Simple Summary
Advanced periodontal disease can create an abnormal opening between the mouth and nasal cavity in dogs. Closing this opening may be difficult when both the bone and the surrounding soft tissues have been damaged. This report describes an eight-year-old Beagle treated using two local tissue flaps. A flap raised from the hard palate was turned over the opening palatal to the left maxillary canine tooth and attached to the remaining buccal alveolar bone using four sutures passed through small bone holes. A second flap was advanced from the cheek side to cover the repair. Bone suture fixation provided attachment points where the soft tissue was considered unreliable for fixation. The dog began eating voluntarily on the day after surgery and was discharged four days after surgery. Healing was documented at 18 days, nasal discharge resolved, and no recurrence was recorded during 45 days of follow-up. At 555 days after surgery, examination of the mouth showed an intact repair, and a computed tomography scan performed for an unrelated ear condition also supported maintained closure. This case illustrates how the available bone and soft tissues can be incorporated into planning a two-layer fistula repair. Additional cases are needed to determine the benefits and limitations of this fixation method.
Abstract
Advanced periodontal disease can compromise the recipient tissues available for flap fixation during oronasal fistula repair. This report describes double-layer repair of an acquired periodontal oronasal fistula in an eight-year-old castrated male Beagle. Radiographs and computed tomography (CT) identified regional bone loss and residual alveolar bone adjacent to the defect. Following extraction of the left maxillary canine and second premolar and debridement of the fistula margins, an inverted hard palatal mucoperiosteal flap was anchored to residual buccal alveolar bone through four transosseous bone holes created with an 18-gauge needle. Transosseous suture fixation used 4-0 polydioxanone simple interrupted sutures. A buccal mucosal advancement flap covered the inverted flap and palatal donor site; no interpositional graft was used. Healing without clinically evident dehiscence was documented on postoperative day 18, and nasal discharge had resolved by day 45. At 555 days, visual oral examination revealed an intact repair, with concordant CT findings obtained for an unrelated otologic indication. This case illustrates the use of residual buccal alveolar bone for palatal flap attachment when periodontal tissue loss limits gingival recipient margins, with maintained closure documented at late clinical and imaging reassessment.