Osteonecrosis of the Jaws in an 8-year-old Mixed Breed Dog

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An 8-year-old female spayed mixed breed dog was presented to the Cornell Emergency Service for a suspected infection of odontogenic origin ("tooth root abscess"). In December 2017, the owners noticed that the patient was lethargic and had stopped eating dry food. The patient was also seen by an internal medicine specialist who suspected masticatory muscle myositis (MMM) and prescribed mycophenolate 250 mg twice daily and tramadol 50 mg twice daily. On 3/27/18 the patient became anorexic and seemed lethargic. A different internist ruled out MMM through a type 2M autoantibody test and discontinued the mycophenolate. A swelling below the right eye and some masticatory muscle atrophy on the right were noted. Physical examination revealed a painful swelling below the right eye, bilateral masseter and temporal muscle atrophy (more severe on the right than left), and halitosis. Bloodwork was unremarkable. A computed tomography study revealed osteonecrosis of a portion of the right caudal maxilla with a sequestrum of bone. An anesthetized oral exam and targeted dental radiographs also showed necrosis of the soft tissues in this region. Extraction of the right maxillary fourth premolar and first molar teeth, surgical debridement with rinsing of the necrosed tissues of the right caudal maxilla, and removal of necrotic bone and the sequestrum were performed. The patient recovered well and began eating that night. The following morning the patient was discharged on antibiotics (clindamycin 10 mg/kg q12h for 4 weeks) and meloxicam and gabapentin for pain control. Several months later the owner reports that the patient is doing very well at home, eating comfortably.
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