case_images: PMC11291449_01
case_images: Photographs and diagnostic images (CT) revealing nature and extent of lesion. Craniodorsal view (A) and left craniolateral view (B). 3D reconstruction skull CT images show the nasomaxillary defect (yellow arrows) from the right lateral view (C), left lateral view (D), and dorsal view (E). Also note the alveolar bone loss of left maxillary premolar region. Extensive loss of the dorsal muzzle cutaneous tissues (F), and left superior labia (G) largely covered by eschar and debris can be appreciated. Also note the nasomaxillary defect (blue arrows) largely covered by eschar, and the discoloration of the cervical area of the left maxillary canine tooth. (H) Transverse CT view depicting the proximity of the bone loss (nasomaxillary defect) at the apex of the right maxillary canine tooth (blue arrow), and a probable sequestrum (orange arrow).
case_images: fvets-11-1416469-g001.jpg
case_images: PMC11291449_01_fvets-11-1416469-g001.jpg
case_images: fig1
case_images: An approximately 2-year-old, 18.5 kg, intact female, mixed-breed dog was presented for evaluation and treatment of orofacial wounds predominately located at the left dorsolateral nasomaxillary complex, suspected to be caused by a chemical burn (Figure 1). Imaging and orofacial examination revealed chronic osteomyelitis of the maxilla, zygomatic and nasal bones bilaterally, a right nasomaxillary fistula with thickened soft tissue attenuating material lining the dorsal conchae, destruction of the rostral left infraorbital canal and extensive loss of the left superior labial and dorsal muzzle cutaneous tissues (Figure 1). In addition, the right maxillary canine tooth was presumed to be non-vital secondary to the degree and location of the osseous nasomaxillary defect (Figure 1H).
case_images: Virtual surgical planning before (A) and after (C) non-vital bone removal. Panel (B) represents the transverse CT window during VSP. The expected vital bone is highlighted in white color, whereas the anticipated non-vital bone is highlighted in blue. In panel (D), a trimmed and contoured 1.3-mm titanium mesh covers the simulated, final nasomaxillary defect (after removal of necrotic bone) on the printed skull model.
case_images: fvets-11-1416469-g002.jpg
case_images: PMC11291449_01_fvets-11-1416469-g002.jpg
case_images: fig2
case_images: Within the axial images panel, the demarcation separating likely necrotic bone from vital bone was highlighted (manual segmentation) on the presumption of sclerotic bone (as indicated by measures of bone density in Hounsfield units/HU and visual appearance on examination) representing likely necrosis (Figure 2). A virtual ostectomy was performed to remove the suspected/anticipated devitalized bone from the patient's computer model (i.e., virtual/simulated surgery) (Figure 2). The resultant skull model reflected the anticipated osseous defect to be reconstructed with a titanium mesh implant (Figure 2C). A 1.3 mm titanium mesh (MatrixNEURO reconstruction mesh, DePuy Synthes) was then trimmed and contoured to cover the resultant nasomaxillary defect on the post-simulated surgical model and subsequently sterilized for use in the nasomaxillary reconstruction surgery (Figure 2D).
case_images: The scar and granulation tissue to be excised were outlined with surgical marking pen (right dorsolateral view, A; left lateral view, B). Panel (C) depicts the surgical wound after excision/debridement and the placement of a commercial fascia late graft, secured with absorbable suture through pre-drilled holes in the maxilla and nasal bones. Panel (D) shows the pre-contoured titanium mesh secured over the nasomaxillary defect. The left angularis oris axial pattern flap was outlined with surgical marking pen (E). Dorsal (F) and left lateral (G) views after wound reconstruction.
case_images: fvets-11-1416469-g003.jpg
case_images: PMC11291449_01_fvets-11-1416469-g003.jpg
case_images: fig3
case_images: An area of soft tissue debridement, including scar and granulation tissue, was outlined with a surgical marking pen and surgically excised (Figures 3A,B). Transplant Services, Kent, USA) was pretreated as recommended by the manufacturer and placed between the osseous boundary of the nasomaxillary defect and the nasal mucosa and, subsequently, secured with 3-0 absorbable suture through pre-drilled holes in the maxilla and nasal bones (Figure 3C). The pre-contoured titanium mesh was then placed over the nasomaxillary defect and secured with a total of four 1.3 and 1.7 mm self-tapping titanium cortical screws (Figure 3D). A left sided angularis oris axial pattern flap was then outlined with a surgical pen and harvested according to published descriptions (Figure 3E). The oral aspect was 'folded over' and sutured directly to the gingiva in the area of the previously healed dental extractions to reconstruct the left superior labia (Figures 3F,G).
case_images: Photograph (A) of patient 5.5 months after nasomaxillary and superior labial defect reconstruction. Note the different hair pattern and length of the flap compared to the surrounding area. CT 3D reconstruction 5.5 months after surgery; right lateral (B), left lateral (C) and dorsal (D) views.
case_images: fvets-11-1416469-g004.jpg
case_images: PMC11291449_01_fvets-11-1416469-g004.jpg
case_images: fig4
case_images: All maxillofacial and oral wounds had healed well (Figure 4A). All signs of osteomyelitis had resolved (Figures 4B-D).