Page 669 - Cote clinical veterinary advisor dogs and cats 4th

308 Epulides

○ Peripheral odontogenic fibroma: effective
but rarely required, as surgical resection
VetBooks.ir ○ Acanthomatous ameloblastoma: effective,
typically results in complete cure
with tumor control achieved in about 90%
of dogs, especially for smaller tumors;
* larger tumors (>4 cm) are more likely to
recur (only about 30% tumor control);
higher radiation doses may be required
* ○ Acute and late side effects can occur, most
to improve control rates.
notably radiation-induced tumors (many
years after radiation therapy in about
3.5%-12.5% of dogs with acanthomatous
ameloblastoma) and bone necrosis.
• Cryosurgery: causes cellular death after
controlled freezing and thawing of the tumor
○ Best for low-grade tumors < 2 cm in
A B diameter and adherent to or minimally
invasive into one cortex; tumor should
EPULIDES A, Rostral lower jaw in a Shetland sheepdog with acanthomatous ameloblastoma. Note red, first be debulked and biopsied, followed
cauliflower-like, and easily bleeding mass located between left mandibular third incisor and canine tooth. B, by cryosurgery applied to underlying bone.
Dental radiograph of rostral lower jaw in same patient (radiograph arranged in labial mounting; rostral toward ○ Inadequate for tumors with extensive
the top of image, and patient’s left side is on right of image). Note displacement of involved teeth, lysis of
alveolar bone (asterisks), and sunburst pattern at left lateral mandibular border (arrows). (Copyright Dr. Alexander fixation to or invasion into bone; full-
M. Reiter, University of Pennsylvania.) thickness freezing of maxillofacial bones
(e.g., maxilla, mandible) can lead to bone
necrosis, bone fracture, or oronasal fistula
• Erythema multiforme (also look for lesions Advanced or Confirmatory Testing ○ Despite maintenance of the bony frame-
on skin) CT is valuable to determine local disease work and preservation of oral function,
• Autoimmune diseases (bullous pemphigoid, extension and bony invasion in dogs with recurrence is more common than with
lupus erythematosus) maxillary or caudal mandibular acanthomatous surgical excision.
• Eosinophilic granuloma (usually on soft ameloblastoma. This facilitates achieving wide
palate and lateral edges of the tongue) surgical margins and allows for radiation therapy Nutrition/Diet
Cats: planning. Soft food and avoidance of chew treats/toys
• Gingival hyperplasia, osteoma, plasmacytoma for 2 weeks after tooth extraction or radical
• Squamous cell carcinoma (most common TREATMENT resection (mandibulectomy, maxillectomy)
malignant oral tumor)
• Fibrosarcoma (second most common oral Treatment Overview Possible Complications
malignant tumor) The primary goal of treatment is complete • Wound dehiscence
• Feline inductive odontogenic tumor (rare) tumor removal with minimal functional and • Incomplete resection and tumor recurrence
• Amyloid-producing odontogenic tumor (rare) cosmetic compromise. • Bone necrosis after cryosurgery or radiation
• Eosinophilic granuloma (usually on upper therapy
lip, tongue, sublingual tissues, and palate) Acute General Treatment
• Surgery: conservative and radical Recommended Monitoring
Initial Database ○ Peripheral odontogenic fibroma: gingival • Clinical re-examination at 2 weeks, 6 and 12
• Physical examination, CBC, serum biochem- excision with conservative margins, extrac- months, and then once yearly after definitive
istry profile tion of the associated tooth (or teeth in treatment
• Dental and head radiographs: case pinpointing the lesion to one tooth • Radiographic re-examination (for acantho-
○ Peripheral odontogenic fibromas: not is difficult), and curettage of the alveolar matous ameloblastoma) once yearly
invasive; radiographic changes to alveolar socket(s) to remove the periodontal
bone unlikely ligament; local excision without tooth PROGNOSIS & OUTCOME
○ Acanthomatous ameloblastomas: invasive; extraction and socket curettage is rarely
changes to alveolar bone visible on dental curative (recurrence is likely because these • Peripheral odontogenic fibroma and giant
radiographs tumors arise from cells in the periodontal cell granuloma: excellent prognosis (after
• CT: superior to radiography, particularly for ligament). complete gingival resection, tooth extrac-
maxillary and caudally located mandibular ○ Acanthomatous ameloblastoma: mandibu- tion, and curettage of the alveolus); cats with
lesions lectomy and maxillectomy with at least multiple fibromas may have higher recurrence
• Biopsy 1-cm margins (depending on location of rates.
○ Cytologic techniques less diagnostic; the tumor) • Acanthomatous ameloblastoma: excellent
biopsy for histopathologic examination • Radiation therapy: considered for nonre- prognosis (after mandibulectomy and
the only definitive test to establish an sectable masses, incomplete resections, and maxillectomy procedures when clean histo-
accurate diagnosis recurrent tumors; options include conven- pathologic margins can be accomplished);
○ Excisional biopsy for small lesions during tional radiation therapy and stereotactic smaller tumors and rostral location are
initial oral examination may be curative. radiosurgery (SRS), such as CyberKnife SRS, positive prognostic factors because these
○ Incisional biopsy for larger lesions to which is associated with high conformality, masses are detected earlier and are easier
determine tumor type will allow the clini- submillimeter accuracy, fewer treatments to remove; postoperative radiation therapy
cian to properly plan for future definitive required (usually three), and fewer side may occasionally be required for tumor
surgery. effects. control.

www.ExpertConsult.com