Just Ask the Expert: A nonhealing dry socket in a cat
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Q: For the last six months, I have been treating a 15-year-old castrated male domestic shorthaired cat with an isolated oral lesion. The lesion started as biopsy-confirmed plasmacytic, suppurative gingivitis adjacent to the left maxillary 4th premolar, primarily involving the juxtaposed buccal mucosa. I initially treated the lesion medically (systemic corticosteroids, clindamycin, doxycycline), but I subsequently extracted the premolar and the left maxillary 1st molar. Both were easily extracted and had full root removal. Alveolar bone was also curetted.
Two months later, a minimal ulcerated gingival lesion remains, but, more significantly, a dry socket about 0.5 x 1 cm is present that will not heal. I tried one buccal gingival graft, which failed, probably because of decreased availability of healthy mucosa for the graft in the area. One week ago, I gave a second intralesional injection of Depo-Medrol in the remaining ulcerated lesion. (I have not seen any results yet.) Do you have any medical recommendation to promote healing of the dry socket before we try another surgical closure (palatal graft)? (The cat tested negative for FELV/FIV, and the serum chemistry profile, CBC, and T4 findings are normal.)
Geoffrey Riggin, DVM
Veterinary Centre of Greenback
A: Dr. Riggin, I would recommend a deep biopsy of the area, including bone, to rule out an underlying neoplastic process. Also, at the time of biopsy, I would gently débride the area, flush, and suture. Additionally, a dental radiograph would be of value, but the No. 1 goal is to get a good, deep biopsy. I suspect squamous cell carcinoma. The other rule-out is a sequestrum.
Daniel T. Carmichael, DVM, DAVDC
Veterinary Medical Center
75 Sunrise Highway
West Islip, NY 11795
Dear Dr. Carmichael,
Update on outcome of feline oral lesion: The biopsy of palatal bone did come back as SCC. Interestingly, the adjacent mucosal biopsy still showed only suppurative plasmacytic gingivitis (as original biopsy). Lesson learned is to obtain various tissues for biopsy (including bone) on a suspicious oral lesion. Obviously, this lesion wasn't healing or responding to any treatment and should have been the tip-off of a deeper problem.
Thanks for your suggestion.