Vet360 Vet360 Vol 05 Issue 04 - Page 30

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. vet360 Issue 04 | SEPTEMBER 30 Issue 2018 04 | | AUGUST 2017 30