Maxillary swelling in an old cat doesn’t always mean cancer

A 14 year old male domestic shorthair was presented to Dr. Greenfield at Your Pet Dentist of Memphis (@ MVS) by the referring DVM for swelling of the left caudal maxilla.  This swelling was firm and located below the eye and near the maxillary 4th premolar tooth (buccal or vestibular bone expansion).  The pet was experiencing difficulty eating, but no weight loss was noted.  Serum chemistries and CBC were within normal limits.

Oral exam revealed firm swelling above tooth 208 (left maxillary 4th premolar tooth). The tooth was not mobile and the gingiva was inflamed.  Other teeth did have gingivitis and extensive calculus/plaque.

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Rule outs should include the following:

  • Neoplasia    (squamous cell carcinoma is the most prevalent oral malignancy in cats)
  • Periodontitis with osteomyelitis

Diagnostic radiographs were taken (see below).  What do you see?

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There is bone proliferation/expansion in the 208/209 area.  Visible tooth resorption (type I) is noted on 208.

Treatment plan:

  • Extraction of 208 and 209
  • Biopsy bone and soft tissue apical to 208 submitted to CCOMP (Wisconsin)
  • Perform alveoplasty prior to closure (after biopsy)

Post extraction images:

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Histopathology results:  Chronic osteomyelitis and osteolytic remodeling of alveolar bone expansion.  No evidence of neoplasia.

Comments:  Swelling due to ostomyelitis can occur secondary to tooth resorptions and/or chronic periodontitis.  This is referred to as expansile or alveolar osteitis.  If you treat the underlying pathology, this resolves.  However, knowledge of how to perform aleveoplasty post extractions with proper flap design is imperative.  Therefore, chronic swelling in an older cat should be worked up both radiographically and histopathologically to get a proper diagnosis.  While tumors do occur in older cats, this individual outcome was quite favorable and this cat returned to a very happy lifestyle.

Barden Greenfield, DVM, Dipl. AVDC      Your Pet Dentist of Memphis and Little Rock

Ref:  Bell CM, Soukup JW.  Histologic, clinical and radiologic findings of alveolar bone expansion and osteomyelitis of the jaws of cats.  Vet Pathology 2015; 52 (5):  910-918.  

Dr. Barden Greenfield is a Diplomate of the American Veterinary Dental College (AVDC) and the founder of Your Pet Dentist of Memphis and Little Rock. He received his BS (Microbiology) at Louisiana State University and his Doctor of Veterinary Medicine (DVM) at Mississippi State University College of Veterinary Medicine. He also serves on the AVDC Board of Directors and is currently President.

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