Oral mass

RE: Oral mass

Iain McAllister — Sun, 18 Dec 2016 19:23:17 GMT

Thanks for all the replies

On clinical exam I had told the owner I suspected an oral tumour and we already had a discussion pre-biopsy about radical surgery which they ruled out - the biopsy was just to try and confirm a diagnosis - I knew there was a chance of getting an inflammatory tissue result (I had warned the owner about that) I don't think they are too keen on re biopsy so I will take the consensus on here to them - thanks

RE: Oral mass

Peter Southerden — Fri, 16 Dec 2016 22:57:24 GMT

Iain - I agree that you should rebiopsy this lesion and that there is a significant possibility that this is neoplastic. I'd add the following to what has been posted so far:

Imaging is very important in deciding where to biopsy. Intraoral radiography is very helpful, CT is much better.
Generally biopsy the centre of the lesion (the periphery is more likely to be reactive/inflammatory tissue)
Biopsy deep and include underlying bone unless there is no evidence of bone involvement on CT.
If the owner would consider resection then avoid complicating the surgery by planning the biopsy carefully.
- The biopsy site and appropriate margin will need to be resected along with the mass.
- Avoid unnecessary involvement of surrounding tissue. So avoid excisional biopsies which require mucosal advancement flaps to close them as this will reduce the tissue available for closing the definitive excision and will require the final excision to include the flap and an appropriate margin around it and therefore be much larger.
If you are unlikely to perform the final resection consider referring the patient for the biopsy - it can be more difficult to plan the surgery if you havent taken the biopsy.
Dogs usually do very well following even radical jaw resection. For example a working Retriever was back picking up pheasants within a few months of a total mandibulectomy.

Regards Peter

RE: Oral mass

Evelyn Barbour-Hill — Fri, 16 Dec 2016 22:19:11 GMT

Wot Mr. Rob. Davis said.

Except that I wouldn't try to excise the whole thing as a biopsy. Incise right down to bone and get a decent slice of biopsy would be my plan. It's common for oral biopsies to be reported "inflammation" or "granulation" because they weren't deep enough to capture the underlying neoplastic tissue.

Try and get more radiographs if you can, you really want to know if there are any detectable bone changes.

From the pictures, I would reckon an appropriate maxillectomy could give excellent results, but delay too much and it will be too late.

RE: Oral mass

David Mills — Fri, 16 Dec 2016 22:00:03 GMT

SCC until proven otherwise.

Don't agree with taking half a jaw off animals personally but it is an option.

RE: Oral mass

Lou Dawson — Fri, 16 Dec 2016 20:13:22 GMT

Have you spoken to the pathologist? Might be worth a call - they might be able to put some more sections through to see if they are more informative. Send photos/rads too, they are so so so helpful for oral masses. Looking at the photo I can believe that the superficial portions of the mass are granulation tissue. If you do re-biopsy then try & go as deep as the mass/tissue/location allows (I am no surgeon, sorry!)

RE: Oral mass

Rob Davis — Fri, 16 Dec 2016 19:08:30 GMT

PPS (and sorry for turbo-posting!) Dentigerous cyst look more like this:

RE: Oral mass

Rob Davis — Fri, 16 Dec 2016 18:16:02 GMT

PS I had a very similar looking lesion in a WHWT. I resected the whole thing and it came back as SCC. CT scan showed no boney involvement and the owners declined follow up radiotherapy. 12 months later and there is no sign of any regrowth so far....

RE: Oral mass

Rob Davis — Fri, 16 Dec 2016 18:08:54 GMT

[quote user="Iain McAllister"] I am still thinking oral tumour but was maybe also thinking about the possibility of a dentigerous cyst [/quote]

This is not a dentigerous cyst - these occur around unerupted teeth and do not generally show mucosal inflammation. I would agree that from the gross appearance I would be very suspicious of neoplasia. Where did you take the biopsy from and how deep did you go? Ideally a bisecting angle radiograph of the affected area would be really helpful, but that doesn't help you much if you don't have any intraoral film or sensors.

If I was re-biopsying, I would want to take a full thickness sample including a margin between normal and abnormal tissue. I would probably consider removing all the grossly abnormal tissue en-bloc and using a split thickness flap to recreate the gingival cuff around the affected teeth (once you incise the periosteum, there is lots of stretchy mucosa to play with in this region, though watch out for the infraorbital bundle!).

If it does turn out to be neoplastic and they would consider more radical surgery (if appropriate) then obviously the whole of the previous surgical site would need to be resected, so you don't want to go too mad with your margins at this stage.

Evelyn Barbour-Hill or Peter Southerden may have more expert advice in due course....