Partial Mandibulectomy

Question
Our rabbit has been fighting osteomyelitis for several months in her right jaw. She is getting care at the UT veterinary teaching hospital everyday. Cultivation of the bacteria showed 3 are present, including the Fusobacterium, an Actinomyces, and I believe a Streptococcus. They are using antibiotic soaked cloth in her cheek, and she is on some form of injectible penicillin, as well as oral baytril. There is a hole from where the abcess broke through her gum and so food keeps finding its way into the abcess. We are all beginning to believe that the only way to cure her is a partial mandibulectomy. Have you had any experience with this surgery in a rabbit? Do they recover well? Is it very painful for them? She is still very spunky despite all she has been through over the months.

Answer
Dear Katherine,

This is a surgery that is done extremely rarely in rabbits, and I don't have any personal experience with it.  Before I opted for this, I would--of course--exhaust all medical options.

Sounds as if the only thing you haven't tried is the old-fashioned dextrose packing method, which can be miraculous--but it's labor-intensive and you have to be *very* tenacious and stick to the schedule so that it works.  But we've even had complete resolution of a retrobulbar abscess (after the eye was removed) that had fingers *way* into the sinuses with this technique.  So if you want to avoid the mandibulectomy, it might be something to consider.

Your vets should be familiar with this.  It involves debriding all the necrotic tissue and bone as much as possible out of the abscess site, and then packing the opened area with sterile gauze soaked in 50% dextrose.  Some people use plain ol' honey!  But the osmotic difference between the sugar solution and bacterial cell is pretty much like napalm to the little suckers.  No bacteria can evolve resistance to such a hypertonic blast.  

The problem is that you have to debride and re-pack at least twice a day, or the whole thing could backfire as the sugar solution dilutes.  But if you can manage the work, it can really do amazing things.

If you decide to go with the hemi-mandibulectomy, then from the little I've heard, it can be done.  Of course the bunny will be uncomfortable for a while after surgery.  But she' undoubtedly uncomfortable *now*, too.  So if it's the only choice, I would at least try.

The fact that she's strong and spunky is in her favor.  I hope she'll be fine, whatever decision you make.

Good luck!
Dana