February 2016 – Case of the Month.

I am getting this in by the “skin of my teeth” before February ends, no pun intended since it is Pet Dental Health Month! In the spirit of dental health – this case will revolve around a common oral tumor that we see in dogs. This stresses the importance of having your pet’s teeth fully evaluated which is part of the routine dental cleanings that your veterinarian can perform, especially as your furry friend ages. Countless times (including the following case), I am referred cases of oral tumors that were noted and biopsied by the family veterinarian.

There are many types of oral tumors and they can range in both their local aggressiveness and there ability to spread to other areas and significantly shorten your pets life and diminish their quality of life. The overall prevailing thought is that early detection of an oral tumor can increase the odds of a successful outcome in many cases. Any new nodules/bumps noted in the mouth or along the jaw line or nose should be brought to your veterinarians attention for further investigation.

The case for this month, involves a German Shepherd mix that presented to me for a mass that was noted in the front of the mouth – incisor 1-3 on the right side of the maxilla (upper jaw). This was noted on a routine dental examination and was biopsied before seeing me. (I love it when patients come with the oral mass already biopsied – it removes that first step for me). It is very important that oral tumors are biopsied prior to developing the final surgical plan. The size/extent of the surgery is very dependent on the tumor type – some are less aggressive and require less of an extensive surgery than others. Also, knowing what we are dealing with can help us predict the course of the disease and survival times.

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Figue 1: Picture of the oral mass on the upper jaw.

The tumor’s biopsy results revealed that it was an acanthotamous epulis/ameloblastoma. The epulid tumors come in three varieties with this type being the most common. These types of tumors can behave locally aggressive (invading into the local soft tissue and destruction of the underlying bone), however they tend to not metastasize (spread to other organs). With this type of tumor, because it doesn’t have a tendency to spread elsewhere, the next step is to perform a CT scan of the head to evaluate the extent of the tumor, which guides us in the surgical planning for tumor removal. If the patient has other concerns, a more thorough work-up may be needed (chest evaluation and abdominal ultrasound). A Complete Blood Count/Chemistry profile/Urinalysis is performed prior to an aggressive surgery and anesthetic event.

With these types of tumors, local excision is generally necessary along with removal of the underlying and surrounding bone. This is why it is so important to catch oral tumors early. I have certainly seen these tumors (among others), where they are too big to safely remove, that will still allow the pet to be comfortable and function normally. Luckily for this dog, she was able to do without the front portion of teeth and bone (incisive bone) and this left her with no visual abnormality, once her fur grew back! The last thing that we look at following surgery is our margin assessment, which tells us whether we removed it all and by how much. For this lucky girl, no further treatment was needed!

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Figure 2: Immediately following removal of mass and affected bone/teeth.

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Figure 3: Patient is visually normal following surgery.