RESUMO
Introduction: Oral malignant melanoma (OMM) is the most common malignant oral neoplasm in dogs. Tumor recurrence, progression, and regional and distant metastasis remain major obstacles despite advanced therapy. Tumor size has been a consistent, key independent prognostic factor; however, other clinical and histopathologic features impact prognosis and likely influence optimal treatment strategies. Adoption of a risk stratification scheme for canine OMM that stratifies groups of dogs on defined clinicopathologic features may improve reproducible and comparable studies by improving homogeneity within groups of dogs. Moreover, it would aid in the generation of multidisciplinary prospective studies that seek to define optimal treatment paradigms based on defined clinicopathologic features. Methods: To build a platform upon which to develop a risk stratification scheme, we performed a systematic review of clinicopathologic features of OMM, with particular attention to levels of evidence of published research and the quantitative prognostic effect of clinicopathologic features. Results: Tumor size and presence of bone lysis were repeatable features with the highest level of evidence for prognostic effects on survival. Overall, with strict inclusion criteria for paper review, the levels of evidence in support of other, previously proposed risk factors were low. Factors contributing to the challenge of defining clear prognostic features including inconsistencies in staging and reporting of prognostic variables, incomplete clinical outcome data, inhomogeneous treatment, and absence of randomized controlled studies. Discussion: To overcome this in the future, we propose a risk stratification scheme that expands the TNM system to incorporate specific designations that highlight possible prognostic variables. The ability to capture key data simply from an expanded TNM description will aid in future efforts to form strong conclusions regarding prognostic variables and their influence (or lack thereof) on therapeutic decision-making and outcomes.
RESUMO
The first molar is the largest tooth in the dog mandible with roots often extending to the level of the mandibular canal (MC). The anatomical relationship between the roots and MC is variable and the normal relationship between those structures in a diverse population of dogs has not been established. The lingual location of the roots relative to the MC poses a risk for iatrogenic trauma during dentoalveolar surgery, and it is unknown if certain skull conformations are predisposed to this relationship. This study aimed to identify associations between patient weight and skull type with molar tooth root location. CT scans performed for reasons unrelated to the study were retrospectively analyzed. Subjects were sorted into one of 12 groups (n=16 per group) based on skull type (brachycephalic, mesaticephalic, and dolichocephalic) and weight (extra small: ≤ 6.8 kg, small: >6.8 to ≤ 13.6 kg, medium: >13.6 to ≤ 25 kg, and large >25 to ≤ 38.6 kg). The mandibular first molar roots were categorized as lingual, buccal, or dorsal relative to the MC. Lingual root location was diagnosed in 50.0% of all roots evaluated, and 64.2% of all dogs assessed had at least one root in the lingual position. The size was shown to be protective, with lingual root location being significantly less likely as size increased. The exception to this was in large brachycephalic patients, which had rates of lingual roots similar to smaller dogs. Buccal roots were rarest, diagnosed in only 9.7% of all roots, and were most common in brachycephalic patients, which had 83.8% of all buccal roots. Additional caution should be employed when removing alveolar bone during surgical extraction in dogs ≤ 13.6 kg and in large brachycephalic patients (boxers) to avoid iatrogenic trauma to the neurovascular bundle.