Thursday, September 4, 2014

1485. Script for 15-year-old JR with carnaissal tooth abscess

Sep 4, 2014


HISTORY
Hi,

I think my 15-year old JRT has fistula with discharge from
carnaissal tooth abscess on his right cheek. Can I check whether it is advisable to do scaling at this age? GA or sedation?
How much is the cost of blood test, scaling,extraction and etc?
Look forward to your reply soonest.

many thanks

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HOOK

           PROBLEM
A discharging facial wound below the right eye. Pus seeps out. Blood seems out. Wound does not heal. Why?





9316.MOV    On August 25, 2014 - 10 days ago.
0 - 2:32     Right facial swelling. Left face is normal. Evert upper lip. Rotten foul-smelling tooth seen on right upper jaw below the facial swelling. On the left side, the tooth had dropped off long ago.


BE KIND TO PETS IMAGE






INTRODUCTION
Case TP  20970  
13-year-old male Jack Russell - has a hole in the right side of the face for 2 weeks. The first vet had diagnosed a tooth problem.
What is this old dog suffering from? Why is the wound not healing?

9319.MOV.
0.18 - 1.05  
Explain with medical illustration from a book. Malar Abscess.
Oro-nasal fistula (define this).   Wound does not heal as the pus keeps coming out from the badly decayed root of the carnaissal tooth. It is the upper premolar tooth closer to the nasal sinus compared to other teeth. So, the nasal sinus becomes infected and rots. Pus comes out through the skin below the right eye. This is called oro-nasal fistula. Fistula means a connecting channel between two mucous membranes. In oro-nasal fistuala, the membrane of the mouth connects with the nasal sinus, discharging pus above the sinus, below the eye.

1.23 - 1.38  Actual fistula from this 13-year-old Jack Russell

2.40 - 3.19. In-patient Pomeranian. Had same medical problem 5 years ago. Now OK as wound had healed. Dog owner did not bother with dental check up in the past 5 years. So, you can see the teeth are crusted with black tartar.

4.15 - 5.15    Is the Jack Russell coughing? Yes. Check heart. Left heart murmur. High anaesthetic risk of heart failure during anaesthesia. 

9320 MOV
4.19 - 4.53   First blood test taken on Day 1 (first day of visit) by Dr Daniel and put inside the blood tubes. Get some scenes.

                 BLOOD TEST RESULTS
Normal                                    Total White Cell Count    Neutrophils    Absolute
                                                 6-17                                  60-70%         3-11.5

26.8.14                                       30.9                                   79.3%          24.5
4.9.14                                         13.8                                  69%             9.52


I had prescribed antibiotics trimaxazole syrup for 7 days from 26.8.14 to 2.9.14. The 2nd blood test showed it was effective as total White Cell Count and Neutrophils returned back to normal on 4.9.14, before surgery. But there is the bad breath still present as the owner came in for surgery on 10th day.

SOLUTION

ANAESTHESIA
1. Painful mouth - hard to mask and give isoflurane and oxygen gas. Struggle.
Some vets would give sedative injections as a routine to make it easier to operate.
But heart disease - can die of heart failure under general anaesthesia

SOLUTION  Antibiotics past 7 days to kill bacteria in mouth and gums. Reduced inflammation and therefore pain. Gave I/V drip + antibiotic (baytril) + frusemide (clear lung of fluids)

9643.MOV 0 - 2:30
Pre-anaesthetic IV drip + medication. Dextrose saline 1 bottle 500 ml + 5% glucose for 5 minutes. The dog had no fever. Now the dog looks alert. A non-aggressive Jack Russell with the large facial swelling of 4 cm x 4 cm seen below the right eye. The oro-nasal wound is now dried up as compared to 10 days ago when there were yellow pus discharging out.

9720.MOV   0.0 - 1:50
No struggle when the dog is masked. The right upper carnaissal tooth (Premolar 4) is extracted out easily. This enable any pus accumulated inside the root area and sinus to drain downwards. Surprisingly no bleeding during extraction as you can see from the video. Another right upper Premolar 2 is extracted easily.


9723.MOV   0.0 - 2:03
The left jaw. The left upper carnaiissal tooth (Premolar 4) had dropped off earlier, so none was seen. Premolar 3 is extracted. Dog wakes up fast under gas. Mask dog to give gas so he can sleep and not feel the pain. Extract the other loose teeth. Scaling of teeth done on the canine teeth. Dog wakes up. Cries.  Gives gas. Change to bigger mask as there is lots of bleeding after extraction of some teeth.

9734.MOV  0.0 - 0:46
One hour after anaesthesia and surgery. The dog is alert. The facial swelling below the right eye has almost disappeared. 11 decayed teeth in a plastic bag are put inside a plastic bag and given to the lady owner who took them home. The young lady is most happy with the outcome.  Her mum is satisfied as it was her daughter who was much worried about the anaesthetic risk. I said it was 50:50 but this is only a guideline. Each old dog with heart disease reacts differently and so it is hard to predict. In many cases, the old dog survives if the anaesthesia is just gas and of short duration.




Not to operate was not an option as pus kept discharging from the wound (known as oro-nasal fistula) below the right eye.


POST OP E-MAIL FEEDBACK FROM THE OWNER

SEP 9, 2014
Hi Dr Sing
My dog had done the extraction of teeth on thursday by you. He is eating well and moving around normally. However, he has some involuntary movement on his cheek/mouth area.

Please take a look at the video that I took.

Kindly advice thanks

REPLY FROM DR SING

Involuntary lip/mouth movements after surgery could be due to painful contraction of holes in the gums after extraction of 11 teeth.


FOLLOW UP 2 WEEKS AFTER DENTAL EXTRACTION
The 15-year-old Jack Russell is back to normal, active and eating.
 

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