Domestic Shorthair Research Articles

Effects of trazodone and dexmedetomidine on fentanyl-mediated reduction of isoflurane minimum alveolar concentration in cats

ObjectiveTo screen modulators of biogenic amine (BA) neurotransmission for the ability to cause fentanyl to decrease isoflurane minimum alveolar concentration (MAC) in cats, and to test whether fentanyl plus a combination of modulators decreases isoflurane MAC more than fentanyl alone. Study designProspective, experimental study. AnimalsA total of six adult male Domestic Short Hair cats. MethodsEach cat was anesthetized in three phases with a 1 week washout between studies. In phase 1, anesthesia was induced and maintained with isoflurane, and MAC was measured in duplicate using a tail clamp stimulus and standard bracketing technique. A 21 ng mL–1 fentanyl target-controlled infusion was then administered and MAC measured again. In phase 2, a single cat was administered a single BA modulator (buspirone, haloperidol, dexmedetomidine, pregabalin, ramelteon or trazodone) in a pilot drug screen, and isoflurane MAC was measured before and after fentanyl administration. In phase 3, isoflurane MAC was measured before and after fentanyl administration in cats co-administered trazodone and dexmedetomidine, the two BA modulator drugs associated with fentanyl MAC-sparing in the screen. Isoflurane MAC-sparing by fentanyl alone, trazodone–dexmedetomidine and trazodone–dexmedetomidine–fentanyl was evaluated using paired t tests with p < 0.05 denoting significant effects. ResultsThe MAC of isoflurane was 1.87% ± 0.09 and was not significantly affected by fentanyl administration (p = 0.09). In the BA screen, cats administered trazodone or dexmedetomidine exhibited 26% and 22% fentanyl MAC-sparing, respectively. Trazodone–dexmedetomidine co-administration decreased isoflurane MAC to 1.50% ± 0.14 (p < 0.001), and the addition of fentanyl further decreased MAC to 0.95% ± 0.16 (p < 0.001). Conclusions and clinical relevanceFentanyl alone does not affect isoflurane MAC in cats, but co-administration of trazodone and dexmedetomidine causes fentanyl to significantly decrease isoflurane requirement.

DIAGNOSIS DAN PENGOBATAN KONSTIPASI DAN MEMAR HEMATURIA PADA VESICA URINARIA AKIBAT TRAUMA PADA KUCING

A two-year-old, spayed female, calico, domestic shorthair cat (Felis catus) was admitted to IPB University Veterinary Teaching Hospital with a history of hematuria, constipation, and inappetence after being hit by a car. Clinical examination showed pyrexia and the presence of pain when the patient was palpated in the abdomen. Laboratory results showed leukocytosis, lymphocytosis, increased glutamic-oxaloacetic transaminase, increased blood urea nitrogen, proteinuria, over-creatinine, as well as blood and struvite in the urine. The radiographic analysis reported abnormalities in os vertebrae lumbalis I and radiolucent of the colon and rectum. Sonographic findings were cholecystitis, cholelithiasis, nephritis, enteritis, and cystitis. The treatments given were intravenous infusion with normal saline, a single Melovem® injection 0.35 cc, Dulcolax® one 5 mg tablet SID for two days, Samylin®Medium Breed ½ tablet once a day, Cystaid Plus® for cats SID one tab, phytomenadione injection 3 mg/kg SID for two days, Claneksi® syrups 20 mg/kg of body weight per oral BID for five days, Renate® SID per oral for eight days. On the second day of hospitalization, the patient had not pooped, so intra-rectal flushing with physiologic saline was performed, and the patient pooed with normal consistency each day after the enema procedure. Hematuria was observed during the first two days of hospitalization, while no hematuria was observed on the third day. The patient recovered after three days of hospitalization with no hematuria or other abnormal clinical signs or complications. The veterinarian discharged the patient with home treatment with the remaining oral medications.

Effect of volume and methylene blue on fluorescence intensity and transit of indocyanine green for sentinel lymph node mapping in a simulated feline tumor model.

To compare the effect of volume and solution on transit time and fluorescence intensity (FI) using near-infrared fluorescence imaging (NIRF) in a simulated tumor model in cats. Secondarily, to describe SLN mapping with indocyanine green (ICG) NIRF and report any adverse effects of intradermally injected ICG in cats. 7 healthy purpose-bred domestic shorthaired male cats. Cats were randomly divided into 2 groups (ICG or ICG + methylene blue [MB]). Transit time and FI were determined for 1 or 2 mL solutions injected intradermally in 4 quadrants around a simulated tumor. Following massage, fluorescence intensity was quantified by calculating the corrected total ROI fluorescence using ImageJ software. Cats were monitored for adverse effects up to 4 weeks post-injection. A larger solution volume had decreased transit times to the SLN (P = .001). There was no significant difference in transit times between ICG and ICG-MB. ICG demonstrated a greater FI (P = .001) in the SLN compared to ICG-MB. Methylene blue did not percutaneously fluoresce under NIRF. The volume of the solution did not significantly affect FI. No adverse reactions were reported. Increased volume of ICG may aid in rapid percutaneous lymphatic tracking from tumor to SLN. Indocyanine green alone may be preferred over ICG-MB for greater visualization of the SLN. Intradermal injections of ICG and ICG-MB were well-tolerated in healthy cats with no significant complications. Clinical evaluation of this technique in an impaired lymphatic system, as seen in cancer patients, should be assessed in future research.

Successful definitive‐intent radiation therapy for recurrent and metastatic feline thymoma with unusual extra‐thoracic metastasis

AbstractA 10‐year‐old, male, neutered, domestic shorthair cat was referred for investigation of cough and dyspnoea episodes. A large cranial mediastinal mass was detected using computed tomography. Upon surgical removal, the mass was diagnosed as a lymphoid‐rich thymoma. Ten months postoperatively, the tumour was reported to recur, followed 2 months later by the development of an axillary mass and enlarged thoracic and superficial cervical lymph nodes. Recurrent and metastatic thymoma was confirmed, which was successfully treated with radiation therapy.

Electrocardiography-documented sudden cardiac death due to ventricular fibrillation in a young cat without echocardiographic evidence of severe structural heart disease

An asymptomatic three-year-old male European Domestic Shorthair cat was referred for an irregular heart auscultation. Apart from localized concentric left ventricular septal hypertrophy, echocardiography was normal. However, ventricular ectopy was observed on electrocardiography (ECG) during echocardiography. The cat died suddenly 55 minutes after the start of the subsequent Holter ECG. Analysis showed sinus rhythm interrupted by 192 single ventricular premature complexes, a ventricular couplet, two incidents of ventricular bigeminy and two runs of ventricular tachycardia (VT). The last run of VT deteriorated into ventricular fibrillation (VF) and ultimately cardiac arrest. Structural heart disease including mild feline hypertrophic cardiomyopathy or myocarditis, primary arrhythmia (channelopathy) or extra-cardiac disease were maintained as differential diagnosis. Unfortunately, a necropsy was declined leaving no definitive diagnosis available. In this case report, it is shown that VF due to ventricular ectopy is a possible cause of SCD even in asymptomatic cats with only mild echocardiographic signs of structural heart disease.

The Use of Triaxial Accelerometers and Machine Learning Algorithms for Behavioural Identification in Domestic Cats (Felis catus): A Validation Study.

Animal behaviour can be an indicator of health and welfare. Monitoring behaviour through visual observation is labour-intensive and there is a risk of missing infrequent behaviours. Twelve healthy domestic shorthair cats were fitted with triaxial accelerometers mounted on a collar and harness. Over seven days, accelerometer and video footage were collected simultaneously. Identifier variables (n = 32) were calculated from the accelerometer data and summarized into 1 s epochs. Twenty-four behaviours were annotated from the video recordings and aligned with the summarised accelerometer data. Models were created using random forest (RF) and supervised self-organizing map (SOM) machine learning techniques for each mounting location. Multiple modelling rounds were run to select and merge behaviours based on performance values. All models were then tested on a validation accelerometer dataset from the same twelve cats to identify behaviours. The frequency of behaviours was calculated and compared using Dirichlet regression. Despite the SOM models having higher Kappa (>95%) and overall accuracy (>95%) compared with the RF models (64-76% and 70-86%, respectively), the RF models predicted behaviours more consistently between mounting locations. These results indicate that triaxial accelerometers can identify cat specific behaviours.

Traumatic injury of left femoral nerve causing unilateral hindlimb lameness in a cat

AbstractA 1‐year‐old, female, domestic shorthair cat was referred for orthopaedic evaluation of acute‐onset, non‐progressive left pelvic limb lameness of 2.5‐week duration. Orthopaedic examination revealed an abnormal gait with impaired ability to support weight on the left pelvic limb. There was marked atrophy of the quadriceps muscles. Neurological examination revealed an absent patellar reflex and decreased sensation in the cutaneous zone of the saphenous nerve of the left pelvic limb. Magnetic resonance imaging showed T2‐weighted/short‐tau inversion recovery hyperintensity and contrast enhancement in the area of the femoral nerve and within muscles innervated by this nerve. Findings were deemed consistent with traumatic nerve injury and denervation/traumatic myopathy or myositis/neuritis. Electromyography of the quadriceps muscles revealed fibrillation potentials and positive sharp waves. Follow‐up over the next 9 months revealed no changes in the neurological deficits. This was deemed to be consistent with either partial axonotmesis or partial neurotmesis of the left femoral nerve.

Vulval apocrine adenocarcinoma with tumour-associated eosinophilia in a cat

A 10-year-old, spayed female, Domestic Shorthaired cat was referred for surgical removal of a mass on the left vulval fold. An impression smear revealed mixed cell inflammation, with eosinophils predominating focally, and a concurrent bacterial infection, suggesting a primarily inflammatory lesion. However, cytology of a fine-needle aspirate of the mass revealed a neoplastic epithelial cell population, confirmed on histopathology as an apocrine vulval adenocarcinoma with lymphatic invasion and marked tumour-associated tissue eosinophilia. One month after surgical excision of the mass, the cat developed inguinal metastatic lymphadenopathy and chemotherapy was initiated. The patient ultimately developed marked peripheral lymphadenomegaly and was euthanized due to concerns for overall quality of life and comfort. This case highlights that neoplasia should be a consistent differential diagnosis for eosinophilic infiltrates/inflammation. The distinct appearance of the two cytological samples in this case stresses the need for sampling of different sites of a lesion and the importance of not relying on superficial impression smears for clinical management and prognosis.

Identification of an ADAMTS2 frameshift variant in a cat family with Ehlers-Danlos syndrome.

We investigated 4 European domestic shorthair kittens with skin lesions consistent with the dermatosparaxis type of the Ehlers-Danlos syndrome, a connective tissue disorder. The kittens were sired by the same tomcat but were born by 3 different mothers. The kittens had easily torn skin resulting in nonhealing skin wounds. Both clinically and histologically, the skin showed thin epidermis in addition to inflammatory changes. Changes in collagen fibers were visible in electron micrographs. The complete genome of an affected kitten was sequenced. A one base pair duplication leading to a frameshift in the candidate gene ADAMTS2 was identified, p.(Ser235fs*3). All 4 affected cats carried the frameshift duplication in a homozygous state. Genotypes at this variant showed perfect cosegregation with the autosomal recessive Ehlers-Danlos syndrome phenotype in the available family. The mutant allele did not occur in 48 unrelated control cats. ADAMTS2 loss-of-function variants cause autosomal recessive forms of Ehlers-Danlos syndrome in humans, mice, dogs, cattle, and sheep. The available evidence from our investigation together with the functional knowledge on ADAMTS2 in other species allows to classify the identified ADAMTS2 variant as pathogenic and most likely causative variant for the observed Ehlers-Danlos syndrome.

Intrathoracic eosinophilic sclerosing fibroplasia with intralesional bacteria in a cat

Case summary A 9-year-old neutered female domestic shorthair cat was presented for investigation of a cranial mediastinal mass. Moderate peripheral eosinophilia and mild-to-moderate polyclonal gammopathy were identified. A thoracoabdominal CT scan documented a cranial mediastinal mass encircling the trachea. Ultrasound-guided fine-needle aspiration and core-needle biopsy were performed, but cytology and histopathology were inconclusive. Surgical debulking was performed. Further histological samples identified severe pyogranulomatous and eosinophilic fibrosing mediastinitis, consistent with feline eosinophilic sclerosing fibroplasia. Gram staining and fluorescence in situ hybridisation (FISH) identified numerous Gram-positive coccoid bacteria. Eosinophilia and hyperglobulinaemia resolved after surgery and combined antimicrobial and immunosuppressive therapy. The cat died 3 months later after developing acute haemorrhagic diarrhoea and dyspnoea. Relevance and novel information Eosinophilic sclerosing fibroplasia is reportedly mainly confined to the gastrointestinal tract in cats. Less commonly, extragastrointestinal cases have been described. Lesions in the mediastinal or sternal lymph nodes have been reported, all in association with evident gastrointestinal involvement. The presence of pleural effusion was variable in these cases. To the authors’ knowledge, this is the first report of eosinophilic sclerosing fibroplasia presenting due to lower respiratory signs in a cat. Intralesional bacteria were identified using Gram staining and FISH examination. The presence of intralesional bacteria in the normally sterile mediastinal tissue may support the involvement of penetrating injuries in the pathogenesis of the disease. Eosinophilic sclerosing fibroplasia should be suspected in any cat with abdominal and/or thoracic masses, particularly if associated with peripheral eosinophilia and polyclonal gammopathy.

Diarrhea, vomiting, and anorexia in a 4-month-old male intact domestic shorthair cat.

Diarrhea, vomiting, and anorexia in a 4-month-old male intact domestic shorthair cat.

Renal histiocytic sarcoma in a cat undergoing nephrectomy and adjuvant chemotherapy

AbstractA 6‐year‐old, male neutered, domestic shorthair cat was presented for further investigation of a right‐sided kidney mass. A contrast‐enhanced computed tomography scan of head, thorax and abdomen showed a right‐sided renal mass, with infiltration of the surrounding tissue, but no evidence of distant metastasis. Cytology was consistent with a poorly differentiated neoplasia, and nephrectomy was performed. Following surgery, the cat underwent multiple blood transfusions due to severe anaemia and developed tricavitary effusion compatible with a protein‐rich transudate. The tumour was confirmed to be a histiocytic sarcoma on histopathology and immunohistochemistry, and the patient received adjuvant chemotherapy with lomustine. Restaging procedures were performed 121 days following surgery and documented recurrence at the previous surgical site together with cutaneous metastasis, therefore a rescue protocol with single agent doxorubicin was started. The patient was euthanased after worsening of its clinical conditions, 152 days since nephrectomy was performed.

Babesia gibsoni Infection in a Cat with Immune-Mediated Haemolytic Anaemia and Thrombocytopenia

Tick-borne haemoparasite Babesia gibsoni has been detected rarely in cats, in surveys of apparently healthy animals. In stored blood from a 6-year-old male-neutered domestic shorthair cat in Hong Kong, B. gibsoni DNA was detected retrospectively using PCR for Babesia spp. 18S rRNA and mitochondrial cytochrome B genes, followed by sequencing and basic local alignment search tool (BLAST) analysis. The cat presented with severe haemolytic anaemia and thrombocytopenia. The cat responded to supportive care and glucocorticoids and was clinically normal despite persistent subclinical thrombocytopenia until six months after presentation, when it succumbed to a fatal haemorrhagic episode. Necropsy revealed severe intestinal and pulmonary haemorrhage and hypocellular bone marrow with megakaryocytosis but no other causes of immune-mediated thrombocytopenia (IMTP) or immune-mediated haemolytic anaemia (IMHA). Blood stored on days 158 and 180 tested PCR negative for Babesia spp. This report demonstrates that geographic range of B. gibsoni detection in cats includes Hong Kong. The exclusion of other causes suggests that B. gibsoni might have potentially played a role in triggering immune-mediated disease in this case.

Melanocortin-4 receptor and proopiomelanocortin: Candidate genes for obesity in domestic shorthair cats.

Obesity is an escalating global health problem affecting both humans and companion animals. In cats it is associated with increased mortality and multiple diseases, including diabetes mellitus. Two genes coding for proteins known to play a critical role in energy homeostasis across species are the proopiomelanocortin (POMC) gene and the melanocortin-4 receptor (MC4R) gene. A missense variant in the coding sequence of the feline MC4R (MC4R:c.92C>T) has been reported to be associated with diabetes and overweight in domestic shorthair cats, and while variants in the POMC gene are known to cause obesity in humans and dogs, variants in POMC and their association with feline obesity and diabetes mellitus have not been investigated to date. The current study aimed to assess the association between the previously described MC4R variant and body condition score (BCS), as well as body fat content (%BF) in 89 non-diabetic domestic shorthair cats. Furthermore, we investigated the feline POMC gene as a potential candidate gene for obesity. Our results indicate that the MC4R:c.92C>T polymorphism is not associated with BCS or %BF in non-diabetic domestic shorthair cats. The mutation analysis of all POMC exons identified two missense variants, with a variant in exon 1 (c.28G>C; p.G10R) predicted to be damaging. The variant was subsequently assessed in all 89 cats, and cats heterozygous for the variant had a significantly increased body condition score (p = 0.03) compared with cats homozygous for the wild-type allele. Results from our study provide additional evidence that the previously described variant in MC4R is not associated with obesity in domestic shorthair cats. More importantly, we have identified a novel variant in the POMC gene, which might play a role in increased body condition score and body fat content in domestic shorthair cats.

Hepatic myxosarcoma in a domestic shorthair cat.

Myxosarcomas are rare malignant neoplasms of soft connective tissues, and there are no reports of hepatic myxosarcomas in cats. An eight-year-old male, neutered, domestic shorthair cat presented with progressive hyporexia, lethargy, and weight loss. An ultrasonography study showed a large abdominal mass connected to the liver. The cat underwent a laparotomy and the mass was removed. Histopathological evaluation of the mass supported the diagnosis of a myxosarcoma. Tumour cells were positive with vimentin and alcian blue stain, and negative with PAS, pan-cytokeratin, s100, epithelial membrane antigen, and α-smooth muscle actin. The Ki-67 index by immunohistochemistry was 6%. The cat was euthanased due to severe lethargy and recumbency. Myxoid soft tissue neoplasms are very rare in cats, and to the best of our knowledge, this is the first report of a hepatic myxosarcoma in a cat. In the present case, the diagnosis was made based on histopathological and immunohistochemical findings and an alcian blue-positive supporting matrix.

Effects of oral propranolol on the resistive and pulsatility indices of major abdominal vasculatures in domestic short-haired cats.

No study has been performed regarding the effects of oral administration of propranolol on pulse-wave spectral Doppler indices of major abdominal vessels in healthy adult cats. The objective of this study was to assess the pulse-wave spectral Doppler indices of abdominal aorta, caudal vena cava, and portal vein in clinically normal adult domestic short-haired (DSH) cats, before and after propranolol ingestion. Twenty intact adult client-owned DSH cats were evaluated (10 males and 10 females). A duplex Doppler ultrasonography machine with a 10-MHz frequency linear transducer was used. Peak systolic velocity, end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), and pressure gradient were measured. All the cats received 1mg/kg of propranolol tablet, and after 2 h, ultrasonography measurements were repeated. The mean RI of the aorta and caudal vena cava significantly decreased in male cats following oral administration of propranolol after 2 h (p = 0.03, p = 0.02). In the caudal vena cava, the PI decreased from 2.98±0.62 to 1.15±0.19 post-propranolol ingestion (p = 0.01). The mean EDV in the caudal vena cava of males and portal veins of females significantly decreased after propranolol ingestion (p = 0.04, p = 0.02). This study showed that propranolol decreased the PI of the aorta and PI and RI of the caudal vena cava in healthy normal cats 2 h post-propranolol ingestion at the dosage of 1mg/kg.

Clinical Characterisation of Caudal Traumatic Malocclusions and Treatment Outcomes in Cats (2018-2022).

Caudal malocclusions in cats may result in a variety of traumatic lesions affecting the soft tissues of the ipsilateral mandible such as fovea, gingival cleft, and proliferative lesions. Fifty-one cats diagnosed with a traumatic caudal malocclusion were compared with a control hospital population and evaluated for prevalence with respect to breed and sex. Twenty-two cats that were treated had radiographic, clinical findings, and the outcome of treatment (extraction or odontoplasty) recorded. Maine Coon, Persian, and male neutered cats were overrepresented while Domestic Shorthairs were underrepresented within the study population. Radiographically, 50% of the fovea lesions had an area of decreased bone density in the region of the lesion and none of these had evidence of periodontal disease. All gingival cleft lesions had radiographic changes consistent with periodontal disease. 15.4% of proliferative lesions presented with radiographic changes, with only half of those presenting with both radiographic and clinical evidence of periodontal disease. Eleven cats were treated by odontoplasty and eleven by extraction. One cat treated by odontoplasty developed new lesions caudally, and another had persistence of the initial lesions. Two cats in the extraction group developed new lesions rostral to the extracted teeth. In most instances, odontoplasty or extraction resulted in successful soft tissue lesion resolution. In rare cases, additional treatment was necessary due to either persistence or development of new lesions.

Characterization of the Domestic Cat Population of Uruguay: Breeds, Coat Colors, Hair Length, Lifestyle, Sex and Spay/Neuter Status According to Guardian Report.

The objective of this study was to characterize the domestic cat population of Uruguay in relation to breed, coat color, hair length, lifestyle (indoor vs. outdoor), age, sex, and spay/neuter status according to a survey completed by their owners or guardians. An online survey, distributed to residents of Uruguay, was completed in full by 2561 cat guardians. Descriptive statistics and Chi-squared tests were performed. The population of cats with guardians in Uruguay is characterized by the following data: higher frequency of female cats (53%), most of the cats were between two and six years old (49%), most of them were neutered (84%, mainly those older than one year of age), most of them have outdoor access (87%), a very low percentage (6%) are purebred (Siamese being the most frequent: 86%), and within the non-pure breeds, short hair cats were the most frequent (79%). This study, in addition to expanding the information on the characteristics of cats with guardians from other countries and continents, is the first study in Latin America to describe some key demographic aspects such as cat breeds, coat color, hair length, lifestyles, and frequency by age, sex, and spay/neuter status (spayed/neutered or not) at the country level.

Computed Tomographic Assessment of Pituitary Gland Dimensions in Domestic Short-Haired Cats.

The detection of subtle changes in the pituitary dimensions has relevant clinical implications. In cats, a few studies have established the cut-off values of the pituitary gland's dimensions using small and inhomogeneous samples. The aims of this study were: to determine by computed tomography (CT) the pituitary linear dimensions and the pituitary-to-brain (P:B) ratio in a sample of domestic short-haired (DSH) cats; to assess the effects of sex, age, and weight on pituitary dimensions; and to evaluate the inter- and intra-observer agreement for such measurements. All skull CTs of DSH cats performed over four years using a multidetector CT and a standardized protocol were retrospectively reviewed. The exclusion criteria were: clinical, laboratory, or CT alterations of the pituitary gland, brain diseases, fractures of the neurocranium, and diabetes. The pituitary dimensions and brain area were assessed by two different observers using multiplanar reconstructions and automated segmentation tools. Fifty-one cats were included in the final sample. The intraclass correlation coefficients for intra- and inter-observer reliability were good/excellent, and moderate/good, respectively. No differences between sexes were detected, and negligible correlations were found between age and weight. According to this study, a pituitary gland with a height > 4 mm or a P:B ratio > 0.49 mm should be considered enlarged.

Characterization of Oral Pathology in Cats Affected by Patellar Fracture and Dental Anomaly Syndrome (PADS).

Patellar fracture and dental anomaly syndrome (PADS) is a congenital bone disease of cats that is characterized by atraumatic bone fractures (most commonly the patella), the persistence of deciduous teeth, and impaction of permanent teeth. Jaw swelling due to osteomyelitis is often the reason that cats with PADS are presented for veterinary dental care. The clinical history, oral examination findings, dental radiological findings, and histopathology were evaluated for 13 cats with dental and skeletal pathology consistent with PADS, including 9 with osteomyelitis. Cats in this study were predominantly domestic shorthair (12 of 13 cats), and there was no apparent sex predilection. All cats had multiple persistent deciduous teeth and multiple impacted permanent teeth, although the number of persistent and impacted teeth varied. Osteomyelitis of the jaw typically occurred within the first 4 years of life. Osteomyelitis of the mandible was 4 times more common than osteomyelitis of the maxilla. Histologically, osteomyelitis was chronic, neutrophilic, and osteoproliferative. Necrotic bone was confirmed in 67% of osteomyelitis lesions. Histological evaluation of jaws without inflammation demonstrated abnormal amounts of unmodeled bone, abnormally dense bone, and retention of cartilage in the caudal mandible. Three cats in the study had mandibular distoclusion and 2 had concurrent paronychia. To obtain a favorable clinical outcome in PADS cats with jaw swelling, prompt and aggressive surgical treatment of osteomyelitis is required. Extraction of persistent deciduous teeth and impacted permanent teeth is recommended when there is associated periodontitis or osteomyelitis.