A 4.5 year old female Red Footed tortoise (Geochelone carbonaria) presented to a veterinary practice. Her husbandry was considered acceptable for this species, included a high fibre diet and a setup with visible and ultraviolet A and B spectrum lighting, optimal temperatures and adequate substrate.

She presented as a referral after being dropped from her setup.

On clinical examination she was bright alert and responsive, had pink mucous membranes, no signs of respiratory distress and no abnormalities found apart from two likely maxillary fractures that ran up to the nares just off centre. There were no issues with occlusion and the temporo-mandibular joint seemed to be free from luxations. An angular misalignment which made the rhamphotheca point outwards was noted. There was some bloody discharge from one of the nares and hypersalivation also.

Radiography (dorso-ventral view) revealed two fractures of the left maxilla with minimal displacement. There were also radiodense foreign bodies throughout the gastrointestinal tract that were likely incidental findings, though monitoring faecal output and calcium intake through a review of her diet was needed due to possible pica through lack of dietary calcium.

Maxillary fractures due to trauma

General anaesthetic was performed using 2ml Alfaxolone (Alfaxan® 100mg/ml; Vetoquinol) subcarapacially. An underlying blood clot was removed and then the area was flushed copiously with dilute iodine. A salvage procedure was decided in view to save the rhamphotheca. Multiple layers of tissue glue and tape were used to fix the upper beak (rhamphotheca) in position. An oesophageal tube was placed to facilitate nutritional and fluid requirements, also to medicate as necessary.

She was given 0.2mg/kg IM Meloxicam (Metacam 5mg/ml; Boehringer), 20mg/kg IM Ceftazidime (Fortum® 100mg/ml; Glaxosmithkline), 5mg/kg SC Enrofloxacin (Baytril 2,5% injectable; Bayer) and 8ml PO Critical care Formula (CCF) (Vetark), fllowed by 8ml water twice daily. She was sent home with oral once daily 0.2mg/kg Meloxicam (Metacam 1.5mg/ml; Boehringer), IM injections every 3 days of Ceftazidime (Fortum® 100mg/ml; Glaxosmithkline) and daily oral Enrofloxacin (Baytril 2,5% oral; Bayer).

On re-examination she was uncomfortable and constantly rubbing at her mouth after daily cleaning. She also presented some serosanguinous discharge from her left nostril.

The tape seemed very stable but she had been drinking and therefore the site was wet. She was not eating. Hypersalivation was noted, likely due to the discomfort.

The oesophageal tube was removed by her constant activity and she was not eating. She was assessed under general anesthetic for a second time and the distal portion of the rhamphotheca was removed. Underneath there was what seemed like faecal material that was cleaned out and the site was flushed with dilute iodine. An oesophageal tube was replaced on the same side. Due to a good anaesthetic plane and cloacal relaxation, a penile prolapse was noted during anaesthesia and as it persisted as she was in recovery from anaesthesia, a pursestring suture was placed and left for 24h.

She was discharged with antibiotics and analgesia. After 5 days she started to eat, the medications were stopped after 14 days and the esophageal tube removed after 20 days. She had a good appetite and demeanor the last time that she was examined.