Serafina. Lip Avulsion in a Hit By Car Cat. How to, why it is so imperative to do early, and cost of care. Warning surgery photos!

Serafina

This is Serafina. Serafina was brought to me one afternoon by a client who witnessed her, minutes before, dragging herself across the road as numerous other drivers passed her by. That single act by this brave woman to stop her car, pull over, and go out into the road to get to her saved Serafina's life.  

Serafina was a wisp of a kitten. Barely three pounds in all, mostly fluff and wide green eyes. When she came to me, just a few minutes after being the victim of a hit and run, (although this wasn't witnessed by the finder I deduced it by the severity of her injuries), she was being cradled in a towel. Her face was obviously injured. Her chin had been detached from the bottom row of teeth and lay flapping midway down her mandible. Her pupils were different sizes, (indicating head trauma), and a left back leg just sort of lifelessly dangling. She was adorably and unabashedly obviously cute, but, also crunchy. Crunching is broken bones. She was crunching from the bottom of her sacrum, because her tail was pulled off of her pelvis, which, by the way was broken in multiple places, and there was a long list of worries I had just on my very quick preliminary over view of her. 

The first few hours were about assessment, observation and pain management. She didn't have much going for her. She didn't seem to be able to feel or recognize her broken left leg. We weren't sure that the head trauma wouldn't cause hemorrhage in her brain which could kill her. With little more than a warm bed, food, an opioid to place inside her cheek she was left for 12 hours to see if she would survive overnight. I wouldn't have suspected that she would have survived her injuries. Life is like that. Chance, fate, luck, it is often little more than this. 

It is important to pause the story here. There is a knee jerk reaction to protest the black and whiteness of this particular case at this specific moment in time. There are spectators among the readers who wanted me to start fixing her. On. The. Spot. Life in medicine in the world of severe trauma isn't like this. In many cases we have to wait to collect information before attempting to repair the obvious that is not life threatening. Serafina's injuries; skull fracture, leg fracture, tail avulsion and lip avulsion are not life threatening unless severe hemorrhage or nerve loss is occurring concurrent with them. She also did not have a parent to provide consent to our care so we have to be careful about what we can and cannot do for her. Many (too many I fear) would see this list of injuries, no discernible home to provide financial assistance or care for. The list of all of the "worst case scenarios" is long, ominous, and foreboding. Many just shrug that they are sparing her further suffering and would have put her down right here, right now. My personal plea is to not give up. These are almost always savable. Maybe not "perfect" anatomically, but perfectly happy and functional, able to live a long happy, healthy life.

When she first arrived at the clinic we tried to find her home. We hope each and every time an unknown pet is brought to us that there is some worried parent out searching for them that we can locate and notify for a tear filled reunion. Some small semblance of extending the compassion we inherently feel when we see some little thing so fragile hurting yet alone and at the mercy of the world. We spent days searching to see if she belonged to someone near where she was found. She was so young, only about 3 months old, but she was affectionate and trusting. She knew people and she wasn't afraid of them. She had no microchip, and no person came forward to claim her even after her finder canvassed the area where she had been found. She was one of the too many who gets overlooked, forgotten especially when trauma with a big price tag presents. She is one of too many unwanted, which makes her disposable and easily replaceable. 

The next morning she was still brightly enthusiastic to see her breakfast and made herself very quickly yet sheepishly at home. The first 12 hours are critical. The first two days reveal almost everything you need to know from where you are and how far is needed to get to fly the coop. 

It was two days before I was convinced that she had any nerve function to her broken leg. This was the first hope to save it. She also was beginning to drag herself to the litter box to go to the bathroom. 

For cats, in my opinion, for a trauma patient to be able to survive they need to be able to do the most basic of things, this includes; eat, drink, pee, poop and ambulate. These things must be intact to allow them a reasonable chance at being adopted and cared for adequately to allow them a safe and comfortable life for many years to come. (This is a general rule. Not a hard and fast rule.. ask me about Dora someday).

Within a week Serafina was beating all the odds. She was alive. She was improving miraculously and at an alarming speed. The injuries that might have been life ending were being crossed out like a bucket list to live.

The last item to resolve, the only one I really felt compelled to correct, the one that would get worse over time, (unlike all the others who were correcting themselves on their own), was her lip. It needed to be reattached to her mandible. It had come in damaged and ripped off the chin of her face, but it was contracting with scar tissue and pulling the chin off of her face at an alarm quick pace daily. Scar tissue is designed by the body to close wounds, pull tissue together, but if the anchor is released the pulling of the tissue can worsen an injury. 

The edge of the front of her lip was being pulled down her chin. Food, hair, and debris was collecting in this pocket. She was uncomfortable with her non-functional chin in the wrong place. 

Lip avulsions happen most commonly, (I have seen it twice, both times with a cat, both times when they had been hit by a car), because the skin of the chin is pulled off the bone of the  mandible when the face is pushed into the ground as the body is pushed forward. Serafina was very, very lucky. Her mandible was not broken, just the skin torn away.

There are reasons I waited a week to do this surgery. She had worse injuries to heal from. Possible internal trauma that would have  made surgery more dangerous and tenuous. The lip had to wait for her to be well enough to survive anesthesia. 

Serafina is lying on her back. Her jaw is clipped,
scrubbed and draped out of the surgery field. 

Serafina went under anesthesia to have the lip replaced and secured to her jaw. This is not a surgery we do every year. Maybe once in a decade. 

Cleaning the tissue, (there was an immense amount of hair, food, debris stuck between her lip and jaw was done under anesthesia. It was the only way it could be done. This is delicate sensitive tissue. You can't clean it well with her awake.

Once the tissue is cleaned it was loosened. We call it undermining. The tissue, her jaw and lower lip was shortening as it was being pulled toward her neck. It is scar tissue contracting. To relieve the tension you have to break down this fibrotic tissue and pull the flap back into place.

Stents (small pieces of surgical i.v. tubing) are used to go through the mandible skin and then looped around her canine teeth. It was the most exciting, aesthetically transforming surgery, (and quickest meets easiest), I have done in a long time. If I could do this surgery every day I would! It was that fulfilling.

A better close up of the closure and stents.

 Waking up her new chin,, just as it is supposed to be.

Serafina was lucky. Incredibly lucky. This case will have a happy ending because someone intervened immediately. She also had her internal organs intact. Bones will heal, especially in young animals. They need time, patience, containment, and monitoring from someone who knows what to look for and what to worry about. 

The cost of the surgery to repair her lip was about $200. It was that quick and easy. Our internal Good Samaritan Fund will cover it.

I have read posts where veterinarians are too afraid, tentative, reluctant to do this surgery. I want to send out a personal plea to all of you looking at a kitten, cat, dog, puppy who has this injury; if the mandible is intact, the canine teeth are anchored, then please try. It is so simple and easy. I'll help in anyway I can.

If you are a pet lover, pet parent, or pet expert I hope that you will join me on Pawbly.com to lend a helping hand for others who need us. If you are interested in more informative cases you can follow me on YouTube, or you can follow our amazing Jarrettsville Vet Facebook page.

Here is another blog about Serafina. The WHY In Who I Am.