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

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Cassie119300

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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.
 
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.
 
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.
 
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.
 
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.
 
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....
 

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