Case Study: Griffin
The Curious Case of Facial Swelling in a Puppy
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HISTORY
Griffin, an 11-month-old intact male German Shepherd, was presented to Veterinary Dentistry Specialists (VDS) for evaluation of a large tumor affecting his right upper jaw and nasal cavity. Griffin had been owned until he was 7 months of age but was given up for adoption after he sustained trauma to the right side of his face. This trauma healed, but months later, in November of 2022, a firm swelling developed, and his adult right maxillary canine tooth was absent. Veterinarians in Texas performed a biopsy of the firm right maxillary swelling that showed plasmacytic osteomyelitis with mild fibrosis. At that time, he was living in a shelter in Texas until he was rescued by ARK Charities in December of 2022 and brought to Brookfield, CT. After ARK Charities got involved, Griffin was presented to Guardian Veterinary Specialists in Brewster, NY for skull radiographs and a CT scan of the head (Figure 1 image series). This scan showed a large, complex odontogenic or dentigerous cyst expanding within the nasal cavity and containing malformed and abnormally displaced elements of the right maxillary canine tooth. Griffin was referred to VDS in Mt. Laurel, NJ for surgical treatment.
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Figure 1 Images. CT and radiographic images of the right maxillary swelling show an expansile, cystic mass containing the displaced, malformed and unerupted adult right maxillary canine tooth (104) and a conglomerate of high-density material.
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EXAMINATION AND DIAGNOSTICS
On physical examination, Griffin had a painful firm swelling of the right maxilla – measuring approximately 11 cm by 6 cm – that caused expansion of the right maxillary and nasal bones. Preoperative CBC and serum chemistry were largely unremarkable. Once Griffin was anesthetized, dental radiography confirmed the presence of his unerupted right maxillary canine tooth within the mass as well as multiple toothlike structures (“denticles”) throughout. The combination of the patient’s young age, the presence of an unerupted tooth within the mass itself, and the toothlike structures made the likely diagnosis a compound odontoma. The recommended treatment was surgical enucleation of the cystic lining and all its contents.
TREATMENT AND OUTCOME
A right lateral approach to the maxilla was made via a mucosal incision dorsal to the mucogingival junction with a single mesial release. The flap was elevated dorsally along with the infraorbital neurovascular bundle to allow for the creation of a bone window in the nasal cavity using a piezoelectric surgical unit. Once the nasal cavity was exposed, the cystic lining was located and undermined from the maxillary and nasal bones. Unerupted tooth 104 was located and removed, as well as numerous toothlike structures, osteoid-like material, and abnormal soft tissue (Figure 2 image series). Once the cystic lining was enucleated, the defect was flushed using sterile saline and suctioned. Alveoplasty was performed using a round diamond bur attached to a water-cooled, high-speed handpiece. The periosteum was released to allow for tension-free closure of the mucosal flap in two layers using absorbable suture material. The removed material was submitted for histopathology and confirmed our suspicion of a compound odontoma.
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Figure 2 Images. A right lateral approach was made through the maxilla to gain access to the nasal cavity. The cyst lining (second photo) as well as numerous tooth-like structures and unerupted tooth 104 (third and fourth photos) were removed prior to closure in a simple interrupted suture pattern.
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Griffin returned for a progress examination two weeks later and was found to have excellent healing of his incision. Some sneezing and nasal congestion were reported; otherwise, he was said to be eating well, gaining weight, and seeming comfortable and playful. |
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Griffin at the time of his two-week medical progress examination, feeling much better. |
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DISCUSSION
Odontomas are benign tumors originating from the odontogenic epithelium and containing well-differentiated cells representing all dental tissues (enamel, dentin, cementum, and pulp). They are divided into complex and compound malformations. Complex odontomas have dental tissues arranged in a haphazard or disorderly fashion, whereas compound odontomas are more organized, leading to the development of “denticles” that resemble smaller, rudimentary versions of normal teeth. These tumors are seen with frequency in humans but are considered rare in dogs and cats. Most odontomas in dogs are associated with unerupted teeth, as was the case with Griffin. Griffin’s right facial trauma as a younger puppy led to displacement and malformation of his right maxillary adult canine tooth, preventing a normal eruption. Unerupted teeth have a physiologic epithelial covering that can become cystic when a tooth fails to erupt. We suspect this contributed to the cystic lining found in Griffin’s case. Clinical signs of an odontoma include alveolar bone swelling, a persistent deciduous tooth, or an unerupted adult tooth in a young animal. Confirmation is made via histopathology. Surgical excision or enucleation of all cystic lining and abnormal material generally results in an excellent long-term outcome; however, if any cystic lining remains, regrowth is possible.
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& ORAL SURGERY LUNCH & LEARN.
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We offer a wealth of topics – or let us know what you’d like to learn about for a customized presentation. You bring your team, we’ll bring the food – and the expertise.
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Events are available virtually, at the VDS Mt. Laurel, NJ practice, or in person (within 30 miles of Mt. Laurel.) |
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OUTPATIENT VETERINARY CARDIOLOGY SERVICES NOW AVAILABLE |
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In support of our promise to provide the safest and most advanced dentistry and oral surgery for dogs and cats, we are pleased to announce the addition of veterinary cardiologist Dr. Megan King and comprehensive cardiology services to our Mt. Laurel, NJ, location. Outpatient cardiology appointments are available Tuesday-Thursday. Patients do not need to be seeing dentistry or oral surgery to be cared for by Dr. King.
Additionally, dentistry or oral surgery patients with cardiac concerns can receive a cardiology evaluation on the day of their procedure to assess heart health [if necessary] before general anesthesia. Along with our cardiologist’s assessment, one of our board-certified veterinary anesthesiologists will design and monitor an anesthetic protocol tailored to each patient’s needs, leading to safer procedures and better outcomes.
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AAHA-Accredited Referral Practice
2061 Briggs Rd, Suite 403 | Mt. Laurel, NJ 08054
Additional Locations: Chadds Ford, PA and Katy, TX
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