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Craniomandibular Osteopathy

by Dr. Patty Khuly, VMD, MBA

This uncommon disease of the bones of the jaw and head is typically seen in small breeds, most often in West Highland
white terriers. This inherited disease is also known as mandibular periostitis, temporomandibular osteodystrophy or
"lion jaw."

Craniomandibular Osteopathy (CMO) is the result of bone swelling during the growth of the bones of the skull and jaw.
Sometimes, only the jaw is involved. As such, young dogs between the ages of three and eight months are the most
commonly afflicted. Though its severity may vary, all affected dogs experience significant pain.

Thankfully, the condition is self-limiting. That is to say, the dogs grow out of it and by one year of age the symptoms
usually resolve.

Symptoms and Identification

Pain when opening or moving the jaw (as for barking and prehending food or chewing) is the most common sign.
Excessive salivation (drooling) may be the only obvious sign in some cases. Visible or palpable swelling can also occur,
as can non-specific signs of pain (such as lethargy and inappetance). Additionally, dogs with CMO may suffer intermittent

Diagnosing the disease can be confusing for some veterinarians. Thats because the disease is no longer considered
prevalent. In other words, its not the kind of process thats on the tip of every veterinarians tongue. And yet, its easy to
diagnose. Breed type and their standard symptoms, along with X-rays of the skull, are generally enough to arrive at this
diagnosis, even when the accompanying fever is not present.

Affected Breeds

Young, growing dogs in the terrier family are the targets of this disease. It affects males and females equally, but early
spaying and neutering seem to improve the odds of acquiring it. When larger breeds are affected with CMO, the pain
related to the condition seems to be significantly reduced.

Though this disease has been studied extensively in West Highland white terriers (Westies) and has been found to have a
hereditary origin, strictly speaking, we cannot say the same for all dogs as the disease has not been sufficiently studied in
non-Westies. Despite the possibility of viral or bacterial involvement, its widely held, however, that this is a disease of
genetic origin.

Apart from Westies, Scottish terriers, Cairn terriers, Boston terriers and Bull terriers are known to rank among the most
affected breeds.

Treatment for this self-limiting condition primarily revolves around pain relief. Dogs are often given corticosteroids (such as
prednisone), NSAIDs (non-steroidal anti-inflammatory drugs) such as carprofen (Rimadyl) or meloxicam (Metacam) or
opiates (such as tramadol).