2 0 0 9   C L I N I C A L   C A S E W I N N E R The Use of HEALx Soother Plus for Postoperative Management of Extensive Osteomyelitis of the Mandible Following Periapical Infection in a Mini Lop Rabbit Vittorio Capello, DVM, Dipl ECZM (Small Mammal), Dipl ABVP (Exotic Companion Mammal) A 3-year-old female mini lop rabbit was presented for anorexia. The physical exam revealed the presence of a huge lump ventrolateral to the body of the left mandible. Pre-surgery Fig 1. Intraoral inspection and skull radiographs demonstrated a severe periapical infection and extensive osteomyelitis of the body of the mandible. The owners declined computed tomography for detailed definition of diagnosis and prognosis, and exploratory surgery was performed. Surgery  Fig  2. Excision of the abscess, extraction of the diseased teeth and thorough debridement of the osteomyelitic bone was performed as routine. The osteomyelitic cavity was very wide and deep, surrounded by a round, thick periosteal reaction. The rostral end of the mandible is under the drape at the bottom left of the image. Surgery  Fig 3. Extensive marsupialization was attempted, even if prognosis was very guarded. Day 0  Fig 4. HEALx Soother Plus® was administered topically twice a day. The rabbit was discharged on antibiotic (procaine penicillin, 40,000 IU/Kg q24h SQ) and analgesic (meloxicam, 0.2 mg/Kg q12h OS) treatment. Assisted feeding was not necessary because the rabbit ate on her own since the very first day after surgery. Frequent rechecks for cleaning of the surgical site were scheduled every other day. Day 7 Fig 5. Follow-up 7 days after surgery. Abundant granulating tissue around the osteomyelitic sequestrum (the diseased teeth) was already present. The black area on the left is necrotic bony tissue from the periosteal reaction. Day 12 Fig 6. Follow-up 12 days after surgery. The oral/extraoral fistula was almost completely healed, and the defect was filling. The black bone was debrided step by step, and the cream-like color is the appearance of fibrin before debridement. Day 15 Fig 7. Follow-up 15 days after surgery. The deep ulceration was reducing in size. Day 21 Fig 8. Follow-up 21 days after surgery. The black necrotic bone was almost completely debrided, and the ulceration was significantly reduced in size. Day 28 Fig 9. Follow-up 28 days after surgery. Day 35  Fig 10. Follow-up 5 weeks after surgery. Day 42 Fig 11. Follow-up 6 weeks after surgery. Control radiographs are still pending.