Disclaimer
This blog post series is purely a record of our journey with Rosie. It is not an in-depth look at the condition, nor are they intended to be used as a diagnosis or recommendation of treatment. Should your horse be showing signs of, or is diagnosed with, ameloblastoma please consult with your equine vet, surgeon and dentist.

Warning
These blog posts contain images that some people may find distressing, however I believe they are a valuable part of understanding the progression of the condition. Please feel free to scroll past the images and only read the text.

Previous Posts
Equine Ameloblastoma: Rosie’s Story – Part 1
Equine Ameloblastoma: Rosie’s Story – Part 2
Equine Ameloblastoma: Rosie’s Story – Part 3

The Eye of the Storm
2021 was like being in the eye of the storm. We’d made it over the 12 month hump and we were heading for the 18 month mark, how much longer did we have? When would the storm hit again?

Her dental exam in February 2021 stated:

• • External: Previously diagnosed ameloblastoma within rostral right mandible.
  • Radiographs: Tumour quite a bit bigger to previous x-rays (Aug 2020) and appears to no longer have solid cortical bone margin along ventral aspect of mandible.
  • Cheek Teeth: 407 drifting lingually and rotating but very solid. No surrounding periodontal disease. Appears as though hypercementosis is occurring down the buccal aspect of 407. Draining hole 407/8 appears very healthy, no surrounding gingivitis. Foul odour omitted from mouth once began floating the teeth. 408 mild movement. Tumour appreciable throughout the length of mandible.
  • Rosie displayed mild resentment when floating 406-408. Administered additional sedation and Rosie tolerated the procedure no problem. Reduced 406-408 to reduce occlusal pressure. Did not want to have an unnecessary amount of time with Rosie’s mouth open due to potential risk of fracturing her jaw. The rest of her mouth was quickly scanned, there were no areas of periodontal or endodontic concern. She appears to be remarkably comfortable in her ability to eat.

I will note here that following her diagnosis and prior to her having a dental speculum on and her mouth opened for her dental exams we x-rayed her mandible at every appointment to ensure the structural integrity of the bone would hold. Opening her mouth with compromised integrity increased the risk of fracturing her jaw. Something none of us wanted to be responsible for.

By around April 2021 the infection had cleared and the external wounds had closed over, she regrew hair and was Rose, a sweet, kind, affectionate girl… with a lump. We had also crossed the 18 month mark… every day was a gift, every day was a question, when would it be time?

The tumour continued to grow and interestingly change shape. There were days where we’d look at it and gently cup it trying to figure out if it was bigger. We started using the left mandible as a guide to its size and shape as this provided a constant place to measure from. At some points there was a gap between the tumour and left mandible and at other times the tumour would almost ‘hook’ over the left mandible.

Rose would let us know when it was sore and request we not touch it and other times it would be so itchy she’d make us scratch it so hard we’d both be cringing just in case the skin broke and pus came out… something neither of us wanted to experience in a hurry!

Her dental exam in August 2021 stated:

• • Incisors: 101 & 102 tall, mildly reduced.
  • Cheek Teeth: Approximately 1mm of movement in 407 & 408 due to tumour on the right side mandible affecting the tooth sockets. Movement is minimal and teeth were comfortable when floating. We reduced the tooth height to take some pressure off the teeth and will monitor for the moment but may require extraction if mobility increases.
  • Radiographs: Ameloblastoma on right mandible appears to have more cortical bone, more settled/osteomyelitis seems to have resolved. The tumour is bigger than previous but the edges are much smoother and appear less active. Will continue to monitor it but appears more settled today than previously.

While the tumour continued to grow and Rosie had a few episodes we really did have a good year. Her episodes are best described as pain spikes, days where perhaps she’d chewed on something a little firm or bumped herself while trying to scratch. We’re really not sure exactly what caused these spikes but we had bute on hand and often found a one off 10ml dose was enough and by the following morning (spikes usually appeared in the evenings) she was back to her version of normal. 

Roll on 2022 and we’re now well past the 24 month mark, she wasn’t giving up! But we knew she wasn’t getting better and the conversations around “when” became more frequent. 

Her 407 & 408 teeth were loose and you could hear them knocking about when she ate. She was placing food and quidding hay. She had started to place herself outside of danger, not getting into places where she might get knocked or have to move too quickly. Living in a herd requires a huge amount of self-awareness.

In February 2022 Rosie had what became her final dental exam. It was clear to all of us that her time was on the horizon and we all agreed there was not much value in pushing her to have a full float. In the lead up to this appointment I spoke extensively with our dentist to create Plan A, Plan B and Plan C just in case the s@#t hit the fan and her jaw broke.

Thankfully we were able to open her mouth using a mouth wedge. This allowed us to open her mouth without placing any pressure on the right side as the wedge was only used on the left. The only reason we took this risk was to check how loose those two teeth actually were.

Turns out the 407 was only being held in by the surrounding teeth and simply popped out in the dentist’s hand! The 408 took a little extra work but was out in about 5-10 minutes. Following the removal of these teeth the flushing resumed and as always she was a trooper.

Soon after the real signs of her being sick started to appear, she dropped what I would estimate was about half her body weight in around one week.

We changed her food and her feed bin. She no longer had any kind of chaff in her hard feed but instead had various pellets that we soaked into a mash so there was no real need for her to chew. The quantity was slowly increased and while it didn’t become necessary we were prepared to start giving her 3 or 4 meals a day instead of 2 in order to get the food in and some weight back on.

Her feed bin was swapped from a hard plastic wall hanging feed bin with a lip to a soft, round rubber ground feeder. The walls sloped slightly outwards, this allowed her to get into the edges without banging the tumour on the edge of the feeder.

She tried to eat hay but it proved a challenge and she spent most of her time out in the paddock picking grass (our herd lives out 24/7 and comes into their stables for their hard feeds). The water troughs got dirty much quicker too and once daily cleaning became twice daily cleaning.

I knew in my gut we had started down the road to her final day.

Equine Ameloblastoma: Rosie’s Story – Part 5