molar root?

Question
QUESTION:  My dutch rabbit has seen the vet for bi-monthly trimmings, had one abscess surgery, now he is on antibiotics for weepy eye and wheezing. No xray was taken, as our regular vet was not available. We feel the cause is due to a molar impinging on the sinus. Does this require surgery? we are not sure what to do at this point, he was put on baytril for 14 days, and is now on a new antibiotic, a very strong one, for 40 days. Since he has had ongoing molar problems, we feel that is what it is, since the antibiotic didn't help. Would like your opinion on what to do, and if it is the molar root, what does it require to be fixed. His nostril on the right side is so congested as is his eye.

ANSWER: FOLLOWUP:
Hi, Robin
Your bunny isn't at all old at this age, so don't despair.  

The zithromax might last a bit longer with refrigeration, but if you are worried about how long it lasts, ask the vet to teach you how to compound it yourself, and then you can mix as much suspension as you need for just as long as it will last.  (I can tell you how, too, if you are able to get a Z-pack with tablets; but try the vet and see if you can get this information.)

Dana

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Dear Robin,

Unfortunately, this is a very common problem.  Chronic weepy eye and runny nose are often caused by a blockage of the maxillary sinus.  This can be due to an impinging tooth root, but sometimes it's just chronic congestion, inflammation of the membranes, and overgrowth of tissue.

Some vets have recently been experimenting with a procedure called a rhinotomy, in which the facial bones are removed, the sinuses are "cored out", and then the face sewed back up.  It's drastic, and it requires pretty sophisticated equipment and a surgeon who really knows what s/he is doing.  But the rabbits I know of who have undergone this procedure (done by a competent surgeon; I do know of at least one vet who has tried this without having the right equipment, and managed to kill several rabbits) have done well.

It is expensive, though.  So you might want to try less drastic means first.  If your bunny has chronic molar root infection problems, you might want to ask your vet about putting him on dual-acting penicilln injections.  In many cases, this can produce drastic improvement.

With our chronic snotty buns, we have used topical application of antibiotic ophthalmic drops in the eyes and up the nose.  If the drops have a bit of corticosteroid, this can help reduce inflammation and open the tear ducts and sinuses enough to restore normal drainage.  Doesn't always work, but worth a try.

We also wash the faces of our runny-eye bunnies daily with a warm, wet washcloth (they love this) and then dry well with a soft cloth and sometimes a blow dryer.  It's labor-intensive, but it does keep the face clean.

Systemic antibiotics can help the problem to some degree, but it's almost never a permanent fix.  You just have to work out protocols that are manageable for you and for bunny, and hope for the best.

Wish I could tell you there was a magic cure...but there isn't.  Not yet.

Hope this helps.

Dana

---------- FOLLOW-UP ----------

QUESTION: We did not continue the zithro, as he was even more so congested. It is funny, he was on baytril, and then zithro, and neither changed anything. He has a dental exam to trim his teeth on the 22nd. He is active, happy and eating fine. Just that wheez! If it was something more, would the other rabbits catch it from him? And would the antibiotics have cleared it up, I say because of his constant tooth troubles. We really cannot afford to keep him on zithro, and I wonder if a culture would be necessary as the other rabbits are not sick, and the antibiotic did nothing to change things. I know I sound stubborn, but I am trying to convince myself it is his molar. My question is this; what other kinds of problems could it be? with no change using antibiotics, and other rabbits not catching it?

ANSWER: Dear Robin,

The good news is that your other rabbits are not at high risk of catching this.  They've already been exposed, and if their immune systems are working well, that means they are already producing antibodies that should protect them, even if the bacteria in your sniffly bunny do somehow get to them.

There are plenty of things that can cause sniffles/runny nose/runny eyes in bunnies, and there's an overview here:

www.bio.miami.edu/hare/sneezing.html

You don't mention whether the wheezing sound is coming from his nose or his lungs.  If the former, he may simply have a chronic schnucky nose because of a blocked maxillary sinus.  This could be a lifelong thing, though there's now a relatively radical (and somewhat experimental) surgery that can correct it *IF* it is done by a competent, experienced surgeon:  a rhinotomy.  But I doubt you'd want to go that route.

If the problem is in the lungs, has he had chest radiographs?  That would reveal lung congestion, and the next course of action might be nebulization twice a day with a cocktail of saline, aminophylline, acetylcysteine and amikacin and/or Baytril.  But I hope it's not in his lungs.  :(

Hope some of this helps, too.

Dana


---------- FOLLOW-UP ----------

QUESTION: OH no, it is just in the nose, right side, doc said lungs sound fine, just the sinus, right side only. Gosh, it just sounds bad, but HE looks fine, just that wheez. Is there something doc's give to minimize the wheez? I did try a bulb syringe like for baby noses, but it is kind of big, maybe a smaller one would help. Vaporizer on all day and night for him, and bunny partner keeping him clean. I would just like to know what your thoughts are on mucomist etc. for our next doc visit is WED. and don't want to ask too many questions as it is a busy clinic, and his appointment is for a dental only. One more very important question; he gets put down when they do his dentals, is it safe for him to have that while his nose is all stuffed up?

Answer
Dear Robin,

Well, if he's really wheezing badly, you might ask the vet about having endoscopy done to see if there is a molar root actually intruding into his nasal passages.  That can happen when there's enough bone density loss to allow the molar roots to move back through the bone as the bunny chews over the years.  Our Fala had that, and it was a constant nidus for infection to the end of her days.

If that is the problem, the only permanent solution would be to have that one tooth removed.  You'd have to be vigilant over the opposing tooth to be sure it doesn't overgrow, but many times an opposing tooth will slow or stop growing in the absence of the other tooth.  Go figure.  If not, you could have them both removed.  

If there is no tooth, and it's just inflamed sinuses, then ask the vet about using a bit of Benadryl to reduce inflammation, or even some mild ophthalmic triple-antibiotic drops with a bit of corticosteroid to do the same.  It might at least relieve that wheezing.  But this is likely a chronic problem with no permanent solution if it's just a blocked maxillary sinus.

Hope this helps get a handle on the situation.

Dana