10/15/2026
UPDATE: This case was interesting as it initially presented as a simple tooth root abscess with an associated sinusitis. However the very rapid progression of the signs (maxillary mass, three loose teeth with a two week period from initial presentation, foul smell and granular/irritated gums) pointed to something much more serious. The gum tissue that came off with one of the teeth was submitted for biopsy. The result was an aggressive undifferentiated malignant neoplasia, most likely squamous cell carcinoma. Given the rapid progression of the disease, humane euthanasia was elected. 😢
It’s past time for an interesting case! This is a 28 year old QH mare that presented for an acute, unilateral purulent discharge. The discharge was foul smelling and at times would pour out. There was no fever and mare was still eating. She was put on antibiotics until her exam which was scheduled for a few days later. On the day of the exam, she was not febrile but there was now a small swelling on her upper maxilla in the area of the upper 4th premolar. An oral exam revealed a loose 4th premolar. The discharge was less but still present. Radiographs at this time showed a darker, more translucent area at the tip of the root of the 4th premolar. At this point, a tooth root infection and resulting sinusitis was the preliminary diagnosis. The plan was to continue antibiotics and schedule a tooth removal and sinus flush. Between appointments the nasal discharge continued despite antibiotics and became extremely foul smelling 🤢😷 the swelling on the face also became more enlarged. At the next visit, an oral exam revealed a very loose 4th premolar that came out with manual manipulation. The first and second upper molars were now very loose and the gums were very granulous(bumpy and irritated). Those teeth came out easily as well in addition to a piece of gum tissue.
What would be on your differential list?(possible diagnosis) what other tests could you perform?