tumor-free margins. 4). for adjunctivetreatment afterconsultation withthereferringveterinarian(Fig. 3and tumor (Fig. 2).Ifthemassismalignant,patient wouldbereferredtoanoncologist in thecaseofabenign procedure that isneeded mayThis betheonly around theentirelesion. 1- cmofnormal margina regardless oftumortype: surgical planisthesame tissues (Fig. 1).The mass and surrounding en-bloc resectionofthe be besttreated with an no radiographicchangesandisinalocation suchastherostral , itwould if excisionalmass to determine biopsy is warranted. If the mass appears benign with was non-diagnostic. thantelling Nothingismorefrustrating that thepatient wouldbeanesthetized andthebiopsytaken definitive treatment? worst The possibleoutcomewouldbe byreferral toaspecialist served forwould thepatientbebetter togetasmall Shouldyouanesthetize ? piece,under or mass for diagnosis. happens ifyoudonothave What thepatient already have thepatient underanesthesiaandcanbiopsythe eventually treat themass. best-casescenarioisthatThe you decisionsonhow todiagnoseare facedwithimportant and to yourattention by anastuteowner (Fig. 1).Now you during aroutine dentalcleaning,oralexamination, orbrought You probably have encounteredthat unexpected oralmass Oral Masses: What Is That? What Should IDo? M Small issues in an (C). Recommend melanoma vaccine. vaccine. melanoma Recommend (C). This lesion (A) had an excisional biopsy (B) that showed melanoma completely excised excised completely melanoma showed that (B) biopsy excisional an had (A) lesion This 4 Fig. a fibromatous with complete margins (B). (B). margins complete with epulis fibromatous a mass was excised and histopathology revealed revealed histopathology and excised was mass diagnosis and a cure with one procedure. The The procedure. one with cure a and diagnosis be an epulid. An excisional biopsy could give the the give could biopsy excisional An epulid. an be Fig. 2 Fig. A A Whether benignormalignant, thegoodnewsistumor Whether “gone” with thegoal of This gingival mass (A) was suspected to to suspected was (A) mass gingival This outh B s plasmacytoma … a cure with normal healing (C) at 2-weeks. 2-weeks. at (C) healing normal with cure a … plasmacytoma This lesion (A) had an excisional biopsy (B) that showed showed that (B) biopsy excisional an had (A) lesion This 3 Fig. A , Big H B ole d Hea location ofthemass, andsize ofthe in this way? We use dental radiographs, ifamasscanbetreated do youdetermine potential cureat the same time. How that wecanachieve adiagnosis anda perform excisional biopsy. means This this beavoided? Manytimeswecan another timefor treatment. How can another biopsyfor diagnosis andlikely anesthesia at least onemore time for case, thepatient willhave toundergo . Inthis a biopsy did not give the answer the ownerthat s B : d &N C eck S examination.. dental cleaning ororal duringaroutine edly may befound unexpect- matous ameloblastoma Fig. 1 Fig. C

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SUMMER Newsletter The CenterW elcomes... Dr. Emily Edstrom!

Specialization Beyond Expectation™

Center for Veterinary Dentistry and Oral Surgery Dentistryu Oral & Maxillofacial Surgeryu Head & Neck Surgery The Center for Veterinary Dentistry and Oral Drs. Mark M. Smith and Kendall G.Taney are partners in the Center for Veterinary Dentistry and Oral Surgery Surgery offers cutting edge knowledge and state-of- established in 2006. Dr. Smith is a Diplomate of the the-art equipment to help you manage your patients American College of Veterinary Surgeons and the American with dental and maxillofacial disease. Veterinary Dental College. He was Professor of Surgery and Dentistry at the VA-MD Regional College of at VirginiaT ech for 16-years before entering private practice in z Root canal therapy 2004. Dr. Smith is Editor of the Journal of Veterinary Dentistry and co- z Restorations for caries and enamel defects author of Atlas of Approaches for General Surgery of the Dog and Cat. z Metal crowns to strengthen fractured teeth Dr. Taney is a Diplomate of the American Veterinary Dental z Surgery for neoplasms of the , mandible & College and a Fellow of the Academy ofVeterinary Dentistry. facial area She has practiced dentistry and oral surgery at the Center z Repair of maxillofacial fractures since 2006. She is a 2002 graduate of the VA-MD Regional z College ofVeterinary Medicine. She completed her residency Correction of congenital palate defects at the Center and has also performed internships in both z Surgical extraction of diseased multi-rooted teeth general medicine and surgery, and specialized surgery. and impacted teeth Dr. Emily Edstrom is a 2010 graduate of the Colorado State z Therapy for oral inflammation University School of Veterinary Medicine. She completed a z Surgical management of diseases of the head rotating internship in small animal medicine and surgery at and neck VCA Veterinary Referral Associates in Gaithersburg, MD. She is a member of the American Veterinary Dental Society.

9041 Gaither Road, Gaithersburg, MD u20877 Phone: (301) 990-9460 Fax: (301) 990-9462u www.centerforveterinarydentistry.com issues in Dentistry and Head & Neck Surgery Newsletter for referring summer 2011

Beyond the Mouth: FELINE DENTISTRY: URGENT CARE: Remove The Tumor… A Pain Too Soon! Avulsion. A Maintain Eye Function. Juvenile In Cats. There are few true emergencies in veterinary Cutaneous tumors are best treated by complete Bringing home a new feline member dentistry, and tooth avulsion is certainly one of excision and histopathologic examination early in of the family is always exciting. All them (Fig. 1). In human dentistry, there is a the disease process when they are small. Whether owners hope that their kittens will term called the “golden hour”. Essentially this benign or malignant, hopefully this treatment be happy and healthy. It can be very means that the best prognosis for successful philosophy will result in positive clinical results. disappointing when a problem is noted reimplantation of an avulsed tooth should occur As we all are aware, sometimes owners will Fig. 1 Biopsy of this tumor below the at a young age. One such problem within 1-hour. This is not always possible in “watch” tumors grow perhaps thinking that right eye was sebaceous epithelioma. It we see is early onset gingivitis (Fig 1). veterinary medicine, but the patient should be they will had been present for 12-months. It can occur in very young kittens and referred as soon as possible. If you have a client just go away! As clinicians, it is important present as halitosis, ptyalism, obvious that calls with this emergency, they should be A Fig. 1 Gingival inflammation surrounding the to emphasize that a definitive action step is gingival inflammation, and oral pain. teeth in a juvenile cat. told to not attempt to clean the tooth at all best performed early in order to minimize any The severity of the symptoms can vary and to place it in milk, not water for transport. B negative impact on the function of important widely and many kittens are asymptomatic. This problem is not directly associated Cleaning the tooth or placing it in water can structures such as the eye. Removing the with any viral diseases, although it can be seen in combination. Unfortunately the damage the periodontal cells that are essential tumor may be the easy component of the surgical writing is on the wall that the problem will need to be addressed. Most importantly the for successful reimplantation and healing of the procedure; reconstructive surgery to maintain owner should be instructed on routine home dental care. This can keep the problem tooth. The avulsed tooth will have lost its blood eyelid function and normal eyelid closure is the under control in many cats. Brushing the teeth at home and regular professional supply, so it will require root canal therapy at a challenge! Additional operative goals include dental cleanings every 6-12 months can later date, but the tooth can still be a functional B prevention of ocular irritation and recurrence. help slow progression of the disease. When part of the . After reimplantation, a Primary closure of a periocular wound, even we are presented with these cases we start wire and acrylic splint is typically placed to hold if relatively small, can lead to the complication with baseline dental radiographs to give us the tooth in place while healing occurs (Fig. 1). of lagophthalmus and corneal irritation from a reference point for alveolar height The splint will be removed in about 4-weeks, decreased moisture and lubrication. and overall periodontal health (Fig. 2). and root canal therapy should be performed at We then perform a thorough cleaning, this time. Without root canal therapy the tooth A high percentage (~80%) of eyelid tumors C are sebaceous adenomas, papillomas, and excise exuberant inflamed gingiva, and will eventually become infected because it is no melanomas. We often remove small eyelid tumors perform any needed extractions. The longer vital. Potential complications with any Fig. 2 Complete excision of the tumor during the dentistry/oral surgery procedure at the single- rooted teeth are often lost first as tooth trauma are that healing may not occur, (A) required reconstructive surgery using request of the owner and referring in the disease progresses. These cats are or in some cases the root of the tooth may a rotation flap based on the facial artery Fig. 2 Chronic inflammation causes loss of likely to lose teeth at an early age, but can undergo resorption spontaneously. However, order to be efficient and avoid a second anesthetic periodontal support tissues such as alveolar and vein (B). still lead healthy and happy lives. In severe these complications are not overly common episode. Sebaceous gland tumors (sebaceous bone. Bone loss is evident on this radiograph.. adenoma, sebaceous epithelioma, and sebaceous cases, we may recommend full-mouth and should not prevent treatment. Many clients A adenocarcinoma) originate from the meibomian extractions relatively early. This removes the source of the problem and avoids years of think there is no hope when an accident like this glands of the eyelid region (Fig. 1). Large unsuccessful medical management or extractions having to be done at every cleaning. occurs; the good news is that we can give the tooth periocular tumors require diligent preoperative It can also be more cost effective for the owner. Anecdotally, we have noted that a fighting chance! planning in order to avoid the aforementioned refractory (stomatitis that does not improve after full-mouth extractions) complications (Fig. 2 and 3). Our goals are to occurs more frequently in patients that have had inflammation present for many years excise the tumor completely with maximum (Fig. 3). So in our opinion, treating E D tumor-free margins while maintaining excellent the problem early has many benefits. eyelid function and cosmesis (Fig. 4). Knowledge of The great news is that these cats have plastic and reconstructive surgical techniques allows an excellent quality of life without B the accomplishment of these goals to the satisfaction these teeth, and their mouth is no of the client and referring veterinarian. longer painful!

Fig. 4 Four-week examination shows A B complete primary healing (A) with only minor devia- Fig. 3 The transposition of the flap has tion of the nose (B). Fig. 1 Complete avulsion of a maxillary tooth (A) with confirmatory radio- been completed followed by incision for The final diagno- Fig. 3 Severe chronic caudal stomatitis in an older graph (B). Note the avulsion of attached incisive bone (arrow). After reimplantation, cheiloplasty (A). The defect has been sis was completely cat. Significant inflammation is present throughout interdental wire is used to stabilize the tooth during healing, while the added interdental closed by a combination of rotation flap excised sebaceous the mouth despite near full- mouth extractions in acrylic strengthens the appliance (C and D). The final radiograph shows reduction of and cheiloplasty (B). adenocarcinoma. this refractory case. the avulsed tooth and stabilization with a wire and acrylic splint (E).