Mandibular symphysis fracture

RE: Mandibular symphysis fracture

Silvia Maldonado — Wed, 23 Feb 2022 16:38:49 GMT

Blimey! it looks hard to miss as a differential. Thanks for the photos and comments :)

RE: Mandibular symphysis fracture

Rob Davis — Wed, 23 Feb 2022 14:40:58 GMT

[quote userid="12670" url="~/001/veterinary-clinical/small-animal/dentistry/f/discussions/30195/mandibular-symphysis-fracture/235929#235929"]could you give us some tips of what we would expect to find in pets with buccal osteosarcoma?[/quote]

This is a mandibular osteosarcoma I saw recently:

This is what it looked like only 12 days previously:

This is the radiograph:

I agree with Evelyn that the radiograph posted by the OP doesn't look obviously neoplastic, but it is difficult to assess without knowing how it looks clinically.

RE: Mandibular symphysis fracture

Evelyn Barbour-Hill — Mon, 21 Feb 2022 20:04:24 GMT

[quote userid="12670" url="~/001/veterinary-clinical/small-animal/dentistry/f/discussions/30195/mandibular-symphysis-fracture/235929#235929"]Evelyn, as you know so much about dentistry,[/quote]

As far as I know, osteosarcoma can occur in any bone, but occurs a good deal more often in the appendicular skeleton than the axial. It's not the commonest intraoral neoplasia, but it's not a rarity either – I'd have it on my second list after the Big Three. In the mouth, as far as I know, it has exactly the same characteristics as anywhere else: commoner in large to giant dogs, most likely in medium age (7ish), can be younger in giant breeds (4 or even younger). Metastasises quite easily, generally to lungs. Radiography can be useful in diagnosis: characteristic sunburst appearance is practically diagnostic but less obvious appearance does not rule it out.

Cornerstone of treatment in my opinion is excision of the entire bone in which the tumour is present. Even so, prognosis very guarded.

I've never seen a "pathological fracture" arise from an osteosarcoma in the mouth. I'm sure it's possible, but just as with a limb the enlarging mass and the pain would surely be observed and dealt with in one way or another long before a fracture could occur.

If you are thinking of the OP case, I may be wrong but osteosarcoma does not present itself to me as a likely diagnosis from the radiograph. I can't tell for sure without a lot more information, though. (And, one might mention, mandibular symphyss separation is not a fracture). Maybe neoplasia is playing a part (in which case one would instantly suspect squamous cell carcinoma) or maybe it isn't.

RE: Mandibular symphysis fracture

Silvia Maldonado — Mon, 21 Feb 2022 07:50:50 GMT

Interesting X-ray.

Evelyn, as you know so much about dentistry, could you give us some tips of what we would expect to find in pets with buccal osteosarcoma? For instance, I would think that the jaw would be painful, as it's been mentioned, but also failing to fix, maybe some bleeding, and at some point it should be obvious that it is not an ordinary fracture. What age gap is it more common to present? any breed? is it more likely in dogs than cats? how fast would you expect it to grow (ie, been "obvious")? etc.

RE: Mandibular symphysis fracture

Evelyn Barbour-Hill — Wed, 16 Feb 2022 01:27:37 GMT

Dear Goncalo

Welcome to vetsurgeon.org.

To be honest, the radiograph is fine butI can't really answer your question from the radiograph alone. Is there any soft tissue appearance suggestive of neoplasia? Do we know how long the symphysis had been separated before it was presented to you?

Labially, there's a tooth (presumably 301) and a chunk of bone missing. That could be from trauma, or from periodontal disease, or possibly from neoplasia.

More caudally, in the main bulk of the symphysis, that irregular appearance is not, in my experience, too unusual for a traumatic separation – others may disagree. The apparent "cavity" is quite notable though, and you are right to be suspicious. However it could be from infection or it could well be just the way the symphysis separated. The "cavity" appears to have a dense rim which to my mind makes neoplasia less likely.

If you have reason to suspect neoplasia I can only suggest you try to scoop or curette a little material from the level of that "cavity" and submit it as a biopsy.

If there are still signs of pain, it's just possible that the pain is caused by your PDS suture. Please, I am not questioning your competence, just suggesting that it might be too tight.

Any chance of sending us a close-up photo or two?