A five year old male terrier mix presented with right ventral mandibular enlargement.

Question:

What is your impression of the bone shown in the photograph?

• Answer:

  

  There is an absence of soft tissue covering the bone.  Brown discoloration of the mandibular bone and the absence of bleeding are suggestive of necrotic bone.

Describe the radiographic findings.

• Answer:

  A diffuse periosteal reaction is present ventral to the right mandibular first molar (409). There is loss of the mandibular cortical bone ventral to the mesial root of 409. There is loss of mandibular bone opacity with an irregular, permeative bone loss between 404 and 409.

  Differential diagnosis included osteonecrosis of undetermined etiology and neoplasia. Thoracic radiographs were taken to rule out metastatic disease in anticipation of excisional biopsy. There was no history that would suggest the origin of the necrosis. Thoracic radiographs were within normal limits. The pet guardians were brought in for consultation. Excisional biopsy was recommended (right unilateral mandibulectomy).

  

  

  

  Lymphoplasmacytic suppurative stomatitis, osteomyelitis, bone sequestrum and surface bacteria.