Lacey is a 6-year-old Pomeranian dog who, according to caretaker Kara, runs the household. I would bet there are a lot of us out there who might say the same thing about our companions. Lacey spends most of her time indoors, but is allowed access into the backyard and goes on regular leash walks with Karen.
Over the past couple of months, Karen has been dealing with a swelling on Lacey’s face just below her right eye. She has taken Lacey to her veterinarian and treated her with antibiotics two times; the last time with prednisone as well. Each time she has treated Lacey, the swelling has disappeared, only to return a few days after the treatment was stopped. Karen is becoming discouraged and, in reading her letter, it is obvious she is worried about Lacey.
Without question, Lacey’s facial swelling needs further investigation. There are a few possible causes that jump to mind right off the bat.
Anytime a lesion such as Lacey’s is treated with antibiotics and there is resolution, whether permanent or temporary, there is likely to be bacterial infection involved. This does not, however, mean that bacteria is the primary problem. There may be an underlying issue that allows a bacterial infection to secondarily occur. For Lacey, because her problem is recurrent when antibiotics are stopped, we are highly suspicious of an underlying disease leading to a bacterial infection.
Let’s start this investigation by first listing a few possible underlying causes for Lacey’s facial swelling and then try to rule them out with logical thought and appropriate diagnostics.
There may be a tumor growing either under the skin in the area of the swelling or perhaps there is a mass inside the nasal passage on the right side of Lacey’s face, causing a bulging out in that area. I would think this less likely because antibiotics alone should not be able to reduce swelling caused by a mass. There is a possibility of a foreign body within the right nasal passage that has caused a secondary infection, which then causes swelling within the nasal passage that might then distort the right side of the face. I am not buying this scenario either.
My No. 1 scenario for Lacey’s facial swelling is a tooth root abscess. Specifically, I am betting she has an abscess in one or more of the roots of a tooth called the carnassial tooth. Technically this tooth is a premolar, but typically it is the largest tooth in a dog’s mouth and is made up of three roots. These roots are quite long and are anchored in the maxillary bone of the upper jaw. If there is an abscess in one or more of these roots, it can cause erosion of the thin layer of bone separating the tip of the root(s) from the nasal passage. This, then, can cause swelling of the face precisely in the described location of Lacey’s lesion.
To diagnose a carnassial abscess, we simply need to take some dental radiographs and look for a tooth root abscess. The molar behind the carnassial tooth could also be a culprit.
Depending on the individual case and preference of the caretaker, we can root canal the offending root(s) or elect simply to extract the tooth. The rest of her teeth can be examined as well, along with a thorough cleaning and polishing followed by a fluoride treatment. Once the root canal or extraction procedure is done and yet another course of antibiotics finished, Lacey likely will be cured.