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TOA
PAYOH VETS toapayohvets.com Date: 14 February, 2013
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Trust & Audit: A rare case of a
hamburger tumour inside the mouth of an old dog
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date: 14 February, 2013 |
toapayohvets.com
Be Kind To Pets Veterinary Education Project 2013-0131 |
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Blog 1286.
Good dental hygiene is very important for people
and dogs as some oral tumours form when the
mouth is not clean. Yearly dental check ups will
be ideal. In February 2013, I encountered a case
of a dog with bleeding in the mouth and face.
"Oro-nasal fistula also known as malar
abscess or carnaissal abscess," I said to the
two interns very confidently as this was a
common problem in old dogs that seldom if ever
was sent for dental check ups or scaling.
I was 50% correct. There was a large oral tumour shaped like an oval elongated tumour! Veterinary medicine throws surprising oral tumours to me even after 40 years of practice! The dog was eating food under this tumour which expanded to fit the length and width and height of the oral cavity. The length of this tumour was estimated to be 10.5 cm long. I doubt I will ever see another case similar to this. Dr Daniel operated to remove this "hamburger" tumour using electro-surgery. I was present for a few seconds during surgery as this was his case and I had confidence he would be able to perform this surgery. "There was a lot of bleeding," he told me when I audited this case on Feb 12, 2013 (yesterday) and phoned the owner as well. He packed the back of the mouth with gauze swabs to prevent inhalation of blood into the lungs. Around 90% of the length of the tumour was excised electrically and then the remnants. He electro-coagulated the bleeders in the remnants so that there would be no more bleeding. Electro-cautery was effective in preventing bleeding. The 50% calculated dosage of domitor and ketamine IV anaesthesia was just sufficient for surgery, with top up of isoflurane gas via the mask. This formula is now used by the vets for IV anaesthesia. It took some time to convince vets that this is a safe and effective formula as all vets have their own judgments and preferences of using various anaesthetics. Stocking a variety of anaesthetics is very costly as they expire and so I don't permit associate vets to order their favourite or their vet professors' choice. A veterinary surgery must be able to sustain its profitability and most associate vets don't bother with this aspect as they are not accountable for the bottom line. Histology confirmed it is non-cancerous. It is known as a ossifying fibroma, originating from the soft palate according to the operating vet. There was also oro-nasal fistula which I diagnosed on first visual inspection and the rotten teeth black teeth as you can see from the image, were also extracted. Blood test had not shown any abnormal findings and so this dog was fit for anaesthesia and survived without any problems. In this case, the profuse bleeding from the excised tumour could be inhaled into the lungs and cause death by asphyxiation if electro-cautery had not been used to seal all bleeders successfully. From my phone call, the gentleman owner of this dog is most happy. As far as the dog owner is concerned, his old Chihuahua is OK and eating and that surgical outcome is what matters in the final analysis. "How long has this tumour exist?" I asked him. "I don't know as I don't look inside the mouth," he said. This is a very rare case of a "hamburger" oral tumour. Yearly dental check up of your dog over 3 years of age with your vet will prevent most oral tumours and rotten loose teeth. MY COMMENTS ON MANAGEMENT OF THIS CASE: 1. Electro-surgery was the correct choice. 2. IV anaesthesia with top up IV would be the choice in this case as isoflurane gas use by mask was not practical. However, the IV anaesthesia at 50% had lasted a sufficient amount of time to complete 90% of the surgery and isoflurane gas top up was effective in this case. IV anaesthesia top up, the drugs would be injected with the IV drip or the syringe with the drugs would be attached to the IV catheter. This webpage: http://www.bekindtopets.com/dogs/20130214ossifying_fibroma_oral_dog_toapayohvets.htm |
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One fine day on
late January 2013, the owner of a male, 10-year-old Chihuahua noticed a
swelling on the right cheek and brought it to Toa Payoh Vets.
At Toa Payoh Vets, Dr Daniel Sing was on duty. I was present. “This looks like a case of tooth root abscess as you can see that the teeth are rotten and filled with tartar. There may also be oronal fistula. It is an abnormal communication between the oral and nasal cavities involving the soft palate, hard palate, premaxilla, or the lip” said Dr. Daniel.
Is it a case of
tooth root abscess and oronasal fistula?
“So what are the
treatment options available?” asked the owner.
“For this case,
we would recommend to go through surgery to remove all the affected teeth and
clean the abscess” explained Dr. Daniel.
“But then how
would my dog eat without teeth” the owner said.
“Don’t worry, the
dog can eat soft canned food or even boiled chicken breast and porridge”
The
financial
costs and risk must be explained fully before any operation is done.
But the owner must give his consent and that is where personality and
financial conflicts come in. He must also be aware of the risk involve
especially in older dogs.
Blood test
Health screening is strongly advised before
anaesthesia and surgery for all patients, esp. in the older dog.
Anaesthetic risks are much higher in old dogs. There is always the possibility that the older dog may die on the operating table. When the owner hears that the dog may die on the operating table, he may decide not to get the surgery done. Some deem the vet incompetent and consulted another vet. A health screening should be suggested by the vet to let the owner knows whether the risks are high or not. "I advise a blood test to screen the health of the Chihuahua," Dr Daniel said. The owners must consent to take the anaesthetic risk if they give permission for the surgery as in this case. No surgeon can guarantee zero risk in any anaesthesia, whether in people or animal.
The total WBC 16.6 (normal
6.0-17.0)
Neutrophils 50.8%, Lymphocytes 19.2%,
Monocytes 24.6%, Eosinophils 1.1%, Basophils 4.2%. The platelets count is 520
which is slightly above normal (normal 200-500)
This blood test indicates that the liver and
kidneys were functioning normally.
"OK," the owner consented to the surgery. Antibiotics were given to the dog.
IV anaesthesia
without Intubation.
Anaesthesia. What
type? IV, gas or both? IV anaesthesia is shorter acting than gas anaesthesia.
Intubation (a breathing tube connects anaesthetic gas and oxygen to the dog)
is usually done in dental extraction.
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