NOVEMBER 2011: TESSA

Tessa is an 8 year old, spayed/female, DMH cat presented with significant left maxillary facial swelling. Her owner felt she was showing signs of discomfort and had been eating less than usual for approximately 2 weeks. She had become lethargic and definitely "not herself". Upon awake oral exam, it appeared that Tessa had a large swelling extending from tooth #206 (left upper 1st premolar) to the distal aspect of the upper left arcade. The gingiva was friable and inflamed and all the teeth including the canine tooth seemed to have level 3 mobility. The rest of the mouth appeared as normal. Her physical exam otherwise showed no significant findings. A treatment plan was created including a senior blood panel, full mouth radiographs and incisional biopsy. Tessa was scheduled for her procedure the following week. The blood panel results came back within normal limits.

The day of the procedure, an intravenous catheter was placed, pre-medication given and Tessa was placed under general anesthesia for her surgery. A full oral exam was performed and showed no other obvious pathology present. Radiographs were taken. The left maxillary region showed sclerotic bony structure with extensive periapical bone loss and root resorption apparent throughout all the teeth of that region. The rest of the teeth, bone structure and gingival tissues were normal and showed no pathology. A deep tissue sample was incised from the most prominent area of swelling, along with multiple other tissue samples harvested at and adjacent to the area of concern. No other procedures were performed and Tessa was recovered from her anesthesia episode. Antibiotics and pain medication were sent home. The biopsy went to the lab for specialist reading, it came back 4 days later described as possible gingival hyperplasia with the probability of a deeper lesion that was not representative in these samples. No neoplasia was evident in the sections examined.

A second procedure was scheduled in 2 weeks to perform a prophylaxis, extract the left maxillary teeth and obtain bone biopsies of this region. Tessa was placed under general anesthesia and a large, full thickness mucogingival flap was created extending from tooth 204 (canine) to tooth 209 (molar). An obvious, prominent bony structure was revealed and the core bone sample was taken there. Other pieces of bone were also removed along with samples apical to and surrounding the sites of the extracted teeth. The extracted teeth would also be included in the biopsy samples. The maxillary bone was debrided and smoothed with a round tip bur on a high-speed handpiece. The gingival flap was closed with 5.0 Monocryl suture. Tessa would recover normally and be sent home to continue her previous drug therapy. The representative samples went to the lab and approximately 1 week later the results arrived. There were some areas of atypia which were of concern but not definitive for squamous cell carcinoma. The gingival fragments showed epithelial proliferation, not overtly malignant and probably hyperplastic changes. A conservative approach was recommended, approaching the case as chronic severe dental disease and low grade osteomyelitis. If the lesion continued to persist, rebiopsy was recommended to rule out emerging squamous cell carcinoma.

Tessa's recheck appointment showed significant reduction in facial and soft tissue swelling and normal healing of the mucogingival flap with only minor inflammation and no suture dehiscence. She was doing well at home, eating and drinking normally with normal activity levels and behavior. Her owner was cautiously optimistic but extremely happy to see her pet doing so well. Tessa will continue to be monitored for any changes that might indicate further diagnostics or treatment but for now, she appears to be on her way to a full recovery.