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
ExecSec@AVDC.org.
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
Submission via DMS
Minimum Case Requirements and Case Log
Letters of Evaluation – Instructions
Page 2
Page 3
Page 4
Page 7
Forms:
Credentials Application Form
Credentials Application Agreement
Applicant and Mentor Accountability Form
Credentials Application Checklist
Credentials Applicant Evaluation Form
Page 8
Page 9
Page 10
Page 11
Page 12
Case Report Instructions
Case Report Evaluation
Case Report Example
Page 16
Page 15
Page 17
Academy Credentials Application and Information, 2015
Page 1
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.
a.
b.
c.
d.
Items to be available in your DMS case log as of July 15:
See Minimum Case Requirements, below.
Case Log showing cases accumulated during at least the 24 months prior to July 15, 2015.
The case log must show that the minimum required case load has been met in all categories.
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.
Academy Credentials Application and Information, 2015
Page 2
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
Academy Credentials Application and Information, 2015
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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 ANIMAL
The 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.
Academy Credentials Application and Information, 2015
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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 OR14 combined.
Academy Credentials Application and Information, 2015
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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 Role
Use 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.
Academy Credentials Application and Information, 2015
Page 6
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
Secretary of the Academy of Veterinary Dentistry
The Carolinas Animal Hospital and Dental Clinic
13331 York Center Dr., Suite A, Charlotte, NC 28273
Phone 704-588-9788
Fax 704-588-9781
Email kqueck@aol.com
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 Credentials Application and Information, 2015
Page 7
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 ___________________________________________________
Academy Credentials Application and Information, 2015
Page 8
Academy of Veterinary Dentistry
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
Academy Credentials Application and Information, 2015
Page 9
Academy of Veterinary Dentistry
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
Academy Credentials Application and Information, 2015
Page 10
Academy of Veterinary Dentistry
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.
Academy Credentials Application and Information, 2015
Page 11
Academy of Veterinary Dentistry
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
Academy Credentials Application and Information, 2015
Page 12
• 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 kqueck@aol.com
Academy Credentials Application and Information, 2015
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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
Academy Credentials Application and Information, 2015
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•
•
•
•
•
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 History
b. 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
Academy Credentials Application and Information, 2015
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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.
Academy Credentials Application and Information, 2015
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Academy of Veterinary Dentistry
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 welldifferentiated 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
Academy Credentials Application and Information, 2015
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(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
Academy Credentials Application and Information, 2015
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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 30 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.
Academy Credentials Application and Information, 2015
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• 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
Academy Credentials Application and Information, 2015
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and then rechecks were recommended yearly thereafter.
DISCUSSION
Oral 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
Academy Credentials Application and Information, 2015
Page 21
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
Academy Credentials Application and Information, 2015
Page 22
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
REFERENCES
1. Dhaliwal RS, Kitchell BE, Marretta SM: Oral tumors in dogs and cats. Part 1. Diagnosis and
clinical signs. Compend Contin Educ Pract Vet 20(9);1011-1022, 1998.
2. Schwartz PD, Withrow SJ, Curtis CR, Powers BE, Straw RC: Mandibular resection as a
treatment for oral
cancer in 81 dogs. J Am Anim Hosp Assoc 27; 601-610, 1991.
3. Schwartz, PD, Withrow SJ, Curtis CR, Powers BE, Straw RC: Partial maxillary resection as a
treatment
for oral cancer in 61 dogs. J Am Anim Hosp Assoc 27; 617-24, 1991.
4. Wallace J, Matthiesen D, Patnaik A: Hemimaxillectomy for the treatment of oral tumors in 69
dogs. Vet Surg 21(5); 337-341, 1992.
5. Thurmon JC, Tranquilli WJ, Benson GJ: Essentials of Small Animal Anesthesia and Analgesia.
Baltimore: Lippincott Williams and Wilkins, 28-60, 206, 1999
6. Haws, IJ; Local Dental Anesthesia. AVDF Conference Procedings 392-395, 2000.
7. Marretta SM: Maxillofacial Surgery. In Vet Clin N Am Small Anim Pract, 28(5); 1285-1296,
1998.
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8. Ogilvie GK, Moore AS: Managing the Veterinary Cancer Patient: A Practice Manual. Trenton:
Veterinary Learning Systems Co., Inc. 327-328, 336-339,479, 1998.
9. Ogilvie GK, Sundberg JP, O’Barion K, Badertscher RR, Wheaton LG, Reichmann ME: Papillary
squamous cell carcinoma in three young dogs. J Am Vet Med Assoc 192(7); 933-936, 1998.
10. Stapleton BL, Barrus JM: Papillary Squamous Cell Carcinoma in a Young Dog. J Vet Dent
13(2):65-68, 1996.
11. Salisbury SK: Maxillectomy and Mandibulectomy. In Textbook of Small Animal Surgery (Ed.
DH Slatter), 2nd ed. Philadelphia: W.B. Saunders Company, 521-524, 1993.
12. Dernell WS, Schwarz PD, Withrow SJ: Maxillectomy and Premaxillectomy. In Current
Techniques in Small Animal Surgery (Ed. MJ Bojrab), 4th ed. Baltimore: Williams and Williams,
124-131, 1998.
13. Dhaliwal RS, Kitchell BE, Marretta SM: Oral tumors in dogs and cats. Part 2. Prognosis and
treatment. Compend Contin Educ Pract Vet 20(10):1109-1119, 1998.
14. Schmidt BR, Glickman NW, DeNicola DB, Gortari AE, Knapp DW: Evaluation of piroxicam for
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