A 7 year old daschund presented for a discolored canine tooth and oronasal fistula. This is taken during the oral exam under anesthesia. The incisive bone is mobile. What is your tentative diagnosis?

Answer:

Bilateral cleft of the primary palate.

In this image considerable debris is present within bilateral oronasal fistuas. There is no bone present on the palatal aspect of either maxillary canine. Root exposure is present on the distal aspect of the left third maxillary incisor. The four central incisors are within normal limits radiographically.

What is the approach to treatment?

Answer:

One approach would be rostral maxillectomy with canine extraction. This would likely result in some ventral nasal deviation and is functionally acceptable. An additional dorsal tacking procedure may alleviate ventral nasal deviation. In this case the incisive bone was not excessively mobile, so preservation of cosmesis and function was achieved by maintaining the incisive bone.

Extraction of the maxillary canines, retention of the four central incisors and incisive bone was chosen here. Mucoperiosteal flap creation is as shown. This created adequate surface area for healing of the tension-free primary closure.