ISSUES IN DENTISTRY AND HEAD & NECK SURGERY SMALL MOUTHS, BIG HOLES: aney are partnersaney are What To Do When There Is Still Tumor Present? A T It is not unusual to remove a relatively small tumor only to find that the pathology report indicates that the tumor was not completely excised. As a general practitioner, how do you advise your client? Well, the tumor will continue to grow and at this time it is as small as it is ever going B to be. Although no owner is happy to hear that a second dstrom is a 2010 graduate of the Colorado State State of the Colorado dstrom is a 2010 graduate E surgery is recommended, watching and waiting only makes in entering practice before private 16-years ech for ditor of the Journal of Veterinary Dentistry and co- Veterinary of ditor of the Journal T E mily mily future surgery more extensive and difficult….especially E Dr. Mark M. Smith and Dr. Kendall Smith and Dr. M. Mark Dr. Surgery Dentistry and Oral Veterinary in the Center for of the Smith is a Diplomate Dr. in 2006. established American and the Surgeons Veterinary American of College of Surgery Professor He was Dental College. Veterinary Veterinary of Regional College VA-MD the and Dentistry at in the mouth where “extra” tissue for wound closure is at Dr. a completed She Medicine. Veterinary of School University at internshiprotating in small animal medicine and surgery She MD. in Gaithersburg, Associates Referral Veterinary VCA Dental Society. Veterinary American is a member of the a premium. Additionally, the patient’s anesthesia status is C www.centerforveterinarydentistry.com aney is a Diplomate of the American Veterinary Dental Veterinary American of the aney is a Diplomate A T only going to regress over time. u since 2006. She is a 2002 graduate of the VA-MD RegionalVA-MD the of graduate 2002 a is She since 2006. Medicine at Virginia Virginia Medicine at 2004. Dr. Smith is Dr. 2004. and Cat. of the Dog Surgery General Approaches for Atlas of author of Dr. Dentistry. Veterinary of Academy of the and a Fellow College the Center at surgery dentistry and oral She has practiced College of Veterinary Medicine. She completed her residency Medicine. Veterinary of College the Center and has also performed at internships in both surgery. and specialized medicine and surgery, general Therefore, it really is an easy recommendation to have the owner consider a definitive, Fig. 1 Scar tissue follow- final surgery to alleviate the Head & Neck Surgery ing incomplete excision problem. u B of a gingival malignant Malignant melanoma is the melanoma (A). A mar- most common oral tumor ginal mandibulectomy was (301) 990-9462 diagnosed in dogs, with performed with minimum 1-cm margins (B). The squamous cell carcinoma most Fax: completed mandibulectomy ™ common in cats. Malignant Fig. 2 Wound closure maintained the ventral includes mucosal apposi- melanoma is the most common cortex to provide mandibu- tion (A) and cheiloplasty to tumor we see that was lar stability (C). restore lip function (B). incompletely excised previously (Fig. 1 and 2). The next most common incompletely excised tumor we encounter on A (301) 990-9460 a referral basis is epulis, especially acanthomatous epulis R (acanthomatous ameloblastoma). Complete removal of epulids require the removal of teeth and associated bone since these tumors emanate from cells of the periodontal ligament. Phone: u For incomplete excision of ossifying and fibrous epulids, B relatively small, “mini” mandiulectomies or maxillectomies 20877 would be sufficient, involving probably 2-3 teeth (Fig. 3-5). LETTE 20877 S Incompletely excised malignant tumors, and tumors that behave aggressively such as acanthomatous amelobastoma Fig. 3 This scar (arrow) is A (301) 990-9462 require a minimum 1-cm tumor where a fibrous epulis had Surgery Oral & Maxillofacial u free margin. Again, removing been incompletely removed and Promotions) Directions for aurel-Call L these “remaining” tumors quickly (A). There were no bony Fax: allows more conservative surgery changes (B). that maximizes a successful Specialization Beyond Expectation Beyond Specialization Closer to Help You! Closer to Help B outcome while preserving normal function. and Oral Surgery Dentistry Veterinary Center for A B (301) 990-9460 Dentistry Dentistry SPRING NEW Gaither Road, Gaithersburg, MD Gaithersburg, Gaither Road, Fig. 4 An enbloc resec- Center for Veterinary Dentistry and Oral Surgery Dentistry Veterinary Center for 9041 Phone: www.centerforveterinarydentistry.com he InterCounty Connector....Putting Us he InterCounty Connector....Putting tion of the adjacent teeth (20 minutes from I-95 at Gaither Road, Gaithersburg, MD Gaithersburg, Gaither Road, and associated bone (A) Fig. 5 The ventral mandible and the canine tooth T was required to completely were unaffected (A) and the wound was closed Root canal therapy for cariesRestorations and enamel defects teeth fractured to strengthen Metal crowns & mandible Surgery for neoplasms of the maxilla, area facial fractures Repair of maxillofacial Correction defects of congenital palate Surgical teeth extraction of diseased multi-rooted and impacted teeth for oral inflammation Therapy Surgical management of diseases the head and neck 9041 remove the tumor (B). z z z z z z z z z The Center for Veterinary Dentistry and Oral Veterinary The Center for Surgery and state-of- offers cutting edge knowledge the-art patients manage your equipment to help you disease. with dental and maxillofacial primarily (B). Referral Information for Today Call 301-990-9460 ISSUES IN DENTISTRY AND HEAD & NECK SURGERY NEWSLETTER FOR REFERRING VETERINARIANS SPRING 2012 BEYOnd THE MOUTH: EndODONTICS: PERIODONTAL DISEASE: Laryngeal Masses…The Cork In The Teeth We Can Save! A B Too Much Of A Good Thing! A Airway! We have come a long way in Gingival enlargement, or gingival hyperplasia The larynx comprises only 3% of the surface veterinary medicine and what we as it is often called, is a common finding especially area of the upper and lower airways. However, can offer our patients. Veterinary in large brachycephalic breeds (Boxers) or when compromised by laryngeal disease, it can have dentistry as a specialty is relatively brachycephalic-cross breeds. However, in many of devastating effects on pet function. Diseases such “new”, and the ability to save the patients we examine, it is an incidental finding. as laryngeal paralysis, laryngeal collapse, everted teeth is especially exciting in our Gingival enlargement should not be ignored as it laryngeal saccules, and laryngeal mass all compromise humble opinion! Many owners C D can expedite the progression of periodontal disease B the already limited airway at the larynx…the cork in are happily surprised to learn from by disrupting the normal periodontal structure of Fig. 1 Image of the laryngeal their veterinarian that not all teeth the tooth. The supporting structure of the tooth, the airway. Clinical signs related to airway obstruction rhabdomyosarcoma compromis- include stridor, change in bark, exercise intolerance, ing the airway (black arrows). have to be extracted when there is or periodontium, includes the gingiva, epithelial fatigue, and hyperthermia from decreased heat Note the remaining functional a problem. So when is a root canal attachment, alveolar bone, periodontal ligament, exchange during panting. This latter clinical sign is a airway (white arrow). indicated? Fracture is the most and cementum. In a normal, healthy mouth, particularly life threatening consequence of laryngeal common scenario where teeth are Fig. 1 Indications for root canal include fractured the normal sulcal depth, or free gingival margin, disease and is most commonly noted in summer treated by root canal followed by (A and B), discolored (C), and luxated (D) teeth. should not exceed 0.5-3mm, depending on the C A months. The good news is that these clinical signs non-vital teeth. A non-vital tooth breed and size of the patient. Exuberant gingival usually have a slow, insidious onset. Unfortunately, may be suspected when the crown is discolored-pink, purple, or gray. Sometimes we see growth can cause an increased sulcal depth, owners may not notice these changes or may consider teeth that have been avulsed creating a pseudopocket where bacteria, plaque, them secondary to their pets advancing age. or luxated (Fig. 1). These teeth and debris are prone to accumulate. Once the A B Laryngeal tumors are rare (Fig 1). The clinical will need root canal therapy pseudopocket is present, no amount of brushing or signs are similar to those described previously. after they are replaced and home-care by an owner will prevent this build-up Treatment options include per os resection with long- stabilized. Dental radiographs of periodontal pathogens and debris, thus creating are always indicated to the perfect environment for inflammation, and B handled instruments. This technique is reserved for small lesions emanating from the laryngeal determine if a traumatized tooth eventually periodontal disease to flourish. What cartilages performed similar to a vocal chordectomy is a candidate for endodontic can be done? Fortunately, gingival enlargement procedure. Other techniques include exploratory therapy, and are also a way to can be corrected by performing gingivectomy of Fig. 1 Right (A), left (B), and rostral (C) preoperative views of gingival ventral laryngotomy with resection of the tumor or Fig. 2 The mandibular determine if a normal appearing the excessive gingival tissue. Radiographs should enlargement in a Boxer dog. Note