| Further Information |
Diagnosis
- Oral examination - examination of the teeth.
- Ultrasonography.
- Radiography of the skull.
- Further imaging - CT scan if available.
- Aspiration of material from the abscess. (B600.8.w8)
- Example:
- In one rabbit, ultrasonography revealed a mass ventromedial to
the right eye, with hyperechoic areas which cast acoustic shadow.
It was noted that the bony orbit appeared incomplete, the mass
projected laterally, and the right globe was mildly indented from
pressure of the adjacent mass. Radiography further revealed destruction
of normal architecture, and along the zygomatic
process of the right maxilla there was reactive proliferation of
bone. CT scan further showed the extent of bony destruction and
defined the anatomic borders of the abscess. (J213.9.w3)
- Culture (aerobic and anaerobic) and sensitivity testing.
- See:
(B600.8.w8, B602.39.w39,
J213.9.w3)
Differential
diagnoses of unilateral exophthalmos: (J29.16.w2)
Differential diagnoses of bilateral exophthalmos: (J29.16.w2)
- Transient, associated with fear or stress.
- Mediastinal masses.
Treatment
- Medical treatment Antibiotic treatment is unlikely to be
curative without surgery. (J29.16.w2)
- Antibiotic-impregnated beads may be implanted. (J29.16.w2)
- Surgical removal.
- In early cases, a periocular approach to the abscess may allow
the eye to be saved. (J29.16.w2)
- In later cases, with ocular damage (usually ulcerating keratitis
and panuveitis), radical surgery, removing all the contents of the
orbit (complete orbital exenteration) as well as extracting associated teeth and draining the
orbit. (B601.12.w12,
J29.16.w2)
- Note: rabbits have a large venous sinus closely
associated with the glands of the orbit, which will
haemorrhage if punctured. (B600.11.w11)
- Haemorrhage should be expected. Control with bipolar
radiosurgery, pressure or gel foam or bone wax applied to the
orbital wall where vessels are bleeding. (J29.16.w2)
- Post-surgical treatment:
- The orbit can be packed with Iodophor-impregnated
gauze [later removed]. (J29.16.w2)
- The abscess may be treated by marsupialization combined with
topical treatment. (J29.16.w2)
- Placement of antibiotic-impregnated beads into the orbit may
be useful. (B531.16.w16,
B601.12.w12)
- Use of calcium hydroxide paste (high pH
therefore bactericidal) in the orbit may be useful. (B531.16.w16,
B601.12.w12)
- Note: even with radical surgery the prognosis is guarded to
poor. (J29.16.w2,
J215.11.w2,
V.w133)
- Long-term management, with initial surgery, is possible in some
cases: (J213.9.w3)
- In one described case, treatment involved removal of involved
teeth via an intraoral approach, which drained a large amount of
purulent material. Three days later, an external approach was made
to the abscess, with curettage of lytic bone of the maxilla and
removal of the contents of the abscess, including the remains of
one molar, using a small bone curette introduced through the hole
in the maxilla; a rigid 2.7 mm endoscope was used to visualise the
abscess and facilitate accurate debridement. The area was flushed
with sterile saline and Gentamicin-impregnated PMMA beads were
introduced (see: Production of Antibiotic-Impregnated Beads)
before the facial incision was closed. As well as
postoperative analgesia, long-term antibiotic treatment was given
(based on culture of Bacteroides). A further operation was
carried out seven months later to remove more diseased teeth and a
migrating PMMA bead, with the deficit being filled with a polymer
gel containing Doxycycline. Ongoing treatment included coronal
reduction of the opposing cheek teeth, periodic cleaning out,
flushing and refilling of the abscess cavity with doxycycline-containing
gel, and long-term antibiotic (procaine Penicillin G, twice
weekly) and NSAIDs
analgesic (Meloxicam) daily). Note: this
treatment was not curative, but had allowed the rabbit to have a
good quality of like (bright, with good appetite and normal
digestion) for more than 18 months. (J213.9.w3)
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