Case File

The Lovely Lily - a Case Story

by Amy Parsons - BVetMed GPCert (SAS) MRCVS Group Surgical Lead

Lily, an 11-and-a-half-year-old Corgi, initially presented in March of last year when her owners noticed a lump on jaw, associated with her lower right canine tooth.  She was booked in promptly for investigations where her lower canine tooth was removed as it was loose. The swelling associated with it biopsied to determine its nature.

The biopsy results indicated that the swelling was benign so we advised close monitoring and re-examination should it change in appearance.  Five weeks later, Lily came back to see us as the mass had grown considerably bigger, something we would not have necessarily expected with the type of benign mass that we had diagnosed.  We quickly booked Lily in again for further investigation. Radiographs were taken under general anaesthesia:

 

Radiograph showing Lily’s lower jaw – note the loss of bone density on the left-hand side of the image.

 

The radiograph showed a loss of bone density and a bony reaction that we typically see in only two conditions – bone infection or bone tumour. New biopsy samples were taken and submitted for histopathology and culture. The results this time reported a severe osteomyelitis, a bacterial bone infection, and the culture performed identified the causative organism and which antibiotic to use.

Lily started a long course of anti-biotics targeting the bone infection, to which she initially responded well. However, after a few weeks, sadly the mass was showing signs of growth again despite the treatment.  Facing the possibility that either a) the infection was too deep seated for the antibiotics to adequately clear or b) that there was in fact a more sinister disease process underlying this, we decided that our only option was to now remove the mass as it was causing pain.  This was no easy feat as the mass had taken over the front of Lily’s jaw, so our best option was a ‘bilateral rostral mandibulectomy’, where we remove the front portion of the lower jaw.  Lily’s owners were naturally very worried about her undergoing a big procedure like this but with minimal response to medications we were faced with a difficult decision of undertaking the surgery or putting Lily to sleep.

On the day of the surgery Lily was admitted, appropriate pre-operative blood tests done to check her blood clotting abilities etc, anaesthetised and prepared for surgery.

 

Lily on her back ready for surgery – note the mass affecting the majority of the front portion of her lower jaw.

 

Using a surgical saw, the affected portion of her lower jaw was removed, and thanks to a new blood clotting product we have on our shelves, haemorrhage was kept to a minimum. The cut portion of her jaw was submitted once again to the lab for histopathology.

The skin was altered to allow for Lily’s shorter jaw length and sutured back in place.  Lily made a remarkable immediate post-op recovery and was sent home later that evening.

 

Lily sat in her kennel a short while after recovery from general anaesthesia.

Her lower jaw is shortened.

The main concern owners have following this type of procedure is how their pet will eat. Lily had no issues in this area! Although picking up the food was a challenge, she did soon get used to it and while initially it was a messy, drooly procedure, this has since normalised!

Sadly, with the whole bone submitted for laboratory analysis, the diagnosis was that of an ‘osteosarcoma’ – a bone tumour.  While this is a malignant tumour, with excision, there is a 70% survival rate at 1-year post-op.

Lily shows no sign of spread and 8 weeks post-operatively is living life to the full. While surgeries affecting the face can have dramatic appearance, it is remarkable how well our canine patients adapt.