Abstract

Background:
Temporomandibular joint (TMJ) ankylosis in cats severely restricts mouth opening and creates a difficult airway, but reports of combined anesthetic and surgical management in adult traumatic bilateral bony cases are sparse.

Case Description:
A 39-month-old, 3.64-kg, spayed female Scottish Fold cat developed bilateral bony TMJ ankylosis (preoperative mouth opening, 8 mm) approximately two months after a fall from a fourth-floor balcony. Because the cat had a brachycephalic-like facial conformation that prevented a satisfactory seal with a conventional cone-shaped facemask, pre-oxygenation was performed using an Elizabethan collar covered with a transparent shower cap as an improvised hood. A mixed alfaxalone-based intravenous premedication followed by slow alfaxalone titration preserved spontaneous ventilation throughout induction. Over-the-endoscope intubation, with a 2.85-mm flexible fiberscope as an introducer, succeeded at the first attempt within 35 seconds. Sequential staged bilateral mandibular condylectomy with stay-suture preservation of the auriculopalpebral nerve, the dorsal buccal branch of the facial nerve, and the parotid duct restored mouth opening to 45 mm. At re-examination 10 months post-operatively, computed tomography (CT) confirmed complete condylar resection without re-ankylosis; the sedated mouth opening was maintained at approximately 50 mm, and body weight had increased from 3.64 to 4.18 kg.

Conclusion:
This integrated airway and surgical strategy offers a feasible alternative for adult cats with bilateral bony TMJ ankylosis, with a favorable structural outcome confirmed by CT at 10-month follow-up.

Key words: Cat; Difficult airway management; Mandibular condylectomy; Over-the-endoscope intubation; Temporomandibular joint ankylosis.