The Mystery Mass ...
Que, a 5 year old, female standard schnauzer, was presented for having a
round swelling of her on her gums. The
owner was concerned that, because Que is very active outside, she may have
traumatized the area. When examined,
a 1cm round inflamed mass was found in her mouth, behind the right
canine tooth. The rule outs at that
time were a tooth root abscess, neoplasia (cancer), or trauma.
The owner elected empirical therapy, so oral Clavamox, an antibiotic,
was given for 7 days.
At the recheck 7 days later, the mass was still present with no change.
Oral radiographs were taken to evaluate for any evidence of a tooth
root abscess or boney changes (radiographs shown to the right).
The radiographs indicated that there were neither tooth root
abscesses nor changes to nasal turbinates (nasal bones).
The owner then elected to remove the mass and send it off for
histopathology (evaluation under the microscope).
The histopathology indicated a tumor called
a low grade papillary gingival squamous cell carcinoma, which extended to
the margins of the sample. The prognosis for this mass was fair to good
depending on whether we could achieve good margins with a partial
maxillectomy (removal of a portion of the upper jaw) and whether the owners
elected radiation or chemotherapy post removal.
A second surgery was scheduled for the partial maxillectomy including the
canine tooth and first and second premolars on that side.
This procedure required removal of the bone around the teeth and into
the nasal passage (see photo to the right).
Once it was removed, the incision was closed with dissolvable suture
(see photograph lower left). Because the
surgery was in the mouth, Que's beard and hair on her muzzle did not need to
be shaved thus once her mouth is closed, the removal is not even
noticeable (see photo lower right).
After the surgery, the entire removed section was submitted for evaluation.
This second histopathology indicated the mass was actually a
different tumor called keratinizing
ameloblastoma that was completely excised.
The maxillectomy with
complete excision was determined to be curative, with no concern for return
or spread to other areas. GREAT NEWS for QUE!!
This case was so interesting because it shows how important it is to address
even small changes that may appear to be unimportant, but could actually be
life-threatening, (and treatable if found early).
Also, the final evaluation of tumors are extremely important in order
to determine actual prognosis…The initial partial sample evaluation in this
case appeared much worse than the final diagnosis.
Finally, even dramatic surgical procedures can still be visually
pleasing!
