This is the left maxilla of a 6 1/2 year-old Keeshound that underwent previous extraction of the maxillary fourth premolar (208) and molar (209). What gross findings are evident?

Answer:

There is a linear region of erythema extending from the maxillary left second molar (tooth 210) to the maxillary left third premolar (tooth 207). The palatal mucosa is slightly raised adjacent to the region. Gingivitis is present adjacent to the teeth. This region is painful for the patient despite current administration of an NSAID.

Here are two radiographs of the left maxilla, followed by a radiograph of the right maxilla for comparison. What radiographic findings are present?

Answer:

Decreased density of maxillary bone from tooth 207 to 210. Absence of a periodontal ligament space surrounding tooth 207 and the distal root of 206. Tooth 210 has an increased periapical lucency surrounding the palatal root and the absence of a periodontal ligament space surrounding the remaining roots.

What is the most likely diagnosis?

Answer:

Neoplasia

What would you recommend?

Answer:

Deep biopsy of the gingival and palatal mucosa and bone. Removal of teeth 207 and 210. Pain management should be augmented with consideration to an opiate, tramadol and gabapentin.

Discussion:

Neoplasia should be considered in all cases where extraction site healing is not complete within a reasonable time period (2-4 weeks). Palpation may be used as a reliable aid in evaluation of discomfort in patients suspected of oral pain. The diagnosis in this patient was histologically low grade biologically high grade fibrosarcoma.