split upper palate trauma

[FuzzyTail]

I picked up a trauma case tonight.
128 grams female.
Looks to have fallen 12 feet or so to hard concrete surface.
Not only got her, but 30 minutes later got call they found sibling.
Inspected site, no more siblings to be found.

Over all exam WNL.
On exam, had blood caked around nose.
Favoring right front paw.
Left side of face slightly depressed and tender.

Treated for shock, swelling and pain.
Warmed and SQ fluids.
Will go on antiboitics tonight for infection.
Once she settled down, I cleaned her face and nose and found no open wounds.
Examined her mouth.....found the problem.

She has split her upper hard palate with her lower teeth.
The upper teeth are unstable.
The gum covering her upper teeth is 70% detached.
The tiny flap of gum just below the tooth bud.
The is very slight weeping of blood from her nose.

Heart, lungs, internals all sound normal.
Eyes, equal and reactive.
She exhibits tenderness to the top not tip, of her nose...

Anyone here ever had experience with a split hard palate?
I can not tell if it is thru to the nasal passage, but I suspect it has.
I have included some close up pics of the mouth.

I also examined the mouths of my other guys to see a normal upper palate.

Any thoughts on a mouth rinse ( I want to prevent any formula from getting up into the hole and causing infections

I know people and some pets have palates sutured, and I will try to get hers repaired.

Photos to follow.

[FuzzyTail]

Photos..
First on, bloody nose...notice how the squirrels left side is a bit depressed..or the right side is puffy.

Also note her right paw is being help with fingers closed. I can not find a fracture..but will get xrays Monday.

Next 2 show the hole in the hard palate.

[Mrs. Jack]

I'm not a vet, or experienced personally, but I have talked to a lot of people that have experienced various maladies.
My opinion is that if she's otherwise healthy- healthy gum tissue etc, then there's a very strong chance she will heal. I've seen squirrels that have broken their teeth off under the gum line and healed up just fine.. I know this is more severe than that, but with that, and the oral things I've gone through myself ;P I know I am constantly amazed at the reparation abilities of the mouth.
that it might be affecting her sinuses is a bit worriesome.. because the way it's all connected together would make me worry about infection issues..

anyway.. good luck with her, hope someone will come in with more info/experience than I have to offer, but I wanted to wish her well and you well with her.

[FuzzyTail]

I'm not a vet, or experienced personally, but I have talked to a lot of people that have experienced various maladies.
My opinion is that if she's otherwise healthy- healthy gum tissue etc, then there's a very strong chance she will heal. I've seen squirrels that have broken their teeth off under the gum line and healed up just fine.. I know this is more severe than that, but with that, and the oral things I've gone through myself ;P I know I am constantly amazed at the reparation abilities of the mouth.
that it might be affecting her sinuses is a bit worriesome.. because the way it's all connected together would make me worry about infection issues..

anyway.. good luck with her, hope someone will come in with more info/experience than I have to offer, but I wanted to wish her well and you well with her.

Thank you for your encouraging post!!!
That is good to hear!
I think if I can get a stitch up there an pull it shut, she should heal just fine.
She is young and still growing.
I am so glad we got her sister so she is not alone!!!

[AmyRose]

Oh, wow. Does that not require surgery in humans? I would look up some ingredients in mouthwash, and if it's safe, try flushing diluted. However, I've had absolutely NO training worth mentioning. Poor baby. Is her sister ok? Any sightings of Mom? Is she still just a baby? I am just assuming she is, but I cannot really tell. That's really open up there...:thinking

[Nutkin]

Poor little one! It makes me hurt just to see her pics. Prayers are with you and this little baby!
:grouphug :grouphug :grouphug :grouphug

[FuzzyTail]

Oh, wow. Does that not require surgery in humans? I would look up some ingredients in mouthwash, and if it's safe, try flushing diluted. However, I've had absolutely NO training worth mentioning. Poor baby. Is her sister ok? Any sightings of Mom? Is she still just a baby? I am just assuming she is, but I cannot really tell. That's really open up there...:thinking

Yes, I used a Vet issued animal mouth rinse after I examined her mouth.
She was OK with it...for the moment!!

It is an oral hygine rinse to prevent dental disease in dogs and cats.
I will feed her formula and use the rinse afterwards.

And yes, the palate will need to be closed.
Just not an easy space to work in...

[Mrs. Jack]

It was dmgualtieri I think, who had the raccoon with the mashed up nose/muzzle? it was the most intense injury I'd ever seen, but stitched up by a good and creative vet and it will be okay. SO keep the faith :thumbsup

[LynninIN]

Poor baby.

It looks like she is biting down straight so probably no jaw fracture. Most likely a nasal fracture that will heal fine. Only blood from the nose right? No clear fluid? I'd be concerned with a sinus/orbital rim fracture, if it's displaced it should be easy to palpate. You could try flushing the nose with normal saline and see if there is a leak through the hard palate. Also make sure there is no fresh blood in the ear canals that would indicate a skull fracture. You said treated for swelling and pain did that include a corticosteroid? This babies face is going to be huge tomorrow.

I'm worried she will be risk for a later malocclusion issue.

[Apple Corps]

This is a snippet from High Rise Cat Injuries:

Treatment

Treatment will depend on the types and extent of your cat's injuries. If your pet shows signs of shock – collapse, weakness and pale gums – your veterinarian will start intravenous fluids. Other treatment will include:

Chest trauma. Oxygen support may be needed to help your cat breathe. Rib fractures are painful and require pain medication, and chest taps or a chest tube may be needed to remove excess air from the chest.

Facial trauma. A fractured jaw may need to be pinned or wired, although fractured hard palates usually heal on their own. Fractured teeth may need root canal, capping or removal, and head trauma is treated with fluids, diuretics and steroids.

[TexanSquirrel]

Poor baby! Keep us posted on her progress!

[FuzzyTail]

Poor baby.

It looks like she is biting down straight so probably no jaw fracture. Most likely a nasal fracture that will heal fine. Only blood from the nose right? No clear fluid? I'd be concerned with a sinus/orbital rim fracture, if it's displaced it should be easy to palpate. You could try flushing the nose with normal saline and see if there is a leak through the hard palate. Also make sure there is no fresh blood in the ear canals that would indicate a skull fracture. You said treated for swelling and pain did that include a corticosteroid? This babies face is going to be huge tomorrow.

I'm worried she will be risk for a later malocclusion issue

Yes, yes and good idea!!

Yes, Pain meds, yes, Dex, a bonus of Vit E for stress and immune system boost. Sub Q fluids for stress, shock and hydration.
External heat all before any of this.

I noticed one side of face is slightly depressed..her left.
and the right is buldging a bit..
She is tender over the left..between her nose and the corner of her eye.
The jaw is fine..I also palpatated the skull..no soft points, no depressions..

Deep exam of both ears, no odor, no fluids.

Great idea about flushing backward via nasal passages. I will do that shortly.

Her uppers are loose..and I did a very tender exam as not to displace any tooth matter.
That tiny piece of gum just under the "bud" is torn up. Another source for the blood.

I will go and flush now and get back to you later.

Thanks so much for your input!!!!!!:grouphug

Oh.. I too worry about malocclusion problems later on.

Be back in a few....:wave123

[FuzzyTail]

This is a snippet from High Rise Cat Injuries:

Treatment

Treatment will depend on the types and extent of your cat's injuries. If your pet shows signs of shock – collapse, weakness and pale gums – your veterinarian will start intravenous fluids. Other treatment will include:

Chest trauma. Oxygen support may be needed to help your cat breathe. Rib fractures are painful and require pain medication, and chest taps or a chest tube may be needed to remove excess air from the chest.

Facial trauma. A fractured jaw may need to be pinned or wired, although fractured hard palates usually heal on their own. Fractured teeth may need root canal, capping or removal, and head trauma is treated with fluids, diuretics and steroids.

Great notes!! Many thanks!!

Right now her "hard" palate is still soft, and it is nore of a laceration instead of a fracture.
Some of the thinner bones in her sinus cavity may be compromised...but they will heal.

And xrays are hard as her bones are soft and not very dense, like those of adults.

Just will have to check around for a really, really good squirrel surgon!

I use a nice, (expensive) neonatal stethoscope..and it is perfect for squirrels!
Her lungs are clear, no abnormal belly sounds and her heart was just beating away!!! too fast to count!!

Only possible problem is her right front paw. She was favoring it, but I could not detect a fracture.
For now, it is untreated. Will get a helping pair of hands tomorrow and splint it.


She has been treated for her head trauma...and the teeth are an issue.

Great check list!!! Thanks for finding it!:grouphug

[muffinsquirrel]

Poor baby! Good luck to the both of you. She certainly sounds like she is in the very best of hands!

muffinsquirrel

[FuzzyTail]

Ok....
GREAT info.
FuzzyTail..you Rock!

BUT........
A Foxer with eyes open would NOT weigh 128 grams...or look as such..:nono
Are there Fox Squirrels in Maryland?:thinking

What you are looking at is NOT an injury.

That squirrel was born with an open palate. BUT, since you are a licensed Wildlile Rehabilaitator, you must have knowledge, plus a great vet that works with you!!!


:peace

I am sorry, I did not mention it is a gray squirrel. She weighed in at 128 grams, tail still a bit flat.
Not a fox. I dont think we have them here.. we do have the Delmarva..on the Eastern Shore., but no fox squirrels.

Are you sure she was born this way?
( I did consider that...)

I check her sisters mouth, closed palate, pulled a few of my own, closed palate.

I thought is may be a birth defect, but there is blood in her mouth and her upper teeth crackel when moved.

Peace back at ya!!!:wave123 :Love_Icon
Thanks!!:)

[Mrs. Jack]

Interesting possibility.. It's quite possible she was born with a disability and it was compounded with injury and now... whoa, the world is before her. good luck!!

[Squirlgirl]

Thankfully, you will be getting her to a vet on Monday!

That is the biggest issue with rehab...having a great vet!:thumbsup

:)

[FuzzyTail]

Thankfully, you will be getting her to a vet on Monday!

That is the biggest issue with rehab...having a great vet!:thumbsup

I am sure that you know that the upper palate "hole" is not a new injury, but more of a birth issue.
No rawness or bleeding, alert eyes, orangey teeth.

128 grams...eyes open..ample front teeth...awesome!

:grouphug

Her sister is 142 grams...she is 128...
Both young..tails still flat...white teeth..nice lowers, uppers just emerging.

A deformed palate would explain the weight differences and the non-trauma look of the defect.

And no, I dont know, initally, it is a defect, but with the brain storming here, it is looking more and more like a defect instead of new trauma.
Have never seen a split palate in a squirrel before.

She is still oozing blood from her nose..

Will see vet Monday. But mine has gone out of town, so it will be another vet. Will be a lot easier doing a full mouth exam under iso!!!!

They were found behind a Dominoes Pizza business, fell out of the roof underhanging...a lot of holes...she was found at 6ish....2nd one found 2 hours later...8pm.
No others or no momma in the roof underhanging.:dono


Have you seen this before?
What was the course of treatment?
Thanks again for your suggestions!!!!:grouphug

[LynninIN]

I noticed one side of face is slightly depressed..her left.
She is tender over the left..between her nose and the corner of her eye.
Suspicious for a fracture of the zygoma at the medial edge. Can you feel a step off in that area? And/or an ethmoid fracture. Can you palpate "air" in this area, not just edema?

I don't know anything about the age of palate formation in a squirrel but fully trust SG knows that info. :bowdown I don't rehab wildlife just people. Most of the info translates however not all. The facial bones are similar but at a little different angle. If anyone could tell me where to find a squirrel anatomy/physiology book I could help more. I've looked and asked everywhere, even the vet school library.

It's very possible that momma rejected the baby due to birth defect and pushed it from the nest resulting in facial trauma. :thinking That doesn't explain why the other one was out though. :dono

[Squirlgirl]

Ok....
There is obvious right buccal inflammation due to the defect.

That palatal defect is NOT new, NOT due to injury.

The inflammation above the upper anteriors is normal for the situation.

Lynn...great calls all around.....:thumbsup
:Love_Icon :Love_Icon :Love_Icon :Love_Icon

[FuzzyTail]

You two are awesome!
This is the first ever palate defect I have seen.

SG/Lynn, what is the prognosis, with the expectation of all other injuries heal?
What is the recommend course of treatment?
Thank you both again!!!

[thundersquirrel]

very interesting case, you've got here! i'm just trying to keep up with the medical lingo. i won't be taking zoological anatomy classes for another couple years. :thinking :)

what i was curious about; is she able to eat? have you tried yet? i'm just worried that this may become a big problem later in life when she has to eat solid foods.

could we get a picture of a normal palate? it'd be a great learning post to be able to compare.

keep us updated!

[Mrs. Jack]

That picture of Baby yawning shows a healthy mouth pretty well ;)

[Momma Squirrel]

Any news from the vet visit yet? Been following the thread but laying low so all our experts and knowledgable members can keep brain storming.

Great job guys, very sad but interesting at the same time. :thumbsup

Fuzzytail so glad you are in the care of these two little ones :grouphug Good luck and keep us posted please.

[TexanSquirrel]

This picture? Too bad you can't see the roof of the mouth too well....

(Gamma I hope you don't mine me posting your pic-just trying to help! :hidechair)

[Mrs. Jack]

lol.. yeah.. you can still see the obvious difference though. Although maybe Baby could cooperate and lie on her back and yawn :D