Baboon with a hemifacial abscess"Sage”is a 18 year old female baboon, with a body weight of approximately 12 kgs.We performed a previous surgery on her about 7 months ago, due to a dental fistula located in the middle of the external corner of the eye and the comissura buccalis on the left side of the face, just along the zygomatic arch. The surgery consisted in the removal of the first molar tooth and fistulectomy. |  | | Fig. 1 |
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| This time there was a very large hemifacial abscess on the opposite side of the face, the swelling involved the whole right side of the face and made very difficult the closure of the eye lid on the right side (Fig.1). There was a large area of the face covered with a crust that resulted after the spontaneous break of the abscess formation and elimination of the purulent discharge. After applying the premedication which consisted of Zoletil, here in a dosage of 0,3 ml, administered intramuscularly and induction with Propofol 35mg, intravenously continued with inhalation anesthesia using isofluran. |  | | Fig. 2 |
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The trajectory of the fistula lead it’s way to the last molar tooth (3rd molar) as we can see in Fig.2 the probe pointing at the intraoral emergence point of the fistula. After local anesthesia (local nerve block) with articaine (Ubistezin forte) at the infraorbital foramen we proceeded to debridement of the external skin wound by removing the crusts and spraying with a propolis-iodine based antiseptic solution. |  | | Fig. 3 |
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After debridement a 2-3 mm size fistula skin opening was revealed as pointed with a black arrow in Fig.3.The intra-oral Xrays were performed using a size 4 occlusal film, a bisecting angle incidence and the dental X-ray Unit. After developing the film it became clear why "Sage” had a facial swelling. |  | | Fig. 4 |
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The red arrow in Fig.4 numbered with 1 shows the first causing tooth was the second premolar tooth that had a large periapical abscess visible on the film as a 1 cm diameter large lucency around the distal root of the tooth. The lucency although not so impressive was present as a 2 mm rim surrounding all 3 roots of the last molar tooth as pointed by the red arrow numbered with 2 in the same Fig.4. After corroborating the X-ray images with the clinical aspect we realized that we are dealing with a dual problem and that our fistula had in fact 2 braches, one leading to the 2nd premolar and the other leading it’s way to the above mentioned 3rd molar. |  | | Fig. 5 |
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The conclusion was to extract both teeth. We extracted the molar by separating the tooth crown in 2 parts. Separation was performed with the high-speed turbine using a round steel burr. The premolar did not necessitate separation and the extraction did not pose any special technical difficulty. After extraction we had a moderate amount of bleeding which was controlled using Tabotamp (cellulose based resorbable hemostypticum, Ethicon) as we can see in Fig.5. |  | | Fig. 6 |
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The pathologically involved premolar was successfully extracted "in toto” (Fig.6). Both post-extractional alveoli were not sutured after extraction. However the 3 by 10 cm large skin wound needed protection after proper antisepsis and curettage. This protection was assured using a non-adherent dressing (Inadine, from Johnson and Johnson) which was fixated to the wound using several simple interrupted sutures using a 3.0 resorbable Vycril material. We used antibiotherapy (Cefazolin) for 10 days and a proper pain management control protocol. Now 3 days later we heard that "Sage” is eating again and is gaining weight after a period of considerable pain and almost total loss of appetite. DDr. Camil Stoian PhD |  | | Fig. 7 |
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Veterinary Dentistry
