Successful treatment of chronic periapical osteomyelitis in a Parma wallaby (Macropus parma) using comprehensive endodontic therapy with apicoectomy

TREATMENT OF ORAL DISEASE IN EIGHT CAPTIVE BENNETT'S WALLABIES (MACROPUS RUFOGRISEUS) BETWEEN 2011 AND 2019: A CASE SERIES

Oral disease, such as endodontic disease and macropod progressive periodontal disease (MPPD), which can progress to chronic alveolar osteomyelitis (CAO), have been identified as a common source of morbidity and mortality in captive macropods. This case series reviews the diagnosis and treatment of dental disease in eight captive Bennett's wallabies (Macropus rufogriseus) over the course of an 8-yr period (2011-2019) in a zoological collection. Two wallabies were treated at four separate times, for a total of 14 anesthetized dental surgical procedures. Two wallabies died after treatment for dental disease. Endodontic disease, MPPD, and CAO were all identified and treated with extraction. Cases in which disease was identified early and treated aggressively had a good outcome with no return of clinical signs in the affected area. Several cases of extensive CAO were treated successfully with extraction and extensive debridement. One wallaby developed immune-mediated anemia, a suspected adverse drug reaction associated with prolonged administration of intravenous clindamycin.

Treatment of mandibular osteomyelitis in two red-necked wallabies (Macropus rufogriseus) by means of intensive long-term parenteral drug administration and serial computed tomographic monitoring

CASE DESCRIPTION 2 female red-necked wallabies (Macropus rufogriseus) were evaluated because of sudden-onset mandibular swelling, ptyalism, and hyporexia. CLINICAL FINDINGS Physical examination revealed a mandibular swelling with a fluctuant center in both wallabies. Hematologic analysis revealed leukocytosis with a mature neutrophilia and monocytosis in one wallaby (case 1) and a slight neutrophilia, hyperglobulinemia, and high serum alanine aminotransferase activity in the other (case 2). Cytologic examination of the swelling revealed a uniform population of gram-negative rods in case 1 and neutrophilic inflammation in case 2. Radiography revealed a soft tissue mandibular swelling with osteolucency around mandibular incisor roots in both wallabies. Computed tomography revealed changes consistent with chronic active mandibular osteomyelitis and reactive bone formation, but also sequestra formation not appreciable via radiography. TREATMENT AND OUTCOME Long-term antimicrobial treatment was initiated with clindamycin (17 to 21 mg/kg [7.7 to 9.5 mg/lb], IV, q 12 h for 40 to 55 days) and high-dose benzathine penicillin G (80,000 U/kg [36,364 U/lb], SC, q 12 h for 150 days). Serial CT was performed to evaluate response to treatment and resolution of disease. A CT scan 18 months after the initial evaluation revealed complete resolution of osteomyelitis and sequestra. CLINICAL RELEVANCE Advanced imaging and long-term treatment and management were integral to the successful outcome for these wallabies, given that the osseous changes visible on CT images were not visible on standard radiographs, guiding therapeutic decision-making. This report provides new therapeutic and diagnostic monitoring information to assist clinicians with similar cases.