DENTISTRY
How to handle oral malignancies
Diagnosing your canine and feline patients is only the
first step. Here’s what to consider next: Talk frankly with
the client. There can be little benefit from attempting
to sugarcoat the diagnosis. If the mass is large, located
caudally or has been present for a while, the prognosis is
generally poor. Recently diagnosed small masses that are
located rostrally generally carry a good prognosis when
surgical excision with wide clean margins can be obtained.
In some of these cases, radiation therapy combined with
surgery adds to the favorable prognosis.
Maxillectomy and mandibulectomy
nomenclature
Partial mandibulectomy: The surgical removal (en bloc)
of part of the mandible and surrounding soft tissues;
also called a unilateral rostral mandibulectomy (Figures
7A-7C).
Find out more about the mass and the patient. Three-view
thoracic radiographs need to be examined for metastasis.
If present, surgery can still be performed, but the prognosis
for long-term success is poor.
Further staging should include intraoral radiographs of
the mass. The availability of computed tomography and
cone beam computed tomography is a game-changer in
treatment planning for oral masses in that they allow the
practitioner to better view the whole iceberg instead of
only the tip. The majority of malignant tumors will have
evidence of bony involvement at the time of diagnosis;
however, radiographic evidence of lysis does not occur
until 50% of the bone has become demineralized (Figure
6).
Figure 7A. Partial mandibulectomy diagram. (All illustrations by Roxy
Townsend).
Figure 7B. A surgical specimen from the squamous cell carcinoma
patient from Figure 3.
Figure 6. Fibrosarcoma with extension into the bony hard palate
Surgery. In cases where metastasis is not present, the
chance to cut is a chance to save - especially if excision
can be accomplished with at least 2 cm of clean surgical
margins in all directions. (Note: It's the “in all directions”
part that often creates a challenge.)
Figure 7C. The healed surgical site with clean margins.
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