dear colleague: - avd web viewthe case report (as a word document, with photographs and radiographs...

CREDENTIALS APPLICATION

ACADEMY OF VETERINARY DENTISTRY

Small Animal - July 2015

Please read this Application document completely before assembling your submission. In 2015, all items are to be submitted through DMS, except as noted below; instructions for submitting an application through DMS are given below. If you have any questions regarding the use of DMS, please read the DMS User’s Guide (available via a link in the DMS Welcome screen). If you are still unable to complete a DMS action, contact Colin Harvey, the Academy DMS Administrator, at [email protected].

The Academy recommends that you prepare your required application items before the deadline, so that a complete package is available for review as of July 15 deadline, and that you submit your case reports for review well prior to the July 15 deadline.

If an applicant is suspected of dishonesty based on the credentials application or case reports, a note will be sent to the applicant requesting an explanation for the apparent discrepancy. The applicant will have ten (10) days to respond to the request for clarification. If the explanation is satisfactory, the credentials application will be reviewed as submitted. If the explanation is not determined to be satisfactory, the credentials committee has the right to not approve the credentials application.

All application materials remain the property of the Academy of Veterinary Dentistry and will not be returned.

Contents of this Document

Required Items and Submission Format Page 2Submission via DMS Page 3Minimum Case Requirements and Case Log Page 4Letters of Evaluation – Instructions Page 7

Forms:Credentials Application Form Page 8Credentials Application Agreement Page 9Applicant and Mentor Accountability Form 0Credentials Application Checklist Page 11Credentials Applicant Evaluation Form Page 12

Case Report Instructions Page 16Case Report Evaluation Page 15Case Report Example Page 17

Academy Credentials Application and Information, 2015 Page 1

mailto:[email protected]

Academy Credentials Application and Information, 2015

REQUIRED ITEMS and SUBMISSION FORMAT

The following items MUST be submitted by July 15:

1. Items to be sent directly to Academy Secretary, Dr. Kathy Queck, The Carolinas Animal Hospital and Dental Clinic, 13331 York Center Dr, Suite A, Charlotte, NC 28273, USA.a. Completed and signed Application form, b. Completed and signed Applicant/Mentor Accountability Form, c. Completed, signed and notarized Agreement form, d. Completed Credentials Application check list,e. Payment of the $300 application fee (included in a separate envelope).f. Letters of evaluation (three), to be sent directly to Dr. Queck by the writer.

2. Items to be available in your DMS case log as of July 15:a. See Minimum Case Requirements, below.b. Case Log showing cases accumulated during at least the 24 months prior to July 15,

2015. c. The case log must show that the minimum required case load has been met in all

categories. d. If there are case log deficiencies present 60 days prior to the July 15 submission date,

the applicant is to send an appeal letter to the Secretary 60 days prior to the July 15 submission date, describing the case log deficiency and providing an explanation for the deficiency. Once received, the Credentials Committee chair will decide if the deficiency is too significant to review the rest of the application.

3. Items to be submitted as files in a Credentials Application document via DMS. See

details under DMS Submission, below. a. Veterinary school diploma and veterinary license.b. Dental chart and anesthesia record.c. Equipment list.d. CE and informal dental education spreadsheets.e. Personal library list.

4. Four case reports approved following blinded review by the Credentials Committee must be on record before a credential application can be approved. See the Case Report section, below, for information on format and content.

a. At least two of the required four case reports must have been pre-approved or have been submitted and are under review by the July 15 deadline, or are submitted at the same time as a credentials application by the July 15 deadline.

b. If you are unable to complete all four case reports by the July 15 deadline, you may request delayed submission up to October 15, 2015 for the remaining one or two case reports. If this is necessary, include a note with your credentials application explaining why delayed submission is requested.

c. Delayed submission requires approval by the Credentials Committee chair; if a credentials application is submitted without all four case reports and no request for delayed submission is included, or if the Credentials Committee chair does not approve the request for delayed submission, the credentials application will not be considered further.


d. If a previously submitted case report is not approved and you are unable to submit a replacement case report by the October 15 deadline, your credentials application will not be approved even if everything else has been completed satisfactorily.


SUBMISSION via DMS

1. Generate and name the files on your computer as directed below.2. Log in to the Academy DMS site using the Academy User Name and Password assigned

to you (the User Name is your FirstnameLastname with no spaces or dashes – e.g. KrisBannon). Your password, unless you have already changed it in DMS, is your last name in lower case letters. Remember that you can change your password once you are logged in to DMS.

3. On the Welcome screen, click Begin a New Document to Submit to the Academy. 4. Click Credentials Application from the Type of Document drop-down menu. 5. Click Attach Multiple Files, and drag and drop the required files to the Upload window,

then click Start Upload. 6. When the screen changes back to the Credentials Application document, check that the

files have all uploaded successfully, and click Save Changes.

A. Veterinary Diploma - Veterinary diploma (scanned or photographed). File name: Lastname,Firstname Diploma (e.g. Bannon,Kris Diploma)

B. Veterinary License - Current veterinary license (scanned or photographed). File name: Lastname,Firstname License (e.g. Bannon,Kris License)

C. Dental Chart and Anesthesia Record - Reproduction of your blank dental chart and anesthesia record, with your name and other identifying informed not visible. Submit as high quality scanned or photographed images, to ensure legibility. File name: Record, Dental and Record, Anesthesia as appropriate. Do NOT put your name on these file names, to ensure that the file will be reviewed anonymously.

D. Equipment: A list categorized by discipline and with photographs of your dental operatory and equipment. Include all instrumentation, materials, and equipment, from the most basic instrument to the most complex materials. Organize the contents under the following categories, as listed in the AVD Application Checklist.

i. Dental Operatory, ii. Anesthesia/Monitoring,

iii. Power hand-pieces, iv. Dental radiograph equipment, v. Periodontal surgery,

vi. Endodontic, vii. Restorative,

viii. Oral surgery,ix. Orthodontics.

Include a single *.doc or *.pdf file named e.g. Equip Endo for each of the categories named above. If more than one image is required to illustrate the full range of equipment etc. for that category, place the individual images into a single .doc file for that category. Do NOT upload each image individually to DMS. The equipment category files are to be NO MORE than 2 MB each, which may require compressing the image.

E. Continuing Education and Informal Dental Education. Three Excel spreadsheets, as listed below, using the excel spreadsheet formats available on the “Become a Fellow” page of www.avdonline.org. Do not include your name anywhere in the spreadsheets.


i. Lecture Continuing Education Hours. A list the continuing education programs you have attended in veterinary and human dentistry during the past three (3) years. Include dates, sponsoring organizations, names of speakers and topics covered. The date of lecture, speaker and number of hours are required. Minimum requirement: 40 hours of lecture, with at least 30 hrs. attended in person and a maximum of 10 hrs. of RACE approved online C.E. The applicant is also required to attend at least 2 Veterinary Dental Forums in the past 3 years. Name this file: LectureCE.

ii. Wet Lab and In Person Instruction Hours: Documentation that you have attended a minimum of 40 hours of AVD or AVDC approved wet-labs during the past three (3) years. In addition, at least 40 hrs must be spent working with the mentor or receiving in-person instruction by a Fellow of the Academy or a Diplomate of the American Veterinary Dental College. An example of in-person instruction would be time spent with your mentor where either the applicant or mentor are performing dental cases, with active instruction and discussion. Name this file: WetLabCE.

iii. Informal Veterinary Dental Education. Examples: informal conversations (either in person, by phone, by e-mail or by internet meeting) with dentists, veterinary dentists, or other qualified professionals regarding dental techniques or theory, and practicing of procedures on cadavers. Include dates, participants, and topics discussed, or dates of cadaver procedures performed. When practicing cadaver procedures, take radiographs and/or pictures to document your work. If an applicant has nearly achieved but is still lacking the minimum case log requirements near the time of submission, performing needed procedures on cadavers with appropriate documentation may allow an almost complete package to be evaluated by the committee (see “Case Log” below). Name this file: InformalCE.

F. Personal Library. List the human and veterinary dental texts and journals available in your personal library, including journals and texts with publication dates and edition numbers. Your personal library should include the textbooks and journals in the ‘Suggested Reading List’. Name this file: Library.

MINIMUM CASE REQUIREMENTS – SMALL ANIMALThe Case Log must show cases accumulated during at least a 24 months period during the three years prior to July 15, 2015, even if the number of cases available exceeds the minimum requirements. The case log must also show that the minimum required case load has been met in all categories. Read the DMS User’s Guide for information on how to enter case information in the online case log. If you have difficulty deciding where a procedure belongs, please ask your mentor for advice.

Radiology:Write Yes in the ‘Radiographs:’ field in the New/Edit Case Log Entry screen if radiographs were taken. Radiographs are REQUIRED in all disciplines and all cases, except OR1 cases that were not anesthetized. Academy requirement: Minimum of 100 cases radiographed.

Periodontics:PE1: Complete prophylaxis not requiring involved periodontal treatment.


PE2: Involved periodontal scaling and root planing. All PE2 cases include complete prophylaxis. PE2 includes placement of a perioceutic medication when no periodontal procedure defined in PE3 or PE4 is performed.

Academy requirement: Total of 300 cases in PE1 and PE2 combined.

PE3: Simple periodontal surgery. Examples: Gingivoplasty (gingivectomy), flap procedure and open curettage, except those combined with bone grafting or guided bone regeneration. Includes periodontal scaling as part of the procedure. When a flap incision(s) is made to extract a tooth, this is an OS2 procedure, not a PE3 procedure.

PE4: Involved periodontal treatment. Examples: Osseous surgery; increasing attachment height; bone augmentation; gingival grafting; guided bone regeneration (requires placement of a membrane); periodontal splinting; crown lengthening procedure with alveolar bone contouring. Includes periodontal scaling as part of the procedure. Note: Extraction followed by placement of a bone substitute or bone promoting material is not a PE4 case.

Academy requirement: Total of 15 cases in categories PE3 and PE4 combined.

Endodontics:EN1: Mature canal endodontic obturation, non-surgical. EN2: Vital pulp therapy (partial vital pulpectomy). EN3: Endodontic treatment other than non-surgical mature canal obturation or vital pulp

therapy. Examples of EN3: Surgical endodontic treatment; apexification; replacement and endodontic therapy of avulsed or luxated teeth; splinting of tooth with horizontally fractured root with follow-up endodontic evaluation.

Academy requirement: Total of 25 cases in categories EN1, EN2 and EN3 combined.

Restorative Dentistry and Prosthodontics:RE: Includes restoration of fracture defects or enamel hypoplasia or enamel bulge

reconstruction that requires cavity preparation, application of appropriate materials including a permanent restorative material and finishing of the restored surface. Does not include restoration of endodontic access openings unless the Academy tracker has accumulated sufficient EN1 or EN2 cases and has not accumulated sufficient RE cases, in which case an endodontic case requiring restoration of the coronal access can be categorized as a RE case if the coronal access is restored using full restorative procedure (cavity preparation, application of appropriate materials including a permanent restorative material, and finishing the restored surface) – the case cannot also be logged as an EN case.

PR: Crown preparation and cementation cases. Cases logged as PR in an Academy tracker case log will be counted as RE cases in the Academy case category summary list because there is no PR requirement in an Academy log.

Academy requirement: Total of 10 cases in RE and PR combined.

Malocclusion Management:OR1: Malocclusion treatment plan, including detailed consultation and recording of the

evaluation of the bite or bite registration, impressions, study models, with or without occlusal adjustment; occlusal adjustment in horses or exotic species. Anesthesia is not necessary for a case logged as OR1.

OR2: Extraction of deciduous teeth or permanent teeth causing malocclusion.


OR3: Management of clinical malocclusion. Examples: Crown amputation; application of an inclined plane. Excludes cases listed under OR1 or OR4. Multiple procedures performed on individual teeth of one patient may not be logged as multiple ‘cases’; for example: Bilateral mandibular canine crown reduction and vital pulp therapy counts as one OR3 case.

OR4: Management of malocclusion using an active force orthodontic device. Excludes cases listed under OR1 or OR3. Multiple procedures performed on individual teeth of one patient may not be logged as multiple ‘cases’; for example: Correction of mesioversion of a maxillary canine tooth followed by correction of labioversion of the mandibular canine tooth counts as one OR4 case.

Academy OR requirement: At least two OR3 or OR4 cases plus a total of 15 cases in categories OR1-4 combined.

Oral Surgery:A procedure is considered “Oral Surgery” if it involves surgical treatment of oral pathology that is adversely affecting the normal function of the oral cavity. OS1: Simple extractions, crown amputations. Academy Minimum OS1 requirement: 10 cases.OS2: Involved extractions (open or closed, requiring tooth sectioning, bone removal or other

procedures in addition to work with elevators and forceps). A “full-mouth extraction” patient may be logged as three OS2 cases if involved extractions were performed in at least three arches.

Academy minimum OS2 requirement: 5 cases.OS3: Fracture management. Mandibular or displaced maxillary fracture fixation (using muzzle

and/or dental acrylic splint; body of mandible fracture fixation with wire, pins, screws or plate; symphyseal separation fixation).

Academy minimum OS3 requirement: 3 cases.OS4: Involved oral surgical procedures. Examples: temporomandibular condylectomy, repair of

existing palatal defects or oronasal fistulas, maxillectomy, mandibulectomy. Academy minimum OS4 requirement: 3 cases: An Academy log that includes only one type of

procedure to fill all three cases in this category will not be approved.OS5: Miscellaneous soft tissue oral surgery. Examples: Resection of traumatic cheek or

sublingual granuloma-hyperplasia; salivary gland surgery; removal of oral masses not requiring maxillectomy or mandibulectomy; operculectomy; gingival wedge resection; laser surgery for stomatitis; closed reduction of temporomandibular joint dislocation.

Academy minimum OS5 requirement: 4 cases.

Case RoleUse the drop-down menu in the Case Role field in the Case Log Entry screen to indicate your role in the procedure: A = Assisted an AVDC Diplomate (case managed primarily by the AVDC Diplomate, including

diplomates who are also Academy Fellows).S = Secondary operator, working as an assistant to an Academy Fellow [who is not an AVDC

Diplomate] or human dentist (case managed primarily by the Fellow or human dentist). P = Primary dentist (case managed primarily by the Academy tracker/AVDC trainee), without

supervision by an Academy Fellow or AVDC Diplomate. PA = The Academy tracker or AVDC trainee was the primary dentist, assisted by an Academy

Fellow, AVDC Diplomate or a human dentist.


RA = The trainee/tracker and another tracker or trainee worked together as primary dentist on the case, under supervision of an AVD Fellow or AVDC Diplomate.

Academy Requirement: Fifty percent (50%) of cases in each subcategory (e.g. EN2, OS4) are expected to have been treated by the Academy tracker as primary dentist (P, PA or RA): if this is not true in a specific category, provide an explanation to account for the discrepancy.

Collaborative Cases: In the column labeled “P, PA, S”, designate those procedures performed in collaboration with another veterinarian or dentist including the name of the individual. You must designate whether you were primary or secondary operator for those procedures that were done with another doctor. P means you were the primary and were not assisted by a Diplomate, Fellow or human dentist. PA means that you were the primary operator for the case and were assisted by an AVD Fellow, AVDC diplomate or human dentist. S means that you were the secondary operator assisting a fellow, diplomate or human dentist.

Fifty (50) percent of cases in each subcategory are required to be either P or PA: if this is not true in a specific category, provide an explanation to account for the discrepancy.

LETTERS OF EVALUATION INSTRUCTIONS Letters of evaluation AND the completed Evaluation Form (page 12) are required from three (3) colleagues and shall be mailed directly by these individuals to: Kathy Queck, DVM, FAVD Phone 704-588-9788 Secretary of the Academy of Veterinary Dentistry Fax 704-588-9781 The Carolinas Animal Hospital and Dental Clinic Email [email protected] 13331 York Center Dr., Suite A, Charlotte, NC 28273 Evaluators shall use the attached evaluation form. Evaluators are also REQUIRED to write a letter of evaluation. Evaluations should come from qualified professionals that are very familiar with veterinary dental techniques and procedures. Academy or College members who have personally observed your work are preferred and highly recommended. A dentist who has observed your work on several occasions could be acceptable. A general practitioner, who has referred multiple cases to you and has seen and followed the referred cases, could also be acceptable, but not as desirable. More weight is given to reference letters from veterinary dental experts than from other individuals.

Be sure to share the information above with the individuals who you ask to write your letters – download the Recommendation Evaluation Form from the Become A Fellow web page.


Academy of Veterinary Dentistry

2015 CREDENTIALS APPLICATION FORM Name ____________________________________________________________________________ (Last, First, Middle)

Office Address _____________________________________________________________________ (Company Name) _______________________________________________________________________________ (Street Address, City, State, Zip Code) Office Phone _________________ Home Phone ___________________Fax ___________________ Email Address __________________________ Date of Graduation _____________________________________________________ Veterinary School and Degree ____________________________________________ Other Degrees/Diplomas ________________________________________________ Veterinary License No. _______________________ State _____________________ Member of American Veterinary Dental Society since _________________________ List the names, addresses and business telephone numbers of three (3) colleagues who will be providing letters of reference. Appropriate individuals include human dentists, Fellows of the Academy and board certified veterinary clinicians with whom you have worked. 1. Name _____________________________________________________________

Address ____________________________________________________________ Business Phone ______________________________________________________ 2. Name _____________________________________________________________

Address ____________________________________________________________ Business Phone ______________________________________________________ 3. Name _____________________________________________________________

Address ____________________________________________________________


Business Phone ___________________________________________________



CREDENTIALS APPLICATION AGREEMENT

I hereby apply to the Academy of Veterinary Dentistry for admission to the qualifying examination in accordance with its rules and herewith enclose the application fee. I also hereby agree that prior to or subsequent to my examination the Executive Board of the Academy may investigate my standing as a veterinarian, including my reputation, for complying with the standards of ethics of the profession. I agree that no fee paid by me shall be refundable to me except and as may be expressly provided by the Constitution and By-Laws of the Academy. I further covenant and agree that: 1. Letters or Reference Forms sent in on my behalf will be confidential to the Credentials

Committee and Board of Directors of the Academy and are not available to me for review. 2. I indemnify and will hold harmless the Academy of Veterinary Dentistry and each and all of

its members, officers, examiners and agents from and against any liability whatsoever in respect of any act or omission in connection with this application, such examination, the grades upon such examination and/or the acceptance or rejection of me as a prospective Fellow of the Academy of Veterinary Dentistry.

3. My status and any certificate as Fellow of the Academy that may be granted to me, shall be and remain the property of the Academy of Veterinary Dentistry.

I hereby state that all documents, photographs, statements and other accompanying material in the application and Credentials Package are true and correct. Signature



APPLICANT and MENTOR ACCOUNTABILITY FORM Anonymous submissions: Be sure to white out all hospital name headings and references to the hospital or you in all of the documents in your application package, except in the Application Form and this Form. The chairperson of the Credentials Committee will hold the Reference forms and letters of evaluation, the diploma, the state veterinary license and the agreement form. Submit this signed letter from yourself and your mentor (see attached) stating that the submitted information is the applicant’s own work. The chairperson will assign each application package a number and the packages will be evaluated anonymously by each committee member. I hereby certify that the enclosed application package is my own work. ____________________________________Date______________________________ Signed Applicant I hereby certify that I have worked with this applicant in his/her application process and I certify that to the best of my knowledge the information contained in his/her application is correct, true, and his/her own work. _____________________________________Date_____________________________ Signed Mentor Case Reports, Case Logs, and Continuing Education documentation: I hereby certify that I have reviewed the applicant’s case reports, case logs, continuing education lists, equipment list, and other requirements and I certify that to the best of my knowledge the information contained in his/her application is complete according to the current requirements. _____________________________________Date_____________________________ Signed Mentor



CREDENTIALS APPLICATION CHECKLIST If any of the items below are not included with the application package the entire application package will NOT be evaluated and will be returned to the applicant as incomplete. ALL of the items below must be included for the application package to be evaluated. □ Three Reference Evaluation forms and letters (submitted directly to the Academy Secretary)* □ Applicant/Mentor Accountability Form signed by applicant and mentor* □ Agreement signed and notarized* □ Reproduction of Veterinary Diploma* □ Reproduction of Veterinary License* □ Copy of Oral Dental Record Forms, Canine and Feline □ Copy of Anesthesia Record Form □ Photographs and List of Equipment and Supplies

□ Dental Operatory □ Anesthesia / Monitoring □ Power Hand-pieces □ Dental Radiograph Equipment□ Periodontal Surgery □ Endodontic □ Restorative □ Oral Surgery □ Orthodontics

□ Lecture Continuing Education Hours □ Wet Lab or In-Person Instruction Hours □ Informal Dental Education □ Personal Library –Books and Journals □ Case Logs □ Minimum Case Log Requirements □ Four Case Reports - See Case Report Requirement section. If only two or three case reports were submitted prior to or with the credentials application, include a request for delayed submission of the one or two case reports not yet submitted.If one or more case report(s) have been pre-approved, include the approval certificate(s).For Case Reports submitted with the application, check the following items: Medical, and other records included (without clinic and applicant names) Four reports in separate disciplines Author was the primary person performing the case Pre-, intra- and post-procedure radiographs Requirements for follow-up are met No more than 10 pages of text (not including title page, footnotes, references or images) Photographic documentation includes pre-, intra-, post-procedure and follow-up: figures

labeled and captioned

*Documents are held by the Committee chairperson to ensure anonymous evaluation of Credentials Application packages.



CREDENTIALS APPLICANT EVALUATION FORM Applicant’s Name: _______________________________________________ Evaluator’s Name: ________________________________________________ FOR CONFIDENTIAL USE BY THE CREDENTIALS COMMITTEE 1. My field of expertise is in: Veterinary Dentistry ______; General Dentistry ______;

Dental Specialty ______; which Specialty? ________________________________; Referring DVM ____________________; Academic ________________________; Other _______________________, (please explain) 2. During what period of time, [hours, days, months or year(s)] and in what capacity did you observe the veterinary dental activities of the applicant? Specifically mention the type of supervision you provided, e.g., mentoring, telephone consultations, performed procedures(s) with the applicant assisting, applicant performed procedures(s) with you assisting. If not applicable, please write N/A.

3. How closely did you supervise the applicant? (e.g., seldom, daily, weekly, monthly, or several times over a period of _____ months)

4. Which of the basic disciplines of veterinary dentistry (periodontics, endodontics, orthodontics, restorative and oral surgery) did you supervise or observe?

5. In terms of primary patient care responsibility, approximately how many cases were under the exclusive control of the applicant during your period of supervision or observation? Not applicable ______ Zero cases ______ 1-5 cases ______

6-10 cases ______ 11-25 cases ______ Over 25 cases ______ • Attention to the patient as a whole _______

• Knowledge of dental radiographic technique and interpretation _______

• Proper management of veterinary dental cases _______

• Proper use of techniques and materials which are generally accepted _______

• Complete and adequate dental charting _______


Continued• Awareness of current literature _______

• Ability to make independent decisions _______

7. Applicant’s characteristics. Please state: N/A, unknown, excellent, very good, satisfactory, needs improvement or unsatisfactory.

• Reliability _______

• Motivation _______

• Attention to detail (follows manufacturers instructions exactly) _______

• Client control and attitude _______

• Professional ethical standards _______

8. Do you believe that the applicant has any characteristics of professional performance that would detract from the applicant’s fitness for membership in the Academy of Veterinary Dentistry? If so, please describe.

Date: ______________ Signed __________________________________ Print Name _______________________________ Address: _________________________________ City, State, Zip ____________________________ Telephone: _______________________________ FAX: ___________________________________ Please attach a letter of recommendation to support the applicant’s application for membership in the Academy. The Academy greatly appreciates your time and effort in writing this evaluation.


This form must be sent directly to and received at the Secretary’s office no later than midnight, July 15. If the postmark is prior to July 8, the form will be accepted even if delayed in transit. Mail to: Kathy Queck, DVM, FAVD, Secretary of the Academy of Veterinary Dentistry Carolinas Animal Hospital and Dental Clinic, 13331 York Center Dr., Suite A, Charlotte, NC 28273 Phone 704-588-9788 Fax 704-588-9781 Email [email protected]


CASE REPORT - INSTRUCTIONS

Four case reports are required. Submission via DMS is required. Name the files as Case Report and category, e.g. Case Report 1 (OS), Case Report 2 (EN). Log in to DMS, click Begin a New Document for Submission to AVD, then click Case Report from the drop-down menu on the next screen. Attach files as instructed in the DMS User’s Guide.

APPLICANTS WHO SUBMIT A CASE FOR PRE-APPROVAL ARE NOT ALLOWED TO RESUBMIT THE SAME CASE REPORT IN REVISED FORM IF THE FIRST SUBMISSION WAS NOT APPROVED. Clarification of details of a case report detail may be sought by the credentials committee reviewers if other deficiencies are not severe enough to warrant non-approval of the report.

Each case report is to contain: A. The case report (as a Word document, with photographs and radiographs individually

labeled in a separate combined image file. The figures are to be referred to within the text. B. Legible copies of the medical and dental records of that patient. It is required that medical

and dental records are submitted for each visit of the case report patient. These items are reviewed by the Academy DMS administrator, and are not viewed by the credentials committee review team.

A sample case report is available at the end of this Application Package.

REQUIREMENTS FOR CASE REPORTS • The applicant must be the primary person performing the case • The case reports and medical record files must be submitted anonymously. • The four required case reports must be in four different disciplines (endodontics, oral

surgery, orthodontics, periodontics, or restorative). You may NOT use the same patient for 2 separate case reports.

• Photographs. Photographic documentation of all cases is REQUIRED. The photographs must be of good quality so that the reviewer can readily evaluate your work. Photographs of the procedure should show ‘step by step’. Photographs and radiographs are to be referred to in the text (for example, “Figure 1” or “Radiograph 1”). The images are to submitted in a separate file that includes appropriate labels.

• Radiographs. Dental radiographs are REQUIRED. Failure to provide diagnostic quality radiographs in appropriate cases will be grounds for rejection of the case.

• Medical records. A copy of your medical, dental and anesthesia records shall be included with each case report. All medical records must be written in or translated into English. Be sure to include a completed Dental Chart for each anesthetic procedure.

• Follow-up. A 6 month follow-up, documented by radiographs and photographs, is MANDATORY in all cases. Any case with less than a 6 month follow-up will be rejected.

• Conclusion. The final summation in each case report should be the author’s own evaluation of the data, not a paragraph that has been constructed by cutting and pasting other sources’ work.

• Original work. You must perform the cases you select for the case reports, and you must write the case reports. If another doctor is involved with the case, this person’s contributions to the case are to be reported. Plagiarism or allowing another person to significantly write your case reports will result in expulsion from the program.


• A grade of 80% for each case is required to successfully complete the case reports requirement.

• The text should be in 12pt, Times New Roman font, and the text must be no more than ten double spaced pages long (not including a title page or pages containing only foot-notes and references). Photos and radiographs are to be submitted in a separate file.

• Pick a case that exemplifies your best work. Cases need not be complicated or advanced to meet the passing criteria. Remember, we are using the case reports to determine your ability and knowledge.

• Before you start……. choose a case with adequate photographic and radiographic documentation and submit the materials to your mentor for review before you begin writing. Your mentor must sign the form that they have reviewed your case report prior to submission.

• Write the case report as if for publication in a peer-reviewed journal, such as JVD. • Describe the treatment in a way that would allow the reader to be able to perform this

procedure. • Discussion should be used to exhibit your knowledge of the subject and address

controversial choices.

Criteria for Evaluation of Case Reports

1. Attention to patient as a whole:a. Patient Historyb. Problem assessment c. Physical examination inclusive of oral evaluation (tableside or anesthetized).d. Preoperative laboratory evaluation (i.e. bloodwork, urinalysis, radiographs, histopath).e. Perioperative pain management (i.e. preoperative opioids, NSAIDS, local anesthesia,

postoperative medications)f. Anesthetic protocol and monitoring (pulse oximetry, blood pressure, capnography,

electrocardiogram, body temperature) g. Intraoperative fluid therapy

2. Appropriate diagnostic and treatment plan a. Differential diagnosis b. Tentative/definitive diagnosis c. Treatment options and prognoses d. Logical stepwise description of the treatment plan

3. Radiographs and radiographic interpretation a. Appropriate views to facilitate evaluation of the case

b. Diagnostic quality radiographs c. Proper interpretation of radiographs d. Pre and post procedure radiographs e. Adequate follow up radiographs

4. Use of generally accepted technique/ materials that are referenced a. Proper technique to achieve desired results

b. Logical stepwise description of the chosen technique - procedures, materials and medications, including drugs, dosages (mg/kg) and routes of administration)


c. Description of the actual clinical results

5. Photographic documentation (high quality photographs, lighting, and composition) a. Adequate pre-procedure photographic documentation b. Adequate intraoperative photographic documentation (step-by-step) c. Adequate postoperative photographic documentation d. Adequate follow up photographic documentation

6. Complete & adequate medical record/dental chart a. Medical record is present (using SOAP format – history, physical exam, oral exam findings, tentative diagnosis, plan for evaluation and treatment) b. Completed dental chart including all oral pathology present for each anesthetic event c. Description of the procedure d. Histopathology report present e. Inclusion of discharge instructions, medications and follow-up

7. Discussion a. All treatment options discussed b. Inclusion of home care recommendations c. Inclusion of follow up recommendations d. Controversial choices adequately referenced

8. Follow-up: a. Minimum period of 6 months MUST be observed b. Radiographic documentation c. Photographic documentation

9. Presentation:a. Title must include discipline, species and procedure with anatomical reference b. Appropriate use of footnotes and references c. Spelling and grammar d. Text should be accurate relative to the medical and dental records with no discrepancies.

An example of a case report is included at the end of this application package.



EXAMPLE CASE REPORT

PARTIAL MAXILLECTOMY FOR TREATMENT OF A PAPILLARY SQUAMOUS CELL CARCINOMA IN A DOG

INTRODUCTION Oral tumors are the fourth most common neoplasm in dogs representing approximately 6% of all malignant tumors.1 Oral neoplasms have been treated with various modalities including surgical excision, cryosurgery, radiotherapy, immunotherapy, or a combination of the above.2 Partial maxillectomy techniques have been described which permit resection of tumors involving the upper palate while maintaining function and acceptable cosmetic results.3 Thorough evaluation of the patient including physical exam, bloodwork, thoracic and oral radiographs, and biopsy assist in determining the treatment protocol for each individual patient. SIGNALMENT AND HISTORY: A 5-month-old male mixed breed dog, was referred on 11/7/75 for evaluation and treatment of an oral neoplasm. On 10/13/75 the patient presented to the referring veterinarian for evaluation of an oral mass. According to the medical records, the owner had first noticed the mass the day before initial presentation. The patient was sent home on clindamycin hydrochloridea 75mg one capsule twice daily. On 10/16/75 the patient returned to the referring veterinarian for reevaluation. At that time, right lateral and ventrodorsal thoracic radiographs were taken which showed no evidence of metastatic disease. Skull radiographs obtained at the same time were described by the referring veterinarian as having a ‘locular appearance to the right maxilla’. Although the right mandibular lymph node was not palpably enlarged, a fine needle aspirate was obtained. The cytology results reported no evidence of atypical cells. On 10/25/75 the referring veterinarian took intraoral radiographs and obtained a punch biopsy of the mass. The histopathology report stated the mass was morphologically consistent with a well-differentiated squamous cell carcinoma. The histopathology report described this biopsy as an example of a syndrome of well-differentiated squamous cell carcinomas in very young dogs referred to as papillary squamous cell carcinomas. According to the report, usually papillary squamous cell carcinomas are of low-grade malignancy and if completely removed, the dogs can do fairly well. As they are well differentiated, the chance for metastasis is low.

PHYSICAL EXAMINATION On presentation the patient was bright, alert, responsive, and normally hydrated. The patient weighed 21.4 kg. General physical examination was unremarkable. Oral examination confirmed the presence of a 3 cm by 5 cm by 1 cm raised smooth mass in the right rostral maxilla. The mass had a 1 cm area of ulcerated surface surrounding the maxillary right intermediate incisor. The mass extended from the mesial and palatal surface of the maxillary right central incisor to the distal side of the maxillary right canine. A widened interproximal space was present between the maxillary right central incisor and the maxillary right intermediate incisor with displacement of the right intermediate incisor laterally. A widened interproximal space also existed between the maxillary right intermediate and maxillary right lateral incisor displacing the maxillary right lateral incisor and canine tooth caudally and buccally. Grade 2 mobility of the right intermediate incisor was present. The mass extended palatally approximately 8 mm caudally from the right maxillary incisor teeth and apically onto the gingival surface approximately 1 cm (Pictures 1, 2). All other oral anatomy was within normal limits.


Oral radiographs from the referral veterinarian dated 10/25/75 revealed a large expansile radiolucent lesion with well-demarcated borders. The lesion involved the supporting alveolar bone at the roots of the maxillary right incisors and extended caudally to the level of the maxillary right canine tooth (Radiographs 1, 2). DIAGNOSIS Based on history, physical examination, radiographs and biopsy results, tentative diagnosis of a maxillary well-differentiated squamous cell carcinoma was made. This diagnosis is consistent with papillary squamous cell carcinomas found in young dogs. THERAPEUTIC PLAN This malignancy had a histologically low grade, therefore, a good prognosis could be expected with complete excision. A recommendation for a partial maxillectomy was made to the owners. Further diagnostic evaluation was necessary which included bloodwork, a left lateral thoracic radiograph, and current intraoral radiographs, prior to devising a plan for the maxillectomy. Anesthetic protocol, the surgical procedure, postoperative care and potential complications were discussed with the owner. Potential complications which were discussed included: dehiscence of the surgical site; hemorrhage intraoperatively; inadequate resection of the mass; and impingement of the lower right canine tooth on the upper lip. Because of the involvement of a significant amount of gingival tissue apical to the teeth within the mass, resection with adequate margins was a concern in this case. PROCEDURE To complete the thoracic radiograph series taken by the referring veterinarian, prior to anesthesia a left lateral thoracic radiograph was taken. There was no radiographic evidence of metastatic disease. Preoperative complete blood count and serum biochemistry profile were completed and values were within normal limits. The patient was premedicated with medetomidine hydrochlorideb 0.009mg/kg, morphine sulfatec 0.55 mg/kg and atropine sulfated 0.04 mg/kg given intramuscularly. An 18 gauge intravenous catheter was placed in the left cephalic vein. Cefazoline 22 mg/kg was administered intravenously. The patient was induced with valiumf 0.15 mg/kg and ketamineg 2.8 mg/kg given intravenously. The patient was intubated with a 10 mm cuffed endotracheal tube. Anesthesia was maintained with isoflurane (1.5 – 2.0%) and oxygen (0.6 liters/min). Intravenous Lactated Ringer’s Solutionh was administered throughout the procedure at a rate of 10 ml/kg/hour. The patient was monitored intraoperatively with a continuous electrocardiogram, continuous pulse oximetry, and indirect blood pressure readings every five minutesi. Intraoral radiographs were obtained (Radiographs 3, 4). There was evidence of an expansile bone lesion of the right rostral maxilla. It was mixed in opacity with areas of bone lysis. The lesion appeared to approach but not cross the midline. Based on radiographs taken 10/25/75 and 11/7/75, gross appearance of the tumor, and palpation of the tumor margins4 a resection was planned to extend from the mesial side of the maxillary left lateral incisor to the mesial side of maxillary right third premolar through the palate. The goal was to obtain a minimum of 1 cm of clinical and radiographic tumor free margin. The planned excision would extend apically approximately 1 cm above the margin of the mass, preserving enough buccal mucosa to close the oronasal defect. To provide analgesia to the surgical area intraoperatively and postoperatively, right and left maxillary nerve blocks were performed with marcaine 0.5% with epinephrine 1:200,000j using a 27 gauge 1” disposable dental needle on an aspirating syringek. Approximately 0.3 cc of the marcaine was injected at each maxillary site. The maxillary nerve block completely desensitizes the soft tissue, dentition and bone in one maxillary quadrant.5,6


The patient was positioned in dorsal recumbancy with the head supported and the mandible retracted caudally.7 The oral cavity was rinsed with 0.12% chlorhexidene gluconate solutionl. The oral cavity was then isolated with sterile drapes. The palatal mucosa was incised down to the incisive bone and palatine process of the maxillary bone with a #10 scalpel blade in a line which extended from the mesial surface of the maxillary left lateral incisor to the mesial surface of maxillary right third premolar at least 1 cm from the grossly visible tumor margins. In the area of the right palatine artery the incision did not penetrate the palatal mucosa to the bone. The right major palatine artery was identified, isolated and ligated with 3-0 polydioxanonem and then transected. The buccal mucosa was incised approximately 1 cm apical to the margin of the tumor. A Freer periosteal elevatorn was used to elevate the mucosa and underlying tissues from their attachment on the hard palate, maxillary and incisive bones. The right infraorbital vessels were identified, isolated and ligated with 3-0 polydioxanone suturem and then transected. The soft tissue of the palate was dissected approximately 2-3 mm beyond the planned resection border of the bone. An oscillating saw was utilized to transect the bone from the mesial surface of the maxillary left lateral incisor to the mesial surface of the right maxillary third premolar. A dorsal osteotomy was performed dorsal to all involved tooth roots through the maxillary and incisive bones using the oscillating saw. The tumor and adjacent tissue including a small portion of the nasal turbinates were then removed en bloc. Gelfoamo was placed in the right caudal nasal area to control hemorrhage. All bone edges were rounded and smoothed with a 4 mm round burr in a Hall air drill. A .045 k wire in a Jacob’s hand chuck was utilized to drill several holes in the palatine bone in a line parallel to the incised bone edge 2-3 mm from the incised edge. The labial mucosa and submucosa was separated from the remainder of the lip using Metzenbaum scissorsp for blunt and sharp dissection. The lip margin based labial flap was created to allow for tension free closure of the oronasal defect. The maxillary right third premolar and maxillary left lateral incisor were carefully inspected for any damage. There was no visible damage to the teeth or tooth root structure and the tooth roots were visibly covered by alveolar bone. The surgical area was copiously lavaged with warm sterile saline solutionq. 3-0 polydioxanonem simple interrupted sutures were placed from the buccal submucosal tissue to the holes predrilled in the bony hard palate. The labial mucosa and palatine mucosa were apposed with 3-0 polydioxanonem sutures in a simple interrupted pattern (Picture 3). Occlusion was evaluated. The mandibular right canine tooth was lateral to the upper lip and did not impact the incision (Picture 4). The resected section of maxilla was submitted for histopathology to Colorado State University to confirm the histologic diagnosis and assess for the presence of tumor free margins.3 Postoperative radiographs of the maxilla showed normal anatomy at the resected margins (Radiographs 5, 6). Morphine sulfatec 0.55mg/kg was administered intramuscularly approximately 15 minutes prior to the cessation of anesthesia. Recovery from anesthesia was uneventful. The patient was placed on a continuous morphine drip postoperatively (0.22 mg/kg/hour) and Lactated Ringer’s Solutionh was continued at a maintenance rate of 2.75 ml/kg/hour postoperatively. An Elizabethan collar was placed on the patient after anesthetic recovery. Postoperative PCV was 31 and total protein was 6.5 gms/100ml. The PCV was to be reevaluated in 4 hours. Four and a half hours postoperatively the patient appeared restless. He was given morphine sulfatec 0.7 mg/kg intramuscularly and acepromazine maleater 0.02mg/kg intravenously. Five hours postoperatively the PCV was 41 and the total protein was 5.5 gms/100ml. Six hours postoperatively the patient received cefazoline 22 mg/kg intravenously and then it was discontinued. The following morning, 11/8/75, the patient was bright, alert, very responsive and normally hydrated. Physical examination was unremarkable. The incision appeared unchanged. The continuous morphine drip was discontinued and oral carprofens 2.2 mg/kg twice daily was started. Twenty-four hours postoperatively the patient was offered a slurry of Canine p/dt and


water, which he ate readily. He was given access to free choice water, which he was drinking. The intravenous Lactated Ringer’s Solutionh was discontinued. The patient continued to eat a p/dt slurry every 6 – 8 hours. The patient remained comfortable throughout the day and night. The second day postoperatively, 11/9/75, the patient was very bright, alert, and responsive. Physical examination was within normal limits and the incision appeared unchanged. The patient was discharged to the client on 11/9/75 with the following instructions: • Wear the Elizabethan collar at all times

• Continue to soften his food to a slurry consistency

• Do not allow him to chew on anything; remove all toys from his environment.

• Continue oral carprofens as directed for 5 days postoperatively

• Return for reevaluation in 10 days

Preliminary histopathology results received on 11/10/75 reported ‘squamous cell carcinoma extending into the nasal/sinus cavity but other margins are free of tumor’. Final written histopathology results were received on 11/15/75. The histopathological diagnosis was ‘squamous cell carcinoma, well differentiated’. Dr. Powers stated that it was ‘consistent with a papillary squamous cell carcinoma reported in young dogs, however this tumor is more invasive than is usually seen with papillary squamous cell carcinoma as there is extensive bone invasion. This tumor appears to be completely removed, although the tumor does extend into the nasal and sinus cavity where there are no tissue margins, rather only air. The caudal bone margin is free of tumor’. FOLLOW UP The patient returned 9 days later on 11/18/75. He was very happy and energetic. (Picture 5) Physical examination was within normal limits. Oral examination showed the incision to be healing with no areas of dehiscence. (Picture 6) There was no impingement of the mandibular right canine tooth on the upper lip. The clients were very pleased with the cosmetic results of surgery. The Elizabethan collar was removed. The owner was instructed to continue softened food and no chew toys for an additional two weeks. On 12/2/75, approximately 24 days postoperatively, the patient returned for reevaluation. He weighed 22.7 kg. The owners reported that he was doing very well at home. He was eating his slurry readily and was showing interest in playing with his stuffed toys. Physical examination was unremarkable. Oral examination showed no evidence of dehiscence. The incision was healed and there was no visible evidence of regrowth of the tumor. The clients were instructed to feed the patient’s normal diet of hard food and recheck in 4 weeks for sedation, intraoral radiographs, and removal of any remaining sutures.

On 1/10/76, approximately two months postoperatively, the patient returned for reevaluation. His owners reported a normal dog at home. He weighed 24 kg. Physical examination was unremarkable. Oral examination showed no visual evidence of any tumor regrowth. A few sutures remained visible. The patient was given atropine sulfated .04 mg/kg intramuscularly followed by medetomidine hydrochlorideb .01 mg/kg and butorphanolu 0.1 mg/kg given intramuscularly twenty minutes later. A thorough oral examination confirmed no gross evidence of tumor regrowth (Pictures 7, 8, 9). The remaining sutures were removed and intraoral radiographs were taken. Radiographs showed normal bony margins with no evidence of tumor regrowth (Radiograph 7). Atipamezolev 0.05 mg/kg was administered intramuscularly. Recovery from sedation was uneventful. The owner was instructed to return in 4 months for another follow up evaluation.


On 6/6/76, approximately seven months postoperatively, the patient returned for reevaluation. He weighed 25 kg. His owners reported a happy normal dog. Physical examination was unremarkable. The haired surface of his right upper lip had some brown discoloration present, likely due to saliva staining. Oral examination showed no visible evidence of tumor regrowth. Thoracic radiographs (3 views) were taken prior to sedation. There was no radiographic evidence of metastatic disease. Utilizing the above protocol for sedation, thorough oral examination confirmed no visible evidence of tumor regrowth (Pictures 10, 11, 12, 13). Intraoral maxillary radiographs were taken as well as radiographs of the maxillary left lateral incisor and maxillary right third premolar. Intraoral radiographs, compared with prior radiographs showed further remodeling of the bone margins and no areas of abnormal bone. Lateral oblique skull radiographs showed remodeling of the osteotomy site with no abnormal bone lysis or production visible. Radiographs of the maxillary left lateral incisor and maxillary right third premolar showed normal tooth crown and root structure as well as normal surrounding alveolar bone (Radiographs 8, 9, 10, 11). The client was instructed to return in three months (10 months postoperatively) for reevaluation and radiographs. Another reevaluation would be scheduled for one year postoperatively and then rechecks were recommended yearly thereafter.

DISCUSSIONOral tumors are the fourth most common neoplasm in dogs, representing approximately 6% of all malignant tumors.1 The most common types of malignant oral neoplasms in dogs include melanoma, squamous cell carcinoma, and fibrosarcoma.8 Squamous cell carcinoma is the second most common oral malignancy in dogs after malignant melanoma.8 Squamous cell carcinomas usually occur in older dogs (the average age is nine years).8 They are locally invasive but have a low rate of distant metastatsis.1 Young age, rostral location and maxillary site carry a better prognosis for survival.8 Oral papillary squamous cell carcinomas have been reported in dogs as young as two months of age.9 Papillary squamous cell carcinomas are essentially squamous cell carcinomas which are well differentiated, sharply delineated and locally invasive.9 Papillary squamous cell carcinoma is a progressive disease with a high rate of bone lysis.8 Although papillary squamous cell carcinomas are locally invasive, they do not tend to metastasize.10 An association between papillary squamous cell carcinoma and papilloma virus infection has not been determined.9 The initial approach to the management of an oral tumor should include histologic diagnosis via biopsy and clinical tumor staging.1 Preanesthetic blood work should be obtained to assess the general health of the patient. After a histologic diagnosis of malignancy has been established, clinical staging should include three thoracic radiographic views to detect distant metastasis.1 Any local lymphadenopathy should be further investigated by fine needle aspiration.8 The extent of bone involvement or local aggressiveness of the tumor can be determined by imaging with conventional skull radiographs.1 The intraoral view is often the most informative and dental radiographs provide valuable informaton.1 If possible, more precise tumor evaluation can be accomplished using advanced imaging techniques (computed tomography, magnetic resonance imaging) which may facilitate surgical and radiation treatment plannning.1 With oral tumors, the first surgical excision is the most likely to result in tumor control.8 The tumor should not be scraped or peeled from the underlying bone, as recurrence is certain and the tumor bed will be enlarged.8 A definitive first surgery, such as a maxillectomy or mandibulectomy should be performed.8 Partial maxillectomy involves excision of portions of the maxilla, incisive bone or palatine bone.11 Partial maxillectomy is indicated for excision of malignant oral tumors and benign oral tumors that involve bone or periosteum, such as the epulides and ameloblastoma.11 Other indications for partial maxillectomy include chronic osteomyelitis, oronasal fistula, and


maxillary fractures with severe bone injury or loss.12 Application of this technique is limited by tumor extension into the labial or buccal mucosa or across the midline of the central or hard palate.11 Sufficient normal labial or buccal mucosa and hard palate mucoperiosteum must be available to allow closure of the oronasal defect that results.11 Adherence to the following principles is important in any type of maxillectomy: • Use of sharp dissection when incising labial, buccal and palatal mucosa • Maintenance of adequate blood supply to the mucosal flap used to cover the oronasal defect resulting from surgery • Use of a two layer closure when possible • Avoidance of excessive tension across the incision line • Establishment of at least a 1 cm border of normal healthy tissue between the tumor and the line of resection.7

Careful preoperative planning is important to determine if adequate surgical margins can be achieved and to ensure that the resulting oronasal defect can be closed primarily.11 The limits for surgical resection of a malignancy should be determined by preoperative imaging, gross visualization of the tumor and palpation of the tumor at the time of surgery.3 The goal of any partial maxillectomy in the treatment of oral neoplasia should be to obtain a minimum of 1 cm of clinical and radiographic tumor free margin.12 Perioperative antibiotics are recommended.12 Antibiotic therapy for more than 24 hours is not indicated unless dictated by the situation.12 The antibiotic chosen should be effective against the bacterial flora normally found in the oral cavity. The first generation cephalosporins, penicillins, and synthetic penicillins are generally considered effective prophylactic oral antibiotics.12 During the procedure ligation of the infraorbital and major palatine vessels to control hemorrhage does not have any adverse effects. With ligation of the infraorbital artery collateral circulation is maintained to the labial mucosa via the facial artery and contralateral infraorbital artery. The left and right major palatine arteries have extensive anastamoses so mucosal circulation can be maintained adequately by the contralateral vessel.1 Polydioxanone is one of the sutures recommended for wound closure after maxillectomy.12 Polydioxanone is a relatively nonreactive suture that minimizes oral mucosal irritation and maintains adequate strength during the critical early period of healing.12 It is also monofilament and absorbable. Its absorption is slow and the sutures may result in irritation of the oral mucosa after healing.12 In this case all sutures remaining after healing were removed 2 months postoperatively. Because of the aggressiveness of maxillectomy procedures, the animal should be supported for the first 24 hours with parenteral fluids and analgesics.12 Intravenous fluid therapy is continued until the animal is eating and drinking well enough to maintain its hydration.11 The patient is offered soft food and water the day after surgery.11 An Elizabethan collar is often necessary to prevent self-induced trauma to the surgical site.12 With a partial maxillectomy, the animal is usually discharged from the hospital when it is eating well. Postoperative care includes the feeding of softened food for one month and preventing the pet from chewing on hard objects for that same time period.11 A major postoperative complication of any maxillectomy is partial suture line dehiscence.13 Major causes of dehiscence include: suture line tension, tumor cells in the edges of the incision, ischemic necrosis of the mucosal flap and excessive movement of the flap.4 Anemia is also a potential complication of any type of maxillectomy.4 Intraoperative hemorrhage in this case was controlled by careful isolation and ligation of the infraorbital and major palatine vessels. The preoperative packed cell volume which was 41 dropped to 31 immediately postoperatively. This drop in hematocrit was not unexpected and may have been due to hemodilution due to intravenous fluids intraoperatively in combination with intraoperative blood loss. The


hematocrit was monitored postoperatively and returned to 41 before the patient was released. Another potential complication is damage to teeth adjacent to the osteotomy site. If the teeth are close together, osteotomy may be difficult to perform without entering the alveolus of the adjacent tooth.11 Careful inspection of the teeth at the time of surgery is important. Intraoral radiographs are necessary to detect iatrogenic trauma to adjacent teeth. Deformity of the muzzle contour can occur after partial maxillectomy and repair with a labial mucosal-submucosal flap.12 Such indentation usually results from an insufficient amount of normal labial tissues to create the flap and the problems that may cause. This indentation was present in our patient, but he was unaffected by it. Preemptive analgesia refers to the application of analgesic techniques before exposing the patient to noxious stimuli.5 Multimodal analgesia is accomplished by preemptive administration of a combination of different classes of drugs that inhibit nociceptive processes at two or more sites.5 The use of an opioid (morphine) and alpha2 agonist (medetomidine) in addition to local nerve blocks allowed multimodal preemptive analgesia to be achieved in this case. Pain management was continued with an injection of morphine before anesthetic recovery followed by continuous morphine infusion for the first 24 hours postoperatively and additional analgesics as needed based on patient evaluation. Oral carprofenn was prescribed for postoperative inflammation and discomfort. Papillary squamous cell carcinoma is a type of squamous cell carcinoma that occurs in young dogs. Rostrally located squamous cell carcinomas of the mandible and maxilla are usually locally aggressive but have a low metastatic potential.14 Therefore, radical surgery, radiation therapy or a combination of surgery and radiation therapy is considered the most appropriate form of treatment with a generally good prognosis for long term survival in these dogs.14 Ogilvie reported on three dogs with papillary squamous cell carcinomas with disease free intervals of 39 months, 32 months, and 10 months after surgery and radiotherapy.9 To date there have not been any studies or case reports on long-term survival or prognosis with surgical resection as the sole treatment for papillary squamous cell carcinomas. Further work is necessary to correlate treatment and survival times in young dogs with papillary squamous cell carcinomas.

A Antirobe, Pharmacia and Upjohn Company, Kalamazoo, MI b Domitor, Pfizer Animal Health, Exton, PA c Morphine, Elkins-Sinn, Inc., Cherry Hill, NJ d Atropine Sulfate, Phoenix Pharmaceutical, Inc., St. Joseph, MO e Cefazolin, Schein Pharmaceutical, Inc., Florham, NJ f Diazepam, Abbott Laboratories, North Chicago, IL g Ketaset, Fort Dodge Animal Health, Fort Dodge, IA h Lactated Ringer’s Solution, Abbott Laboratories, North Chicago, IL I DRE ASM 5000, DRE Inc., Louisville, KY j Marcaine 0.5%, Abbott Laboratories, North Chicago, IL k Aspirating Syringe,Henry Schein, Port Washington, NY l CHX guard, VRx Pharmaceuticals, Harbor City, CA m PDS II, Ethicon, Summerville, NJ n Freer periosteal elevator, Spectrum Surgical Instruments, Stow, OH o Gelfoam, Pharmacia and Upjohn Company, Kalamazoo, MI p Metzenbaum scissors, Spectrum Surgical Instruments, Stow, OH q 0.9% sterile saline, Abbott Laboratories, North Chicago, IL r Acepromazine, Boehringer Ingelhelm Vetmedica, Inc., St. Joseph, MO s Rimadyl, Pfizer Animal Health, Exton, PA t Canine p/d, Hill’s Pet Nutrition, Inc., Topeka, KS


u Torbugesic, Fort Dodge Animal Health, Fort Dodge, IA v Antisedan, Pfizer Animal Health, Exton, PA

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