Retrobulbar abscess in a dog

Added: 2026-05-25

[00:00:05]Hi guys, this is Charles and one of the surgeons at the Animal Emergency Centre in Marvin, Melbourne, Australia.

[00:00:12]Um we had an emergency present today, which is a dog that has a lot of pain on opening the mouth.

[00:00:22]Um and exophthalmos, swelling associated with the orbit. Um and incidentally, it had been chewing on uh venison bone.

[00:00:36]You Americans would know more about that.

[00:00:39]Um about 3 days ago.

[00:00:42]We've done a CT scan and there's no obvious bone in the retrobulbar space, but I have found what looks like a little abscess.

[00:00:56]Um and so we're going to go in surgically and explore it. If you haven't already done so, please subscribe to our channel.

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[00:01:09]So, the trick here is that it's a hard place to get to because the swelling or the inflammation is all um right behind the maxilla and in front of the vertical ramus of the mandible. So, we've got about 2 cm and also ventral to the zygomatic arch.

[00:01:38]So, we've got about 2 cm access.

[00:01:42]Um dog maybe getting light, definitely getting light.

[00:01:47]Um 2 cm access uh to get in and find this thing. So, I'm guessing either a grass seed, maybe maybe a I don't know, a bit of cartilage or something like that. Um or potentially a stick or something that it might have chewed on before.

[00:02:03]Um did not show up on the CT scan. Can I get another Gelpi, please?

[00:02:13]Dog's just getting a little bit light with our approach. So, the zygomatic arch is sitting right up there.

[00:02:20]I can already see what looks like a little bit of edema.

[00:02:26]If you hear that that suction sound, that's cuz we've got the suction um for the smoke from the electric cautery.

[00:02:39]Um the cautery is um pretty energetic here. Um Tanner, could you turn it down maybe to 20 and 20?

[00:02:50]So, just to reiterate, we've got a 6-year-old Vizsla that has a history of what looks like a retrobulbar abscess.

[00:02:59]Uh he uh or or presenting clinical signs of what looks like a retrobulbar abscess, and it has been chewing on a stick.

[00:03:08]Um nothing obvious on the CT scan.

[00:03:15]So, we're going on a foreign body search, and I'm coming in just ventral to the zygomatic arch.

[00:03:23]So, that's the zygomatic arch right there.

[00:03:27]And the problem is that the vertical ramus of the mandible is going to be right in our path.

[00:03:37]Got the zygomatic ligament right up here.

[00:03:48]So, kind of going on a fishing trip.

[00:04:13]Not too much going on as far as really important structures at risk out here, but once we get into the orbit, then obviously you have the ocular nerve optic nerve and a few other important things. Now, there's a chance that I'm going to have to take out the zygomatic arch, which is fine.

[00:04:37]Uh not yet. I don't I'm not definitely going to use it. Can I get just a freer elevator, please?

[00:04:45]The I don't know what brand of smoke evacuator we are using. Somebody's just asked that.

[00:04:52]Knight Benedikt.

[00:04:54]So, Knight Benedikt is a company that we get a lot of our equipment from.

[00:05:09]All right, so So, that's masseter muscle right there.

[00:05:27]And I'm going to try to get in without having to do anything with the vertical ramus of the mandible and find this thing, but may not be able to.

[00:05:38]I have to be careful because the globe is right there. So, we just with my Gelpi retractors rather not stick a gelpi in the eyeball.

[00:06:16]Obviously knowing your orbital anatomy is helpful in these surgeries.

[00:06:35]Yes. Is it leaking a little bit?

[00:07:07]So that's behind the maxilla there.

[00:07:12]Can I get suction plugged in and turned on, please?

[00:07:22]So I'd love a grasper to just pop out of here, but I don't know if I'm going to be that lucky.

[00:07:35]Yeah, I'm doing a fairly limited approach right now.

[00:07:39]And then if I'm unsuccessful then I'm going to have to convert to a larger uh exposure.

[00:07:52]And the abscess that I found was about 29 mm deep on the CT scan.

[00:08:04]I don't want to go around just reaching in here and grabbing on to stuff with a hemostat because of the risk of damaging the optic nerve.

[00:08:50]So, I can see a lot of inflammatory tissue in here.

[00:09:07]Yeah.

[00:09:14]Is there any other Um so, you could go up uh transoral approach.

[00:09:27]Um might be might be better than this. I'm not sure. I've always done them this way.

[00:09:39]So, I think I'm into the little abscess area.

[00:10:01]Uh and again, you could you know, in desperation, you could remove the vertical ramus of the mandible. You could remove the zygomatic arch.

[00:10:13]And I usually do whatever it takes to find these things. So, I'm you know, I don't want to have to come back. As long as I'm not creating too much morbidity for the patient.

[00:11:07]I'm right up to the vertical ramus of the mandible right there.

[00:11:13]It's definitely a diseased area.

[00:11:38]>> I'm getting into salivary gland here, just zygomatic salivary gland.

[00:11:46]>> [snorts] >> Can we get a Senn retractor, please?

[00:12:01]That's zygomatic salivary gland right there.

[00:12:06]And I'm just palpating for the vertical ramus of the mandible right there.

[00:12:24]>> [snorts] >> So, that's all zygomatic salivary gland.

[00:12:49]No problem removing that.

[00:12:58]Can you get a thumb forceps, please?

[00:13:04]Yeah.

[00:13:21]So, this zygomatic salivary gland was highly inflamed on the CT scan.

[00:15:14]I'm trying to avoid cauterizing too much cuz I don't want it to distort or change the color of the normal tissue, which would make it easier to identify abnormalities.

[00:15:36]Or harder to identify abnormal tissue, I guess.

[00:15:50]Can I get a uh hemostat, please?

[00:16:18]Um I won't need that for a minute.

[00:16:20]Thanks. Sorry.

[00:17:03]Uh hemostat, please.

[00:17:48]>> So, that's the mandible right here.

[00:17:57]The other thing I don't want to do is push the whatever foreign body it is for the further in.

[00:18:30]So, that's mandible right there.

[00:18:34]Can I get a home in, please?

[00:18:37]Can you get a home in in that area?

[00:19:36]>> Can I get some warm jars, please? Big ones.

[00:19:43]Uh this was a very sudden onset as far as the clinical signs were concerned.

[00:19:49]Uh it started basically yesterday or day before.

[00:20:24]That's fine. I'll let you know if that's fine.

[00:20:26]Yep.

[00:20:27]Thank you.

[00:21:14]>> Can you get me some bones, please?

[00:21:22]Some grizzle there associated with the masseter muscle.

[00:21:31]And I'm going to chip away at the vertical ramus of the mandible a bit and just try to increase my exposure.

[00:22:24]>> [snorts] >> So that's medial to the ramus of the mandible.

[00:23:55]So that's masseter muscle and tendon there.

[00:24:10]Ooh.

[00:24:17]I thought that was a yellow piece of bone, but it's tendon of the masseter.

[00:24:26]So that's medial orbit right there.

[00:24:49]You probably You can probably take out that homan.

[00:25:05]>> So that's medial orbit there.

[00:25:36]So what we warn these owners about as risks would be nerve damage, inability to find a foreign body, and potential for recurrence.

[00:25:51]Let's say we usually find about 95% with a combination of exploratory surgery and CT.

[00:26:01]But we usually I not we usually resolve about 95%.

[00:26:08]Hold off on that. Hold off on that.

[00:26:12]Thank you.

[00:26:15]So that's going to be down in the oral cavity down there.

[00:26:32]And it's possible that it was just a bone that poked through and left some bacteria in there, but not an actual foreign body.

[00:26:40]Yeah.

[00:27:09]>> So that's No, that's not. I was going to say that's Oh, that's a tooth.

[00:27:22]Okay, so that's as far medial as we can go. That's as far medial as we can go there.

[00:27:27]Just have a poke around up here.

[00:27:50]Ouch. Ouch. Ouch.

[00:28:09]That looks like something, maybe.

[00:28:15]Maybe not.

[00:28:23]But that's how subtle it can be.

[00:29:06]>> It's just more salivary gland.

[00:29:15]Salivary duct.

[00:29:34]Uh Yeah.

[00:29:55]>> [clears throat] >> Uh Usually [snorts] I like to take these out in block, but that's not possible in the orbit without doing serious damage.

[00:31:34]Uh Holman, please.

[00:31:36]Probably get rid of that as well. Sorry?

[00:31:39]Probably get rid of that.

[00:32:02]It definitely still looks abnormal in there.

[00:32:08]We're getting deeper, closer to the optic nerve.

[00:32:28]It's also possible that I've already taken out whatever it was.

[00:32:59]>> Yeah.

[00:33:06]Thanks for the advice to concentrate.

[00:33:09]>> [laughter] >> Very helpful.

[00:33:17]We're just changing the blood pressure cuff here.

[00:33:30]I had some on a brain surgery. Somebody just commented B plus.

[00:33:34]>> [laughter] >> Yeah.

[00:33:44]Okay. Here we go.

[00:33:57]It still looks pretty diseased right in here.

[00:34:22]I so badly want to see a um grass seed.

[00:34:28]Oh, it's those.

[00:34:34]See?

[00:34:40]>> So, I think that's the optic stalk right there.

[00:34:45]Right there, I think that's optic nerve with all the um the bundle of extraocular muscles.

[00:34:54]Right there.

[00:35:08]Let's grab a um freer elevator.

[00:35:41]I'm wearing my loops, if you can't tell.

[00:35:44]I'd be really lost without them trying to look in here medial to the vertical ramus of the mandible.

[00:36:10]So, that's the optic stalk right there, the bundle.

[00:36:21]Right there. Oh my god, that's huge.

[00:36:31]>> No.

[00:36:38]Okay, can I get the rongeur, please?

[00:37:09]Just trying to get back to normal tissue.

[00:37:27]There's a couple questions.

[00:37:35]Uh you can take out a lot of the ramus of the mandible. You can take out the whole ramus of the mandible, honestly.

[00:37:41]If you leave the TMJ in, uh they'll be fine.

[00:37:49]It's a nice thing about being a cancer surgeon is that I know that I can take all this stuff out. Right.

[00:38:51]>> So, I'm almost looking all the way back up into the like the calvarium.

[00:39:05]And the top of the orbit up here.

[00:39:29]Um I can actually see something back there.

[00:39:33]Um Trying to think the best way to retract that. Can I get a sand, please? Can I get the table up?

[00:39:39]Thank you.

[00:39:49]>> [snorts] >> Right up if we can.

[00:39:59]That's great. Thanks.

[00:40:48]>> Can I get a hemostat, please? Got it.

[00:41:56]Vagal?

[00:42:16]>> I think let's go let's go It started with So if you're hoping for the big payoff here, you might be disappointed.

[00:44:32]What's the blood pressure doing?

[00:44:34]71 >> [snorts] >> That's more of the zygomatic.

[00:45:04]Salivary gland there.

[00:45:12]Sorry that I'm not doing anything important here.

[00:45:15]>> [laughter] >> I'm going to try to move the camera so you guys can see down in the hole a little better.

[00:46:22]>> All right, so So, that's the optic stalk right there.

[00:46:31]Can you see that on the screen?

[00:46:36]So, that's the optic nerves and all the periocular muscles and stuff like that.

[00:48:17]>> All right, I think I've done all I can.

[00:48:19]Hopefully it was just an infection.

[00:48:24]We could feel a soft bit in the roof of the mouth.

[00:48:34]Okay, let's go ahead and flush.

[00:48:45]Can I get some um paper towels, please?

[00:50:18]>> If you could see me now, you might be able to see it in the picture in picture. I look like a giraffe trying to drink out of a water hole.

[00:50:47]That was still diseased up in there.

[00:51:51]>> Get more flesh.

[00:51:53]And I'm not going to put a drain in here.

[00:51:57]No reason to.

[00:52:22]That's great. Thank you.

[00:52:36]>> [screaming] >> A bunch more.

[00:52:54]Sorry? Bunch more zygomatic salivary gland.

[00:53:45]>> Okay.

[00:54:00]It seems to be bleeding in there nicely.

[00:54:04]I'll just pack that off for about 5 minutes.

[00:54:08]All right.

[00:54:10]>> [snorts] >> So, nothing terribly exciting.

[00:54:14]Um No, there won't be any vision loss associated with touching that optic bundle. We haven't really grabbed onto it or pushed on it too hard or anything, so there won't be yet there won't be any issue with that.

[00:54:38]>> [snorts] >> And I'm not going to use any um gel foam yet cuz I don't want to create a foreign body.

[00:54:47]Put a foreign body in there that'll potentiate an infection.

[00:54:51]I guess [snorts] the other thing we should probably do is do a culture.

[00:54:55]Just submit some of that for that for culture.

[00:55:01]Can we get a culture up, please?

[00:55:09]>> [snorts] >> So, I'm just going to be closing that masseter fascia up to the periosteum of the zygomatic arch.

[00:55:20]And then just sub-Q. Our optic nerve palpebral nerve runs right up here.

[00:55:26]So, we haven't come close to that.

[00:55:34]I might stick the culture in here as well.

[00:55:41]In case it was just some weird bacterium that's causing this.

[00:55:49]And then we'll just get some of that just stick stick some of that salivary gland down in here as well.

[00:56:07]Some 2000 PDS when you're ready.

[00:56:17]>> [snorts] >> Can we get a little piece of um Jelfoam, please? I've last it.

[00:56:51]Just get like a 2x2 piece.

[00:57:16]Uh 2x2?

[00:57:18]Yep.

[00:57:32]Sorry, I put it right in the blind spot.

[00:57:37]Give me the um bandage.

[00:57:48]Don't want to put a lot of pressure on that optic nerve.

[00:57:55]Uh so, I don't really do a lot of um of uh local antibiotic infusion. I think that because you have a lot of inflammation, um that uh you're going to get good good um levels just from systemic antibiotics.

[00:58:15]So, we'll put it on about a week's worth of Clevilox.

[00:58:23]Um that uh purified bovine collagen that I use called Liostate is just so good.

[00:58:31]It stops the bleeding basically like a cork.

[00:58:38]And starts back up when I mess with it.

[00:59:18]All right.

[00:59:26]Not terribly exciting.

[00:59:28]No, it's your shorties. Oh, well.

[00:59:33]Uh the long handled ones are really delicate, so if you're doing suturing a um blood vessel wall or something.

[00:59:57]>> [snorts] >> Yes, please. We'll send it home on um actually we'll send it home on cephalexin since we've had it we have it on Keflex and so I want to change midstream.

[01:00:12]All right, so I'll try to grab onto the periosteum here.

[01:00:37]Cut, please.

[01:00:43]They're cute.

[01:01:30]>> Have this guy on soft food for a week.

[01:01:33]This way I just say he's more comfortable.

[01:02:19]And if this recurred, we'd send them off for an MRI, probably.

[01:03:33]>> Um I use Heine loops.

[01:03:37]Um which are pretty much best in the business or at least they were when I bought them.

[01:03:44]So they're about five five thousand dollars.

[01:03:49]Um Rose microsystems also make some nice ones that are about a thousand. That's Australian dollars, so probably about 3,500 US for the Heines and the Rose would probably be about seven or eight hundred, especially if you get them at a conference where they usually give you a discount.

[01:04:50]So see um Emma, how I'm closing that fairly superficially, like I'm not taking really big deep bites.

[01:04:58]So that'll keep the skin from puckering.

[01:05:00]You happy to finish that off? I'll just drop the table for you.

[01:05:05]>> [clears throat] >> Okay. Um So, I have never used collagen type O from jellyfish for reconstructive surgeries.

[01:05:23]Um Yeah, it's just not something that I've um I guess I've seen or needed to my knowledge.

[01:05:32]Um the suture is monofilament. It's a PDS.

[01:05:36]The dog symptoms were just severe pain and lethargy. Uh severe pain on opening the mouth and then lethargy.

[01:05:43]>> [snorts] >> Uh hi Germany.

[01:05:50]Uh So, um the anesthetic is moderately deep. I mean, we have it on about 1 and 3/4 percent on isoflurane.

[01:06:15]Uh so, you could try to go through the roof of the mouth.

[01:06:18]Hi Mexico. Hi Philippines. Hi Costa Rica.

[01:06:22]Hi Stephanie.

[01:06:24]Um all right. So, we'll go ahead and wrap it up now. If you haven't already done so, please subscribe to our channel. Make sure you turn on notifications so you'll get a ding on your phone the next time we live stream.

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