Getting to the Root of the Problem
There is an old adage that you see common things commonly, but some days, you see such weird stuff that you just have to get excited and talk about it. I had one of those days last week!
“Max” is a four-year-old neutered male that came in with a 2-year history of nasal discharge from his left nostril. Now, he improves on antibiotics, but the discharge soon returns when antibiotics are discontinued.
At this point as I am taking the history, I am starting to run differential diagnosis lists through my head, and these include a foreign body, dental disease/tooth root abscess, cancer (less likely based on dog’s young age), allergic rhinitis (unlikely since only one side was affected), or infectious (usually dogs feel much worse than this dog if they have fungal disease). Then, the owner told me that Max lost his upper canine tooth approximately 2 years ago.
So, I ran some lab work to ensure that Max didn’t have any problems that would make anesthesia and biopsy unsafe for him, and his lab work was all normal. Then, I anesthetized him for his CT. Here is an image from his CT scan.
As you can see, there is asymmetry and something with a bone density inside the left nasal passage. The next step was his rhinoscopy. With the scope, I could see a large amount of whitish discharge approximately 2.5 cm inside Max’s nose. As we were trying to get a piece of it for biopsy and culture, we pulled out this.
That’s a tooth root! Is that not the coolest thing ever?! When Max’s tooth was pulled, the root broke off, broke through the bone into his nose, and migrated into his nasal passage! That doesn’t happen often. In fact, it's really rare according to veterinary dentists. I have never pulled a tooth out before – sticks, yes. Teeth, no.
When, we finished pulling out the tooth root, we re-scanned Max, and here is his CT afterwards.
As you can see, there is no foreign material left in his nose. A culture has been performed, and after this round of antibiotics, Max should be good as new!
Before I finish this, let me say a couple of things about nasal disease. In case you don’t know, I have lost two of my own pets to nasal lymphoma – Harley, a huge orange and white polydactyl cat from Boston, and Peyton, my beloved standard poodle. Nasal discharge is a symptom of many diseases, and allergic rhinitis is really common in Oklahoma. However, if you ever see blood in the discharge, panic. Nosebleeds in animals are never normal! A nosebleed from both nostrils can be seen with systemic diseases like immune disease, tick-borne disease, or even high blood pressure, but a nosebleed from one side is almost always cancer. That’s why I hit the panic button, and I will always recommend a CT and rhinoscopy to evaluate this problem.
Pretty cool, huh?! I may never see this again, and I hope this was as fun and satisfying for you as it was for me!
#dog #vet #Veterinarian #dental #dentistry #rhinoscopy #CTscan #CT #tooth