FIND OUT WHY
A 7 year old Golden Retriever presented for a fracture of the right maxilla. Erosive palatitis was present adjacent to the right maxillary fourth premolar (108) and 1st molar. There was an uncomplicated crown fracture of tooth 108. What additional diagnosis should be considered in addition the chief complaint of a maxillary fracture?
What are the intraoral radiographic findings? Are the consistent with a fracture? Significant bone loss is associated with 108. However observe the bone adjacent to the first and second molars. There is generalized decrease in density and lack of a periodontal ligament space associated with all the dentition in the radiographs. What is your primary differential diagnosis?
Additional images demonstrate 100% bone loss of the maxillary 3rd premolar (107) in addition to the 4th premolar (108). The radiographic finding of aggressive maxillary bone loss is consistent with a neoplastic process.
Clinically, the right entire right maxillary arcade was mobile giving the impression of a fracture of the right maxilla to the referring veterinarian.
Thoracic radiographs showed no evidence of metastasis. Biopsy was accomplished by removing the first and second premolar and collecting sufficient regional tissue for histopathology. The histological diagnosis was osteosarcoma. Oral and maxillofacial osteosarcomas have a different pathobiology compared to long bone osteosarcoma. Less metastasis is reported in oral osteosarcoma.
Following the histopath diagnosis the right maxillary dentition, bone, and nasal turbinates were excised and closed with a vestibular mucoperiosteal flap in order to debulk the tissue, eliminate secondary infection associated with the neoplasia, and provide palliative care. Additional advanced imaging and adjunctive treatment were declined by the owner. Wide excision of oral osteosarcoma is the recommended to achieve tumor free margins.
Following excision, adjunctive therapy such as regional radiation and systemic chemotherapy may be indicated in some cases. However, little information is known and reported in the veterinary literature regarding additional treatment for oral osteosarcoma compared to osteosarcoma of the long bones. Consultation with a veterinary oncologist is recommended.