This is a long shot, but you might try to add iodine to the water. Does he have a lump in his throat area? If so this might be a goiter, which is common in sharks due to deficiencies in iodine intake. Sometimes the goiter will inhibit the animal to work the jaw area. I've never heard it happening with a puffer but you never know. It might even be hard to see a goiter on a puffer due to their elastic skin? The ideal way to adminisiter the treatment is soaking the food in iodine but if he's not eating that may be a bit difficult.
Like I said this is a long shot but adding a small amount of iodine daily wont hurt anything.
2cts.
Gary
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