* This is a case discussion submitted to the Exotic DVM Yahoo group
Male slow loris, 530 grams, big amount of pus in the cheek due to a tooth extraction.
history:
almost 2 months ago we’ve made the dental extraction of the right and left upper P4 premolars (they were rotten insde), and put him on oral Amoxi/Clav ac. and metacam. The folowing days we saw that there was a little amount of pus from the right upper premolar hole, flush it for a little while and after some other couple of days everything seemed cleaned so we’ve send him to his rehab place.
It passed one week and we saw a fairly big amount of puss coming down from the extraction hole of the right premolar. This time we’ve started giving Baytril for 5 days, but still no improvement so we’ve changed it to Synulox (8 days), and this time we did not see animore the pus (so back to his place agian).
After another 10 days the condition releapsed, and in a few days the whole right cheek, form the right nostril up to the ear was just a big bag of pus, but the tooth entrance was closed his time. We’ve made two half a centimeter cuts on the cheek(one underneath the other), took all the pus out (incredible amount for the loris size; the pus wasn’t under the skin but somewhere under the maseter muscles, close to the bones), flush it and put a improvised IV-drip drain. We’ve then flush it for a couple of days with a mixture of penicilline and saline, and it seemed to go well. Took the drain out after 3 days and clean it trough the holes until it seamed to heal properly.
Yesterday the cheek was closed, no swelling, nothing, but this morning the history repeated : another bag of pus which we had to wash out and we’ve set another drain. This time we’ve improvised the drain from a piece of latex glove, trying to louse as much as dead space inside. We’ve considered not to suture the drain on the skin but to make a loop and suture it by the ends, so that we can slide the drain inside while flushing the pus out.
Luckily today we’ve received the culture result (Klebsiella pneumoniae) and the antibiogram. It seems that every antibiotic we have given by now, it had resistance to it. Still there are a couple of others that is still sensible to : Amikacin, Gentamicin, Cloramfenicol. For now we only had in the clinic cloramphenicol in an eye ointment gel so we’ve put it inside the wound. Next days we hope to buy the other antibiotics in a systemic form.
The loris doesn’t mind the drain, is eating normally, did not loose any weight and temperature is in parameters.
During this period we had to treat also from stongildosis and ameobas, and animal most probably was immuno-suppressed.
So… our question to you:
Please tell us if we had done something wrong, starting with the drug management to the improvised drains. Hoping the antibiotics will work, should we consider some other type of surgical approach (make one bigger cut and check what’s under the muscles?, remove this rubber drain, because of future reaction/ or not leave it to slide and suture it?…), etc.
Ovidiu Rosu
International Animal Rescue Indonesia
www.internationalanimalrescue.org
