99. The Pom's face wound would not heal --- Oronasal fistula.

"Why didn't you come for the surgery?" I gently admonished the lady owner of the Pomeranian. "You wasted more money buying antibiotic powder to dust onto the facial wound after consultation."

Her dog had a weeping wound of around 5 mm in diameter below the left eye, above the maxillary 4th premolar tooth. It did not heal over the past weeks despite various medications and powders she had sprinkled on. Pet shops sell wound powders.

Some 14 days ago, I had patiently explained to her that there was an infection from the root of the maxillary 4th premolar. The infection went through into the nose below the eye. The bacteria from the decayed roots of this premolar attacked the nasal bone area and made a hole. This was an oronasal fistula and surgery to remove the infected premolar would resolve her Pomeranian's non-healing wound problem once and for all.

I guessed she could not understand how a rotten tooth inside the left upper jaw could be related to a hole on the skin below the left eye. Her husband thought, "This doctor is nuts. Mouth and nose. So far apart. How could there be a connection?"



"Surgery was to be done 7 days ago after antibiotics were given but you did not turn up till today --- 14 days later. Why spend more money on wound powders when they don't work?" It was not good for the dog. The anaesthesia and tooth surgery was $200 which was affordable for most pet owners. If it was $2,000, it would be high.




Sometimes it is good bedside manners not to elaborate in such situations and just simply accept the case. There was an optimal time to do extraction of the infected and decayed tooth. It was after 7 days of antibiotics and she had been given an appointment. She did not turn up and now the effects of antibiotics were no more. The bacteria in the infected teeth had returned.

The lady smiled sheepishly. "My husband wanted to use the $200 for the anaesthesia and surgery to go to India lah!"

Now that the dog is no longer on antibiotics, should I operate? There was no urgency in the sense that it was an emergency.

But it would be in the best interest of this poor dog to be cured as soon as possible.

The decayed 4th premolar and lst molar were loose as their roots had shrivelled from bacterial attack. They were extracted.





The wound should heal and the Pomeranian should have a face with no wet weeping hole.