Surgical management of maxillary and premaxillary osteomyelitis in a reticulated python (Python reticulatus)

• La'Toya V. Latney ^[2] ; John R. Lewis ^[3] ; Colin McDermott ^[4] ; Gregory Scott ^[1] ; Maria M. Soltero-Rivera ^[5] ; Kyla Beguesse ^[6] ; Melissa D. Sánchez ^[2]
  1. [1] Long Beach Animal Hospital

     Long Beach Animal Hospital

     Estados Unidos

     
  2. [2] University of Pennsylvania

     University of Pennsylvania

     City of Philadelphia, Estados Unidos

     
  3. [3] Department of Dentistry and Oral Surgery, North-Star VETS, 315 Robbinsville-Allentown Rd, Robbinsville
  4. [4] Department of Animal Heath, National Aquarium, 501 E Pratt St, Baltimore,
  5. [5] VCA San Francisco Veterinary Specialists, 600 Alabama St, San Francisco
  6. [6] Department of Pathobiology, School of Veterinary Medicine, University of Wisconsin, Madison

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• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 248, Nº. 9, 2016, págs. 1027-1033
• Idioma: inglés
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• Resumen

  • CASE DESCRIPTION A 1-year-old reticulated python (Python reticulatus) was evaluated because of a 2-week history of wheezing and hissing.

    CLINICAL FINDINGS Rostral facial cellulitis and deep gingival pockets associated with missing rostral maxillary teeth were evident. Tissues of the nares were swollen, resulting in an audible wheeze during respiration. Multiple scars and superficial facial wounds attributed to biting by live prey were apparent. Radiographic examination revealed bilateral, focal, rostral maxillary osteomyelitis.

    TREATMENT AND OUTCOME Wound irrigation, antimicrobials, and anti-inflammatory drug treatment resulted in reduced cellulitis. A 3-week regimen that included empirical antimicrobial treatment and improved husbandry resulted in resolution of the respiratory sounds and partial healing of bite wounds, but radiographic evaluation revealed progressive maxillary osteomyelitis. Microbial culture of blood yielded scant gram-positive cocci and Bacillus spp, which were suspected sample contaminants. Bilateral partial maxillectomies were performed; microbial culture and histologic examination of resected bone confirmed osteomyelitis with gram-positive cocci. Treatment with trimethoprim-sulfamethoxazole was initiated on the basis of microbial susceptibility tests. Four months later, follow-up radiography revealed premaxillary osteomyelitis; surgery was declined, and treatment with trimethoprim-sulfamethoxazole was reinstituted. Eight months after surgery, the patient was reevaluated because of recurrent clinical signs; premaxillectomy was performed, and treatment with trimethoprim-sulfamethoxazole was prescribed on the basis of microbial culture of bone and microbial susceptibility testing. Resolution of osteomyelitis was confirmed by CT 11 months after the initial surgery.

    CONCLUSIONS AND CLINICAL RELEVANCE Focal maxillectomies and premaxillectomy were successfully performed in a large python. Surgical management and appropriate antimicrobial treatment resulted in a good outcome.