This 12 year old MN Bloodhound presented for evaluation of a right sided oronasal fistula (ONF). The patient had the right maxillary canine tooth extracted years earlier and subsequently developed an ONF. He had the ONF repaired a short time thereafter, but the procedure was unsuccessful. The patient has been living with a chronic ONF for years. Below is the gross appearance of the right maxilla.
What recommendation would you make to the owner for this patient? What single diagnostic is absolutely essential in a case like this?
The most important diagnostic for this patient was dental radiographs. Despite several prior dental procedures, he never had dental radiographs. Below is a left maxillary dental radiograph.
As you can see, there is a root tip of the right maxillary canine tooth. A large gingival flap was created, the root tip was identified and removed and all granulation tissue was debrided from the ONF.
A bone grafting material called Ossiflex (Veterinary Transplant Services) was utilized to cover the ONF and the gingival flap was sutured using 4-0 Monocryl in a simple interrupted pattern. A post operative dental radiograph was taken and therapeutic k-laser was utilized while the patient was anesthetized to stimulate healing.
The patient also returned for a series of k-laser treatments throughout the healing period. At the 2 week post surgery recheck appointment the patient had completely healed and was feeling great