Feline Mandibulectomy

Information below intended for veterinarians.
Some photos may be graphic.

Cat MandibulectomyThe oral cavity is a relatively common site for tumors in the cat.  Oral tumors account for approximately 10% of all feline tumors. Unfortunately, the vast majority of neoplasms found in the mouth of the cat are malignant.  Squamous cell carcinoma is identified approximately 70% of the time, fibrosarcoma approximately 10%, with the remaining neoplasms identified as lymphosarcoma, melanoma, osteosarcoma or other less common tumors.

Photograph 1 at right, and Photograph 2 below right - Willie, a purring 15yr old DLH, diagnosed with mandibular squamous cell carcinoma (SCC) 30 days post total mandibulectomy.

A common but subtle presentation of oral neoplasia is when teeth can be extracted too easily. 

Other common presenting signs for cats with oral neoplasia may mimic severe periodontal disease with associated osteomyelitis and include:  an obvious swelling or mass, increased salivation, weight loss, halitosis, bloody saliva and/or dysphagia.

Cat MandibulectomyAny swelling (soft tissue or boney) or other abnormal tissue found in the oral cavity should be investigated immediately.  Thorough examination under general anesthesia, biopsy and intra oral radiographs will aid in identifying the abnormality. Lymph node aspirates are indicated even if the nodes palpate normally, to help stage the tumor.

The most common malignancies; squamous cell carcinoma and fibrosarcoma are both locally invasive and generally slower to metastasize than some malignancies.  Treatment consists of aggressive local control:  surgery obtaining 2cm margins, which is generally hard to achieve in the cat (another reason early detection is important).

Studies show that squamous cell carcinoma treated with aggressive surgery may provide survival times of 6-12 months.

Photograph 3 below right - Willie, a 15 year old DLH diagnosed with SCC.  Note the large swelling on the ventral mandible.

Cat MandibulectomyAggressive surgery followed by radiation generally improves survival time.  One study provided the interesting statistic that if a cat survived one year it was more likely to survive an additional year as well.

Maxillary and sublingual tumors are rarely resectable, especially if discovered late in the course of the disease.  Palliative radiation and nutritional support may however, provide acceptable quality of life for weeks to months.

Aggressive surgery generally means removing bone as well as soft tissue.  Several studies have reported that overall mandibulectomies are well tolerated by cats, even total mandibulectomy.  While 72% of cats showed some signs of inappetence or dysphagia immediately postoperatively, only 12% of cats never regained the ability to eat on their own.  Several studies have reported that > 80% of cat owners whose cats received a mandibulectomy were satisfied with the outcome.

Cat Mandibulectomy X-rayRadiographs 1 and 2 below right - Preoperative radiographs from a 15 year old DLH diagnosed with mandibular SCC.  Note the invasiveness of the tumor into the bone.

Cat Mandibulectomy X-rayIn our practice, we generally place an esophageal feeding tube at the time of surgery to allow owners to provide nutrition until the cat begins to eat again.  If possible, at the time of surgery, we also prevent the potential for occlusal trauma to the palate as a result of “mandibular drift” commonly seen after one mandible is removed.  This is achieved by performing a crown reduction/vital pulp therapy to the contralateral mandibular canine, effectively lowering the crown to prevent contact with the palate; yet retains a vital tooth. 

Due to the length of the original procedure and Willie’s age, he returned 30 days later for the crown reduction.  This procedure generally dramatically decreases the excessive drooling and associated cheilitis reported in some surgery studies.

Radiograph 3 below right - Radiograph of the canine tooth of a 15 year old DLH, after crown reduction/vital pulp therapy.  This prevented trauma to the palate after mandibular drift commonly seen after total mandibulectomy.  A special medication is placed on the pulp to keep the tooth vital after crown reduction.  The final restoration of composite is then placed to seal the tooth.

Photograph 4 at bottom right - Willie, a 15 year old DLH, diagnosed with mandibular SCC (1 month post op).  Willie presented for crown reduction vital pulp therapy due to mandibular drift.Cat Mandibulectomy X-ray

To summarize; while oral tumors may yield a poor or guarded prognosis for most cats; mandibulectomies are generally well tolerated by cats and may extend quality of life by months to years. 

Early diagnosis, aggressive local treatment and appropriate supportive care are the best ways to improve survival times.Cat Mandibulectomy

 

 

 

 

 

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