Life Threatening Complication Associated with Anesthesia in a Dog with Masticatory Muscle Myositis

Objective— To report a serious complication in a dog with masticatory muscle myositis (MMM) that occurred during general anesthesia for diagnostic testing. Study Design— Case report. Animals— A 2‐year‐old male Pug. Methods— MMM was diagnosed in a Pug with a 2‐week history of trismus by electrodiagnostics, histopathology, and 2M antibody test. During anesthesia tongue protrusion occurred and because of trismus, an inability to reposition the tongue resulted in venous congestion and severe swelling. Forceful physical attempts and subsequent removal of the rostral digastricus and masseter muscle attachments from the mandible did not increase jaw mobility. Mandibular symphysiotomy was necessary to resolve lingual venous congestion and to reposition the tongue into the oral cavity. Results— Tongue swelling rapidly subsided after symphysiotomy allowing the tongue to be repositioned into the oral cavity. After treatment of MMM with corticosteroids, jaw range of motion improved and at 6 months was ∼70% normal. Conclusions— Trismus could not be overcome by detachment of the masseter and digastricus muscle insertions from the mandible, and symphysiotomy was required to reposition the tongue in the oral cavity. Clinical Relevance— In dogs with MMM, tongue position should be monitored during anesthesia to avoid inadvertent protrusion and swelling from venous congestion. Use of anesthetic monitoring equipment on the tongue, such as a pulse oximeter probe, should be avoided in these patients.