Read the full September 2015 newsletter

Arizona Veterinary
Specialists’ News
September 2015
LEADERS IN SPECIALTY CARE
Common Oral Tumors:
Canine Acanthomatous Ameloblastoma
By Donald Otten, DVM
Resident, Arizona Veterinary Dental Specialists
Curt Coffman, DVM, DAVDC
Arizona Veterinary Dental Specialists
Dr. Donald Otten received his B.A. in biology from Luther College in Decorah, Iowa in 1989 and his Doctor of Veterinary Medicine from the
University of Minnesota in 1998. Dr. Otten spent time in the Peace Corps and then worked in general veterinary practice until 2014 when
he joined Arizona Veterinary Dental Specialists as a Resident to work towards completion of his requirements for Board Certification in
dentistry. Dr. Otten is interested in all facets of dentistry from root canal treatment and crown therapy to oral surgery. He enjoys dentistry
because “pets leave our office with healthier, more comfortable mouths every day.
Dr. Otten is a member of the American Veterinary Dental Society (AVDS), American Veterinary Medical Association (AVMA) and the
Arizona Veterinary Medical Association (AZVMA). Personal interests include climbing, cycling, yoga, border collies and photography.
Acanthomatous ameloblastoma (CAA) is a
“benign” odontogenic tumor of epithelial origin
that arises from cells within the periodontium.
It is one of the most common oral tumors
we see in our practice. These tumors are
classified as benign, which means they are
contained locally and do not metastasize, but
they are locally destructive. There have been
reports of malignant transformation of canine
acanthomatous ameloblastoma. They have
historically been known by several names,
such as acanthomatous epulis, peripheral
ameloblastoma, and adamantinoma. Based on
histopathological characteristics and clinical
behavior, these tumors have been reclassified
as canine acanthomatous ameloblastomas.
Canine acanthomatous ameloblastomas
belong to the group of odontogenic tumors
commonly seen in the oral cavity. These
odontogenic tumors arise from remnants of
the embryonic tissues destined to develop into
teeth and associated structures. Occasionally,
not all of the embryological tissues that form
the tooth bud undergo apoptosis when tooth
formation is complete. Remnants of this
embryological odontogenic epithelium remain
in the periodontal ligament and gingiva for life.
It is these tissue remnants that contribute to the
formation of most odontogenic tumors.
In the past, CAA and the closely related
peripheral odontogenic fibroma (POF) were
frequently called acanthomatous epulis,
fibromatous epulis, or ossifying epulis. Recently,
pathologists have replaced acanthomatous
epulis with canine acanthomatous
ameloblastoma and fibromatous epulis
with peripheral odontogenic fibroma. The
word “peripheral” is often used to describe
odontogenic tumors, occurring only in the soft
tissues covering the tooth-bearing parts of the
jaws (i.e. gingiva and alveolar mucosa).
The term epulis (plural epulides) is derived from
the Greek word, epi-oulon, meaning on the
gum, and has been used to describe a nonspecific, focal gingival enlargement. The term
“epulis” is general and non-descriptive and
does not specify the origin, histologic or clinical
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appearance of any one specific tumor type.
Every oral swelling can be classified into either
a reactive lesion (i.e. focal fibrous hyperplasia,
pyogenic granuloma) an odontogenic tumor
(i.e. peripheral odontogenic fibroma, canine
acanthomatous ameloblastoma, odontoma,
amyloid-producing odontogenic tumor) or
a malignant oral tumor (i.e squamous cell
carcinoma, malignant melanoma). In dogs,
many epulides are actually odontogenic tumors.
Microscopic analysis by a pathologist with
formal training in oral pathology is required to
determine the true nature of any “epulis” tissue.
It is important for veterinarians to be aware of
the histologic classification of any epulis, oral
swelling or tumor, as the management of each
will be different.
ameloblastoma is accomplished by performing
an incisional biopsy with subsequent
microscopic examination of the biopsied tissue.
A wedge biopsy or punch biopsy should be
obtained within the bulk of the mass itself.
Peripheral biopsies, including marginal tissue
at the edge of the tumor are often unrewarding
and can complicate examination of the margins
following definitive excision.
Clinical Presentation and Management
Acanthomatous ameloblastoma often presents
as a non-pigmented exophytic gingival mass
with an irregular surface and may or may not
have an ulcerated surface (See figure 1). It
often will cause displacement of adjacent teeth.
The tumor generally occurs in the incisor and
canine region of the mandible and maxilla. The
radiographic appearance is dominated by bony
infiltration, alveolar bone resorption and tooth
displacement (See figure 2).
Acanthomatous ameloblastoma is the most
clinically significant odontogenic tumor due to
its aggressive invasion of bone, though it does
not metastasize in the dog. Prognosis is good,
but aggressive treatment is warranted to prevent
further bone destruction and local recurrence.
Simple excision or no treatment is not a good
option as these tumors can grow rapidly leading
to significant morbidity and ultimately will lead
to anorexia if left untreated. There is no breed
or sex predilection, but the tumor occurs most
often in dogs 7.5 to 10.5 years old.
Diagnosis of canine acanthomatous
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www.azvs.com Punch biopsy using a baker punch of a large CAA
Because acanthomatous ameloblastoma is
locally aggressive and invades bone, curative
surgical treatment requires an en bloc excision
of the tumor and at least 1 cm of normalappearing tissue. This is achieved by performing
partial mandibulectomy or maxillectomy (See
figures 3 and 4). Radiation therapy is also an
option, and good results have been reported.
Conventional radiation involves multiple
treatments over about 3 weeks of time. Local
side effects include hair loss and blister like
lesions in the mouth. We now have stereotactic
radiosurgery available, however, which takes the
treatment time down to only 1-3 fractions and
virtually eliminates the side effects. In addition,
malignant tumor formation has been reported
in up to 18% of previously irradiated sites.
Therefore, wide surgical excision is considered
the treatment of choice for acanthomatous
ameloblastoma. If the tumor is completely
excised, the prognosis is excellent.
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In a study of 154 oral tumors with the clinical appearance of epulides in 129 dogs, canine
acanthomatous ameloblastoma was reported in the rostral mandible (41%), caudal mandible (29%),
rostral maxilla (21%), and caudal maxilla (6%). Thus, for most cases of canine acanthomatous
ameloblastoma, partial or complete maxillectomy or mandibulectomy is necessary to achieve clean
surgical margins. While these procedures may sound quite invasive, most dogs recover quickly with
good function, minimal or acceptable disfiguration, and 100% long-term survival.
Figure 1
Figure 2
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Figure 3
CAA affecting the rostral left mandible
Figure 4
Immediate Post-op appearance of partial rostral left mandibulectomy
References
Verstraete FJM, Lommer MJ. Textbook of Oral and Maxillofacial Surgery in Dogs and Cats, 2012.
Bell CM, Soukup JW. Nomenclature and Classification of Odontogenic Tumors. J Vet Dent 2014; 31 (4) 234243.
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ARIZONA V
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AVS CORE VALUES
INNOVATION
We will strive to discover and share knowledge
that will continuously improve the veterinary
profession.
EXCELLENCE
At Arizona Veterinary Specialists, our standard is
excellence in all that we do and the way in which
we do it.
LEADERS IN SPECIALTY CARE
September 2015
Arizona Veterinary Specialists, LLC
86 West Juniper Avenue
Gilbert, Arizona 85233
Phone: 480.635.1110
Fax: 480.892.0540
COMPASSION
The spirit of all our relationships will be driven by
compassion.
PATIENT CARE
We are committed to providing compassionate,
ethical, and quality care to our patients. We treat
them as if they are members of our own families.
INTEGRITY
We will conduct ourselves in a manner that will
instill confidence and trust in all of our interactions.
Our mission is to enhance the quality of our
patients’ lives, to strengthen the human-animal
bond, and to provide a safe and stimulating work
environment for all of our team members.
Questions or comments?
E-mail us at [email protected]
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AVS news 5
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Services Offered at Arizona Veterinary Specialists, LLC
Arizona Veterinary Dental
Specialists, PLLC
Dentistry
♦♦Periodontics
♦♦Dental digital radiography
♦♦Root canals
♦♦Nasal disease treatment
♦♦Oral disease treatment
♦♦Oral surgery
♦♦Orthodontics
♦♦Restoration
♦♦Professional teeth cleaning
♦♦Maxillofacial surgery
♦♦Oral fractures
♦♦Fractured teeth treatment
♦♦Malocclusion treatment
♦♦Crown therapy
♦♦In house lectures
♦♦Telephone radiographic consultation
♦♦Bite evaluation
Eye Care for Animals, dba
Ophthalmology
♦♦Biomicroscopy
♦♦Indirect ophthalmoscopy
♦♦Electroretinography
♦♦Ultrasonography
♦♦Applanation tonometry
♦♦Fluorescein angiography
♦♦Glaucoma treatment
♦♦Cataract surgery
♦♦Corneal reconstructive surgery
♦♦Treatment of eyelid abnormalities
Arizona Veterinary
Oncology, PLLC
Radiation Oncology
♦♦Chemotherapy
6 AVS news
September
2015
Desert Veterinary
Medical Specialists
Internal Medicine
♦♦Endoscopy
•Bronchoscopy
•Bronchoalveolar lavage
•Colonoscopy
•Cystoscopy
•Foreign body retrieval
•Gastroduodenoscopy
•PEG tube placement
•Rhinoscopy
♦♦Endocrine disorders
♦♦Emergency consultations
♦♦Blood and plasma transfusions
♦♦Gastrointestinal diseases
♦♦Genitourinary disorders
♦♦Hepatic diseases
♦♦Infectious diseases
♦♦Intensive care treatment
♦♦Immune-mediated diseases
♦♦Nutrition consultations
♦♦Oxygen therapy
♦♦Pancreatic diseases
♦♦Pulmonary diseases
♦♦Renal disease
♦♦Respiratory diseases
♦♦Second opinion examinations
♦♦Ultrasonography
♦♦Tracheal and urethral stenting
Cardiology
♦♦Conventional Radiation Therapy
♦♦Stereotactic Radiosurgery
♦♦I-131 radioactive iodine treatment
Medical Oncology
♦♦Immunotherapy
♦♦Cryotherapy
♦♦Oncologic surgery
♦♦Clinical trials
♦♦Echocardiography
♦♦Electrocardiogram (ECG)
♦♦Chest radiographs
♦♦Blood pressure
♦♦Pericardiocentesis
♦♦Cardiology breed certification
♦♦Holter monitoring
www.azvs.com ♦♦Event monitoring
♦♦Non-surgical PDA repair
♦♦Balloon valvuloplasty
♦♦Pacemaker implantation
♦♦Invasive blood pressure measurements
♦♦Angiography
♦♦Implantable ECG Loop Recording
Radiology
♦♦Outpatient and inpatient ultrasound
♦♦Radiology Rounds
♦♦Digital radiography
♦♦Helical CT scanning
♦♦Fluoroscopic urinary, GI, and tracheal
studies
♦♦Nuclear imaging
•GFR scans
•Bone scans
•Thyroid scans
•Splenic scintigraphy
♦♦Radiographic interpretation
♦♦CT and MRI interpretation
Dermatology for Animals, PC
Dermatology
♦♦Allergy testing (skin testing) and
immunotherapy
♦♦CO2 laser for ablation of skin tumors
♦♦Testing for food allergies and
hypoallergenic diets
♦♦Ear disease diagnosis and treatment
♦♦Bacterial and fungal skin disease
diagnosis and treatment
♦♦Cytological smears and microbiologic
examinations
♦♦Ectoparasite identification and
treatment
♦♦Immune-mediated and hormonal skin
disease diagnosis and treatment
♦♦Treatments of nail and nail bed
disorders
♦♦Skin biopsy sampling and
histopathology interpretation
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Southwest Veterinary
Surgical Service, PC
Surgery
♦♦Abdominal surgery
♦♦Airway surgery
♦♦Angular limb deformity surgery
♦♦Arthroscopy
♦♦CT Scans
♦♦External skeletal fixation
♦♦Fracture repair
♦♦Laparoscopy and Thoracoscopy
♦♦Neurologic surgery
♦♦Oncologic surgery
♦♦Oral surgery, such as maxillofacial
surgery and oral fractures
♦♦Orthopedic surgery
♦♦Otologic surgery
♦♦Perineal surgery
♦♦Reconstructive surgery
♦♦Ring fixators
♦♦Soft Tissue surgery
♦♦Thoracic surgery
♦♦Tibial Plateau Leveling Osteotomy
(TPLO)
♦♦Triple Pelvic Osteotomy (TPO)
♦♦Total Hip Replacement (THR) both
cemented and cementless procedures
available
♦♦Tracheal Stenting
♦♦Tibial Tuberosity Advancement (TTA)
Anesthesia and Pain
Management
♦♦Anesthetic management of high risk
and critical care patients
♦♦Extensive anesthesia monitoring
•Blood pressure, both direct
and indirect
•Pulse oximetry
•Electrocardiogram
•Capnography
•Body temperature
•Ventilator therapy
♦♦Pain patches
♦♦Chronic pain management consultations
Emergency Animal Clinic,
PLC
Emergency and Critical Care
♦♦In house diagnostic tests
•STAT laboratory blood tests
* Complete Blood Count (CBC)
* Serum biochemical analysis
* Blood gas analysis
* Urinalysis
* Blood lactate measurement
* Coagulation testing
* Ethylene glycol (Antifreeze) testing
* Parvovirus testing
•Digital x-rays
* Radiologist interpretation
•Scanning ultrasound
•Gastrointestinal endoscopy
♦♦Specialized Therapies
•Intravascular volume expansion/shock
therapy
•Blood component therapy
•Rattlesnake antivenom therapy
•Oxygen
•Short and long term ventilator therapy
•Anesthetic ventilator
•Pain medication delivery via
constantrate infusion
•Nutritional support
•Feeding tube placement
•Peritoneal dialysis
•Continuous suction for chest and
other drains
•Central and peripheral IV catheter
placement
•CPR with advanced life support
•Electrical defibrillation & emergency
cardioversion
•Anesthesia for high-risk critical
patients
♦♦Soft tissue emergency surgical
procedures performed by our
emergency veterinarians
(included, but not limited to):
•Wound repair
•Emergency tracheostomy
•Chest tube placement
•Abdominal surgeries
•Gastric Dilatation Volvulus (GDV) or
bloat surgery
•GI foreign body removal
•C-section
•Splenectomy
•Bladder stone removal
♦♦Intensive monitoring
•Electrocardiogram (EKG)
•Blood pressure
(direct arterial and indirect)
•Urinary catheter placement and
measurement of urine output
•Pulse oximetry (Oxygen saturation)
•Capnography (End Tidal CO2)
•Central venous pressure
•Arterial and venous blood gas
measurement
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AVS Specialty Practices
ARIZONA V
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Southwest Veterinary
Surgical Service, PC
Arizona Veterinary
Oncology, PLLC
Dermatology for
Animals, PC
Desert Veterinary
Medical Specialists
♦♦Bradford C. Dixon, DVM, MS
Diplomate, American College of
Veterinary Surgeons
♦♦Eric Boshoven, DVM
Diplomate, American College of Veterinary Radiology
(Radiation Oncology)
♦♦Thomas P. Lewis II, DVM
Diplomate, American College of
Veterinary Dermatology
♦♦Victoria Heffelman, DVM
Diplomate, American College of
Veterinary Radiology
♦♦Anthea E. Schick, DVM
Diplomate, American College of
Veterinary Dermatology
♦♦Janet K. Bailey, DVM
Diplomate, American College of
Veterinary Internal Medicine
♦♦Rebecca Mount, DVM
Diplomate, American College of
Veterinary Dermatology
♦♦Whit M. Church, DVM
Diplomate, American College of
Veterinary Internal Medicine
(Cardiology)
♦♦Tara M. Enwiller, DVM, MS
Diplomate, American College of
Veterinary Surgeons
♦♦Jeffrey A. Steurer, DVM, MS
Diplomate, American College of
Veterinary Surgeons
♦♦Kathleen M. Rowe-Guthrie DVM, MS
Diplomate, American College of
Veterinary Surgeons ♦♦Rachel Seibert, DVM, CCRP
Diplomate, American College of
Veterinary Surgeons
Arizona Veterinary
Dental Specialists,
PLLC
♦♦Chris Visser, DVM
Diplomate, American Veterinary
Dental College
Diplomate, European Veterinary
Dental College
♦♦Curt Coffman, DVM
Diplomate, American Veterinary
Dental College
♦♦Lynda Beaver, DVM
Diplomate, American College of
Internal Medicine
(Medical Oncology)
♦♦Rachel Venable, DVM, MS
Diplomate, American College of Internal Medicine
(Medical Oncology)
Emergency Animal
Clinic, PLC
♦♦Brandi Garcia, DVM
Diplomate, American College of
Veterinary Emergency and
Critical Care
♦♦Raegan Wells, DVM, MS
Diplomate, American College of
Veterinary Emergency and
Critical Care
♦♦Katherine Smith, DVM
Diplomate, American College of
Veterinary Emergency and
Critical Care
Oral Surgery)
September
2015
♦♦Carine Laporte, VMD
(Practice Limited to Dermatology)
♦♦Diana Simoes, DVM
♦♦Michael Balke, DVM
(Practice Limited to Dentistry and
8 AVS news
www.azvs.com (Practice Limited to Dermatology)
Eye Care for
Animals, dba
♦♦Lisa M. Felchle, DVM
Diplomate, American College of
Veterinary Ophthalmology
♦♦Paul M. Barrett, DVM
Diplomate, American College of
Veterinary Ophthalmology
♦♦Melissa Riensche, DVM
Diplomate, American College of
Veterinary Internal Medicine
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