Surgical Correction (Apicoectomy) of a Molar Dental Plate Sequestrum in an African Elephant (Loxodonta africana)
American Association of Zoo Veterinarians Conference 2007
Wm. Kirk Suedmeyer1, DVM, DACZM; Jim Oosterhuis2, DVM; David Fagan3, DDS; George Kollias4, DVM, DACZM; Bill Hornoff5, DVM; John Dodam6, DVM, PhD, DACVA; Heidi Shafford6, DVM; Ginger Takle1, DVM; Sathya Chinnadurai6, DVM; Susan Bartlett4, DVM
1Kansas City Zoo, Kansas City, MO, USA; 2San Diego Wild Animal Park, Escondido, CA, USA; 3Colyer Institute, San Diego, CA, USA; 4Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA; 5Eklin Medical Systems, Inc., Sunnyvale, CA, USA, 6College of Veterinary Medicine, University of Missouri-Columbia, Columbia, MO, USA
A 29-yr-old female African elephant weighing 3,384 kg was anesthetized with a combination of 7.5 mg etorphine, 15 mg acepromazine, and 3,000 IU hyaluronidase for surgical treatment of a chronic ventral mandibular fistula. The fistula originated from a previously diagnosed dental plate (tooth root) infection.2 Initial effects were noted within 3 min and the elephant became recumbent within 8 min. The elephant was guided into right lateral recumbency with preplaced ropes. The elephant was orotracheally intubated and maintained on isoflurane in oxygen through the use of paired large animal anesthetic machines equipped with four 30 L reservoir bags. Digital radiography was utilized to guide the surgical procedure which involved the surgical creation of a second fistulous tract through the lateral wall of the mandible and directly into the apically infected dental plate portion of the molar tooth. The infected area was aggressively curetted, lavaged, and the resultant apical bony deficit and access tract was back filled and closed with an antibiotic-impregnated calcium sulfate dental plaster. Pulse oximetry, ECG, blood gases, direct and indirect oscillometric blood pressure were consistently monitored. Goals for blood pressure parameters and respiratory excursions were achieved, which minimized deleterious effects of lateral recumbency upon systemic circulation. The elephant was reversed with naltrexone and recovered uneventfully, although additional naltrexone was administered for one episode of renarcotization later in the day. The original ventral tract was allowed to drain and continued to do so for an additional 6 mo, whereupon the fistulous tract resolved. No further drainage or swelling has been noted for an additional 7 mo. The elephant continues to prehend, masticate, and behave normally. This case demonstrates the ability to diagnose and surgically correct dental abnormalities in an elephant based on similar reported cases in other animals.1
The authors would like to thank every department at the Kansas City Zoo for their contributions to the success of this procedure.
1. Fagan D.A., J.E. Oosterhuis, and K. Benirschke 2005. “Lumpy Jaw” in exotic hoof stock: a histopathologic interpretation with a treatment proposal. J. Zoo. Wildl. Med. 36(1):36–43.
2. Suedmeyer, W.K., J. Oosterhuis, G. Kollias, D. Fagan, B. Hornoff, J. Dodam, and H. Shafford. 2006. Elephant restraint device assisted anesthesia in an African elephant (Loxodonta africana). Proc. Amer. Assoc. Zoo Vet. Pp. 189–192.