Swelling under jaw

RE: Swelling under jaw

Rachel Perry — Thu, 24 Sep 2020 07:23:49 GMT

Have you performed any haematology on this dog? Is there any pyrexia? Any history of trauma? Did you perform any cytology on the discharge?

Certainly looks like there is periostitis occurring, and could be a form known as periostitis ossificans as Alix says. Do you have any photos of the teeth we can look at? Is the patient painful with it- certainly would recommend NSAIDs cautiously and if you think there is an infectious component then you might want to add metronidazole to counter the anaerobes. A biopsy of the area might be worth it before tooth extraction.

sorry for all the questions! Interesting case- keep us posted

RE: Swelling under jaw

Evelyn Barbour-Hill — Wed, 23 Sep 2020 23:38:22 GMT

[quote userid="17561" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29371/swelling-under-jaw/225557#225557"]that 409 is likely to need to come out. Arranged with the owner to come back Monday with a view to it coming out.[/quote]

No, only if you can demonstrate something abnormal about it. Sorry if i didn't make that clear.

RE: Swelling under jaw

Alix Freeman — Wed, 23 Sep 2020 21:54:04 GMT

Dear Hannah. Is this puppy painful? This could well be an osteomyelitis. There is also a possibility that it could represent periostititis ossificans (this is thought to be a mild osteomyeltis type reaction)

2010 jvd blazejewski Mandibular Periostitis Ossificans in Immature large breed dogs: 5 cases).

Culture and sensitivitiy will be of little to no benefit unless you're sending tissue for fresh tissue culture- still of questionable benefit in this case. I wouldn't be in a hurry to extract the tooth, the radiographs you've posted don't give me a definitive reason to extract yet and this is a strategically important tooth. As norman has said it would be helpful to have a radiograph of the contralateral tooth for comparison to better assess this. Instead I would plan to biopsy the abnormal tissue using the lateral approach they suggest in this paper and await results, particularly if the puppy isn't painful? Periostitis self resolves within a couple of months. Let me know if you don't have access to the paper and would like a copy. Do you have any photos of the dogs oral cavity?

Alix

RE: Swelling under jaw

Rob Davis — Wed, 23 Sep 2020 14:13:13 GMT

Advice as above. If you have a sinus tract, radiographing with something radiopaque inserted can help confirm communication with the periapical region. Gutta percha points are ideal if you have them, but a probe can be used too.

RE: Swelling under jaw

Norman Johnston — Wed, 23 Sep 2020 07:52:34 GMT

Great advice to compare the contralateral tooth

RE: Swelling under jaw

Hannah Munns — Wed, 23 Sep 2020 07:41:22 GMT

Thank you both for your answers, good to know that 409 is likely to need to come out. Arranged with the owner to come back Monday with a view to it coming out.

RE: Swelling under jaw

Evelyn Barbour-Hill — Tue, 22 Sep 2020 14:18:02 GMT

Wot Norman said.

You have to ask yourself what C&S will achieve for you – although it may be useful information – because it's highly unlikely that this is going to be cured by administration of an antibacterial drug anyway.

On the basis of making the best use of what you've got – I had a good look at the radiographs. On the isolated-jaw one, it does look as if there is something very wrong with the 409 roots. But there is a long oval radiolucency lying over the whole area which is plainly artefact, which makes interpretation a little uncertain. On the other radiograph it's hard to be sure if there's anything wrong with those roots.

The changes in the ventral cortex of the bone are of course quite dramatic.

I'd guess that the tooth is well involved, whether as original cause or as secondary involvement, in which case extracting it will be at least part of the surgical treatment.

So, sorry, no definite answer, but certainly don't delay. I suggest that you see if you can get some more radiographs of the tooth (and 309 for comparison). Also pass a probe into the discharging point – you may need to feel around a bit with the probe – and radiograph to see where it goes. Then – unless the tooth looks perfectly normal (compare it with the contralateral!) and there are no lucent tracks from tooth into bone – extract it. You may then even find that you can pass a probe into the bony lesion from the alveolus.

RE: Swelling under jaw

Norman Johnston — Tue, 22 Sep 2020 09:14:57 GMT

Unfortunately the rads need to be better to give a good answer. With dental plates the definition will be better with the two minimum projections needed. Having said that my money is on traumatic damage to or developmental abnormality of the first molar and your solution will be surgical. The alternative diffs of odontoma or neoplasia are less likely

No point in hanging around though. It’s not improved over a month and will be very painful I would think. Culture is rarely worth the time and money in the month in my experience