A favorable outcome
Because the mass in this patient extended to the midline, bilateral rostral mandibulectomy distal to the right mandibular
third premolar and distal to the left mandibular second premolar was performed (Photos 2 and 3,). A fentanyl analgesic patch
was placed upon admission. Additional pre-emptive pain management included an opiate and an NSAID. Bilateral inferior alveolar
nerve blocks were used for maximal intraoperative anesthetic safety and ideal postoperative patient comfort.
Photo 3: Margins should extend at least 1 cm into normal tissue.
Recovery was uneventful, and the patient was able to lap soft food gruel within two hours of waking. An esophagostomy feeding
tube is an option for patients undergoing mandibulectomy and maxillectomy, but this is not generally necessary. An Elizabethan
collar was placed as a precaution to preclude self-trauma, and two days later the patient was discharged (Photo 4). A recheck
for patch removal and evaluation was scheduled with the referring veterinarian in three days. For continued pain management,
an NSAID and tramadol were dispensed for four additional days. Soft food was recommended for two weeks.
Photo 4: The patient at discharge 48 hours after the procedure.
Anticipated clinical changes included lateral and ventral tongue deviation and minor drooling. Gruel was changed to soft food
at two weeks. Initially, the owners found that hand feeding aided in prehension. The patient quickly learned to prehend soft
food from a plate by tilting its head to the side. Although patients can eat kibble after bilateral mandibulectomy, this patient
preferred canned food, and the owners chose to continue it. The patient returned 30 days and 18 months after surgery and showed
no complications or evidence of recurrence (Photo 5).
Photo 5: The patient 18 months after the procedure; there was no evidence of recurrence.
Benign and malignant oral masses are indistinguishable grossly, and histopathologic examination must be performed to determine
the disposition of all oral masses. Early detection and excision are paramount in either case. Staging is required for any
malignancy. Surgical, radiation and chemotherapy options must be weighed and discussed with the pet's guardian, depending
on the tumor type and location within the oral cavity. As seen here, mandibulectomy can be used to eliminate aggressive mandibular
masses while retaining function and quality of life.
Dr. Beckman is acting president of the American Veterinary Dental Society and owns and operates a companion-animal and referral dentistry
and oral surgery practice in Punta Gorda, Fla. He sees referrals at Affiliated Veterinary Specialists in Orlando and at
Georgia Veterinary Specialists in Atlanta, lectures internationally and operates the Veterinary Dental Education Center in