locally extensive, expansile bone lesion
(historic, presumed tooth root abscess), left mandible with new mineralized bodies
Mildly overgrown, 206 and 207 [teeth]
Mild, dental points, left maxillary and mandibular cheek teeth
IMPRESSION: The appearance of the left mandibular tooth root abscess
demonstrates some signs of healing with improved mineralization of the lingual margins,
however persistent lysis buccally may be due to persistent infection and drainage.
The new mineralization is prioritized to be mineralization associated with
retained tooth root buds; a sequestrum is possible.



Tomorrow I will be dropping Budja’s off for her second marsupialization procedure as the abscess is still present. I myself, have found pus leaking from time to time from the old marsupialization wound, so I don’t think it ever 100% properly closed, there is also a weird marble feeling bump in-between the area of her eye and nose almost directly above the old marsupialization area. I went down the rabbit hole so to speak with her C-T findings looking up the term on google “locally extensive, expansible bone lesion” which led me to the result of osteosarcoma in rabbit jaws, needless to say I’m pretty anxious right now and wanting to ask the veterinarian about this being a possibility, although I would think if it was they would have told me so already but the panic from reading this and just about Budja’s having another surgery in general really sucks right now. She will be staying a few days again with a drop off of 2:45 pm tomorrow at Cornell. I will be going in with a list of questions. Fingers crossed.

 

[JBun]

I'm glad her surgery went well. The gut imbalance might have to do with the meds she's on and not the surgery. Particularly the antibiotics. How's her hay eating? And is she on probiotics currently?

I hope tomorrow goes well. Rabbit pus is certainly a very persistent thing. It seems to just want to keep oozing out, no matter what you try to eradicate it.

 

[Cassie119300]

Hello, sorry I haven't updated this for a while. Apparently, what had happened was that the lower bottom tooth they had removed had regrown and had become re-infected, she had to have another marsupialization done during this time and everything seemed to heal up nicely. I also had to inject her with penicillin at home (I really suck at doing this and it's definitely not easy) but it was a match for the bacteria cultured as we wanted to avoid upsetting her stomach at the time. The sticky poops seemed to right themselves. I think what was contributing to that issue was her eating a lot of 3rd cut hay rather than having 2nd cut mixed in which really helped with this as well as her more than likely having a genetic predisposition to megacolon. Fast forward, we just recently had another CT done (this time with contrast) I was told they weren't too sure what was going on last time due to the lack of contrast, so they decided this time to go ahead with it. Everything on the CT looked good and the lower bottom jaw does appear to be healing and gaining more bone (yay), however two of her upper top teeth were slightly overgrown and were getting closer to her outer cheek (not yay) and I was told the two teeth were "wiggly". I know that's really not so good news. I have also noticed a noticeable size difference underneath the eye bone area on her original affected jaw side. I can't tell if it's changed or not, but I do think it the past I had to press in a little to find the type of marble bone feeling, now it may be a little bigger, yet no abscess was detected on the CT. I was told we will have to monitor her carefully over the next 8 months which is when they want to repeat her CT scan again, probably with contrast again as well, to make sure an infection doesn't occur in these two teeth. These teeth are also the opposing teeth where the bottom three were removed. Overall she still seems to eat her hay pretty well but she does seem to avoid the longer stick like pieces, I can't tell if it's just been because the hay batches are changing and there's some brown in them here or there, but she will literally burrow out a hole in her hay box no matter how good the hay is that I put in and ignore the rest. She doesn't seem to be dropping food out of her mouth as much anymore, just occasionally little bits of greens or pieces of hay she doesn't want to eat the entire stem of. She is drinking well, and occasionally seems to pee on her nice cotton pad I got her? Not very regularly but I'm keeping an eye on that. She has started chewing on some wooden pieces again too, like my desk, her apple sticks which she doesn't normally care for or bother with, she always loves the willow baskets from binky bunny though. She doesn't appear to be having difficulty with urination. She does still have the occasional odd small poo's but there are times she gets really anxious as well if she hears the littlest noise. She is continuing to binky and act overall happy though. I was told she will always have dental disease and need to be monitored. Overall though her original surgery did seem to have very good results for her osteomyelitis combined with the use of the antibiotic vancomycin. I do not currently have her on any probiotics, I have had good luck with the Bio Lapis ones though, just very expensive.