Management of a locally aggressive mandibular mass in a dog - DVM
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Management of a locally aggressive mandibular mass in a dog


DVM360 MAGAZINE


A favorable outcome


Photo 3: Margins should extend at least 1 cm into normal tissue.
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 4: The patient at discharge 48 hours after the procedure.
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 5: The patient 18 months after the procedure; there was no evidence of recurrence.
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).

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 Punta Gorda.


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Source: DVM360 MAGAZINE,
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