Good dental hygiene is very important for people
and dogs as some oral tumours form when the
mouth is not clean. Yearly dental check ups will
be ideal. In February 2013, I encountered a case
of a dog with bleeding in the mouth and face."Oro-nasal fistula also known as malar
abscess or carnaissal abscess," I said to the
two interns very confidently as this was a
common problem in old dogs that seldom if ever
was sent for dental check ups or scaling.
I was 50% correct. There was a large oral tumour
shaped like an oval elongated tumour! Veterinary
medicine throws surprising oral tumours to me
even after 40 years of practice! The dog was
eating food under this tumour which expanded to
fit the length and width and height of the oral
cavity. The length of this tumour was estimated
to be 10.5 cm long. I doubt I will ever see another case
similar to this.
Dr Daniel operated to remove this "hamburger"
tumour using electro-surgery. I was present for
a few seconds during surgery as this was his
case and I had confidence he would be able to
perform this surgery.
"There was a lot of bleeding," he told me when I
audited this case on Feb 12, 2013 (yesterday)
and phoned the owner as well. He packed the back
of the mouth with gauze swabs to prevent
inhalation of blood into the lungs. Around 90%
of the length of the tumour was excised
electrically and then the remnants. He
electro-coagulated the bleeders in the remnants
so that there would be no more bleeding. Electro-cautery
was effective in preventing bleeding.
The 50% calculated dosage of domitor and
ketamine IV anaesthesia was just sufficient for
surgery, with top up of isoflurane gas via the
mask. This formula is now used by the vets for
IV anaesthesia. It took some time to convince
vets that this is a safe and effective formula
as all vets have their own judgments and
preferences of using various anaesthetics.
Stocking a variety of anaesthetics is very
costly as they expire and so I don't permit
associate vets to order their favourite or their
vet professors' choice. A veterinary surgery
must be able to sustain its profitability and
most associate vets don't bother with this
aspect as they are not accountable for the
Histology confirmed it is non-cancerous.
It is known as a ossifying fibroma,
originating from the soft palate according to
the operating vet. There was also oro-nasal
fistula which I diagnosed on first visual
inspection and the rotten teeth black teeth as
you can see from the image, were also extracted.
Blood test had not shown any abnormal findings
and so this dog was fit for anaesthesia and
survived without any problems. In this
case, the profuse bleeding from the excised
tumour could be inhaled into the lungs and cause
death by asphyxiation if electro-cautery had not
been used to seal all bleeders successfully.
From my phone call, the gentleman owner of this
dog is most happy. As far as the dog owner is
concerned, his old Chihuahua is OK and eating
and that surgical outcome is what matters in the
final analysis. "How long has this tumour
exist?" I asked him. "I don't know as I don't
look inside the mouth," he said. This is a very
rare case of a "hamburger" oral tumour.
Yearly dental check up of your dog over 3 years
of age with your vet will prevent most oral
tumours and rotten loose teeth.
MY COMMENTS ON MANAGEMENT OF THIS CASE: 1. Electro-surgery was the correct
2. IV anaesthesia with top up IV would be
the choice in this case as isoflurane gas use by
mask was not practical. However, the IV
anaesthesia at 50% had lasted a sufficient
amount of time to complete 90% of the surgery
and isoflurane gas top up was effective in this
IV anaesthesia top up, the drugs would be
injected with the IV drip or the syringe with
the drugs would be attached to the IV catheter.