Facial Swellings: What do they mean? What do we do?

David E Anderson, D.V.M., MS, Diplomate ACVS
College of Veterinary Medicine
The Ohio State University, Columbus, Ohio

Facial swellings increasingly are recognized in Alpacas across North America. There are several possibilities for facial swellings that you should be aware of. First, animals that are disturbed while eating may retain their cud, or food bolus, in the side of their cheek for some time. This swelling is soft and indentable and will disappear soon after the animal returns to normal activities. Be careful examining the inside of the mouth, you may accidentally get bitten! Food boluses that are retained for prolonged periods or that appear uncomfortable to your alpaca may indicate a dentition problem. Your veterinarian can easily perform a tooth examination to determine if this is the case. I prefer to sedate Alpacas before dental exams because this appears to lessen the stress that may accompany examination of the interior of the mouth.

Soft, fluctuant masses along side of the face, either below the jaw or along the face and behind the eye may represent abscesses. These masses are not easily moved and usually have a soft, indentable center with a firm capsule around them. Abscesses need to be drained and flushed, and the affected alpaca may need to be given antibiotics. However, you must be sure that the mass is an abscess and not some other vital structure (such as a lymph node). Also, you should ask your veterinarian about contagious abscesses of ruminants. I have seen numerous cases of abscesses caused by the infective bacteria Corynebacterium pseudotuberculosis (caseous lymphadenitis). These abscesses are highly contagious from one animal to another, are most readily spread by direct contact with the pus or infected tissues, and may spread to internal organs. These abscesses are best to be completely removed by surgical excision to ensure that they do not become widespread in the herd.

Hard, bony, masses along the border of the jaw or along the face may be infections within the bone and often are caused by a tooth root abscess. Most tooth root abscesses affect the caudal root of the second mandibular molar or the cranial root of the third mandibular molar teeth. These roots are very close to one another, therefore both teeth may become infected over time. Treatment of tooth root abscesses can be very frustrating. Antibiotic therapy alone has met with limited success. Surgical curettage of the infected bone and tooth root in addition to antibiotic therapy (3 to 4 weeks) may be curative in some cases. However, in my experience, medical treatment fails to resolve the infection in the long-run and most tooth root abscesses return within 6 to 12 months. A root canal may be satisfactory for very early tooth root abscesses, but the diagnosis must be made before significant damage has occurred to the alveolus of the tooth. Most of the tooth root problems that I see have been on-going for 2 to 18 months and have had extensive medical treatments. Extraction of the affected tooth is nearly always curative. The tooth is removed while the patient is under general anesthesia and the wound is cleaned daily until healed (2 to 4 weeks).