Friday, October 25, 2013

1127. My Jack Russell has a "fistula" - oro-chin fistulas?

Friday Oct 25, 2013

As there was no need for 2 vets on this Friday evening, I asked Dr Daniel to brief his client about the treatment and medication and to go home early at around 7.15 pm. We close at 8 pm. One of his clients came in a white Mercedes at around 7.45 pm to pick up his Jack Russell that had dental scaling.

I thought it was an ordinary case of dental scaling. He pointed to an open wound of around 8 mm x68 mm on the right lower jaw below the right lower premolar tooth.

"I was so happy when I saw similar cases of fistulas in your website," he pointed to this sore. "Now I know that my Jack Russell has a fistula".

"Why do you say that?" I doubted he knows what a fistula is but many Singapore dog owners are much more knowledgeable and informed nowadays.

"This wound has pus. It takes a long time to heal. It disappears and then appears. I have 6 Jack Russells and only this one has the problem. Sometimes the wound appears on the left side and also in the back side."
"Are you sure it is not due to a dog bite or self-inflicted scratching from the paws?"
"No, I am sure of that. My two female Jack Russells do fight with each other. Over him, I suppose."
"Do you have a video camera switched on 24 hours to monitor them since you are frequently overseas on business?"
"I am sure the sore is a fistula, as in your cases. I have consulted two other vets in the past 4 years but the sores below the side come back now and then. Now, it is the right side. It is a fistula!"
"What did the other vets recommend?" I asked.
"They said nothing is wrong and prescribe some mouth wash. But it is a fistula!"

I was skeptical.
But vet medicine is full of surprises. An oro-chin fistula is possible in theory.
"I have not seen fisulas on the lower jaw," I replied. "Almost 100% are from the upper jaw below the eye! They are oro-nasal fistulas. But it is possible."
I asked if the dog bites and since he appeared docile, I opened the mouth to examine the white teeth scaled by Dr Daniel in the afternoon.  The teeth were sound in this 6-year-old dog. Except for 4 canine teeth which had decayed brown as their sharp tips had been cut off by somebody to prevent this Jack Russell from inflicting deep bite wounds on family members. This was done some 5 years ago.
Decay had set inside the four canine teeth. The lower right had a cracked side of 3 mm x 2 mm brown exposed dentine.

It is just possible that the infection had gone inside the pulp cavity of the lower canines and into the side of the gums. I asked my assistant Naing to flash his phone light onto the right lower gum. There was a small hole with blood. This hole was 3 mm x 2 mm and was bleeding.
"Check the other left lower gum as well," I said to Naing. "This is for comparison."
There was also a much smaller hole also below the first lower premolar. So, it is possible that infection had gone into the roots and seeped out through the gums laterally.

The owner would return 10 days later and get X-rays done. He was a busy man in his 50s but he loves the dog very much and is confidently sure he has a fistula! An oro-chin fistula due to decay in the fractured canine. Their pulp cavity in the long root became infected and the bacterial infection seeped downwards to the tip of the roots over the last 4 years. The infection leaked out from the long root and into the skin causing open sores with pus.

It is a hypothesis. The treatment is to extract the whole planed canine teeth of the left and right and there should be no oro-chin fistulas. Does it sound logical to readers?  .


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