Case Study: Weston
Papillary Squamous Cell Carcinoma 
Weston is a 7-year-old, male, neutered Shih Tzu. He initially presented to his rDVM, My Pet’s Veterinary Center, for a swelling on the rostral mandible. Weston was prescribed three weeks of antibiotics, but there was no resolution, and the swelling continued to increase in size (~1/3 to 1/4 larger). Weston was referred to VDS for further evaluation and treatment. 
Weston had a pink to red fluctuant mass on the buccal aspect from 301–404 (mesial aspect). Weston also had intrinsic staining of 102 and 202. On awake exam, the following teeth were not visible in the mouth: 110, 210, 305, 311, 405, and 411. Weston also had a class III malocclusion.

Anesthetized oral examination confirmed a 1.5cm x 2cm x 6mm raised (see photos below), pink to red fluctuant mass on the buccal aspect from 301 to the mesial aspect of 404. The mass extended within a few millimeters of the mucocutaneous junction but was not visible on the lingual aspect. A biopsy was performed, and within the lining of the mass, a friable, spongy soft tissue with a viscous fluid was present. The biopsy was submitted to SOPA for review by Dr. Cindy Bell, an oral pathologist.
Large, pink to red raised mass buccal aspect of 301-404.
Full-mouth dental X-rays were performed, which showed displacement of 401–403 secondary to the mass with enlargement of the periodontal ligament space around those teeth. Both 311 and 411 were impacted, and the other missing teeth were not present radiographically. The pulp canal of 102 and 202 were symmetrical and appeared to be developing similarly to the other incisors.
Intra-oral x-rays showing widened periodontal ligament space and displacement of right mandibular incisors. 

Pre-operative blood work (complete blood count and serum chemistry) was within normal limits. Three-view thoracic radiographs were performed, which showed no evidence of metastatic disease. 
Weston was diagnosed with papillary squamous cell carcinoma (SCC). Papillary SCC carries a favorable prognosis with local control and has not been reported to metastasize. Given the prognosis and need for local control, Weston was scheduled for a bilateral rostral mandibular resection (from 304 to 404) with curative intent. (See photos below.) 
Segment of mandible excised and submitted for histopathology. Note the mass was previously debunked during the biopsy 1 week prior.
Weston post mandibulectomy showing the skin and intra-oral incisions.
Weston post mandibulectomy showing the skin and intra-oral incisions.
Weston began eating the evening of surgery and did great in recovery. The final biopsy report with margin review confirmed the complete excision of the mass. Ten months post-op, Weston returned for extraction of impacted 311 and 411 and a recheck of his rostral mandibulectomy site. Now just shy of three years, Weston continues to have normal eating, drinking, and behavior. Patients such as Weston are expected to be messier when they eat and drink and can have hypersalivation but otherwise, thankfully, live a normal life.
Weston at 6 months post mandibulectomy.
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Events are available virtually, at the VDS Mt. Laurel, NJ practice, or in person (within 30 miles of Mt. Laurel.)
We are proud to introduce our newest team member, Megan King, VMD, DACVIM (Cardiology) as part of the VDS family of exceptional specialty veterinary care providers. 
Many of the patients we see here at VDS have underlying cardiac disease that are often not diagnosed at the time of presentation to VDS. With Dr. King on board, we will have the ability to diagnose and more effectively determine their level of risk prior to undergoing general anesthesia and surgery. This will undoubtedly lead to more appropriate patient selection and ultimately better outcomes. 
Stay tuned for additional information.
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2061 Briggs Rd, Suite 403 | Mt. Laurel, NJ 08054
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