Clinical manifestations of CLAD. A, Hypertrophy of the muzzle due to craniomandibular osteopathy (CMO). The nasojejunal tube is used for total enteral nutrition and is necessitated by the dog's inability to open its jaws fully because of CMO. The Elizabethan collar is to prevent the dog's removing an intravenous catheter necessary for the administration of antibiotics. B, Foreleg of a CLAD dog with HOD and carpal swelling. C, Gingivitis, likely due to a combination of CMO and oral infection. D, Forelimb radiograph of a dog with HOD. The double physis sign, pathognomonic for HOD, is evident as lucent bands proximal to the femoral and distal to the tibial epiphyses.