March 2010
Dr Gerhard Steenkamp

A 1 year-old Greyhound dog is presented to you with bilateral symmetrical swellings at the level of the rostral opening of the infra-orbital canal. The patient is asymptomatic and is not painful to manipulation of his face. On palpation the swellings are well circumscribed and solid.

a Give your diagnostic protocol to make a diagnosis
b What would your differential diagnoses be?
c What is your most likely diagnosis?

Memo
a Oral investigation under general anaesthesia

Radiography,
If soft tissue structure ultrasound
Fine needle aspirate

b Periapical abscess of right maxillary 3rd and 4th premolars (107/108) and left maxillary 3rd and 4th premolars 207/208.
Hematomas post trauma
Neoplasia
Buccal lymph nodes

c Buccal lymph nodes - these lymph nodes occur unilaterally in about 4.4% of dogs as well as bilaterally in 4.4% of dogs. One study showed that there was an 8.7% incidence in Greyhounds. These are normal lymphoid structures that drain the buccal, dorsal, nasal, lateral nasal and superior labial regions. These nodes drain into the mandibular lymph nodes.

Periapical abscesses - This diagnosis could be plausible as bilateral fractures of 4th premolar teeth do occur. The chances of having the similar abscesses at the same time I think would be less than that for buccal lymph nodes.

Hematomas - possible, however again to have symmetrical lesions is probably unlikely.
Neoplasia - lymphoma would be the only tumour that I would expect to show this kind of presentation, but, to my knowledge this has not yet been reported.

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