Hi everyone. My cat, Cheeto, currently has a hole in his head (photo below). The problem started when we woke up one day and Cheeto had a large cyst-like skin lesion on his head. We took him to the vet immediately, and they drained the cyst. It grew back and then went away on its own. After the cone came off and he began scratching at it, and it opened up again. The vet told us he likely had an underlying infection, so we had the whole area removed. Once his stitches were removed, all looked good for about two days, and then the area started oozing.

Our vet sent us to a specialist and we learned Cheeto had a hole so deep it went down to his skull. She hypothesized that it was there since birth, but was unsure why it was suddenly causing issues. Now they want to put the cat through an MRI and surgery in the 24 hours following. I am concerned, since nothing has made this problem go away, that this may wind up being a $5000 mistake. We would never let Cheeto stay this way, but I just feel that something is being overlooked. I clean the hole every night, and his skin just refuses to grow back in this area. Help?

http://static.tumblr.com/m1wyyck/83Klvfgiz/cheeto.png

FYI: There is a similar posting about this here: https://www.askmehelpdesk.com/go/explore.php?do=showthread&t=376189&sort=newest&p=15. This person's cat wound up having a bot-fly larve in its head ("Wolf Worm is a nick name for the larvae of a cuterebra fly, also known as Bot Fly. It is most commonly seen as Warbles in wild rabbits and squirrels, but has also been found on the domestic cat."). Do you think my cat could have this, or does it sound like something else?

A cuterebral infection may be at the base of this problem. The organism developing inside secretes or produces some sort of material that inhibits healing in tissues that will become the lining of the pocket in which the larva will develop, lest the pocket close and kill it. Surgical removal of the end stage larva may involve removing the tissue adjacent to the pocket to prevent healing problems later. There are several stages of larval development, and the earlier ones are apparently more difficult to see.

I am thinking that attempting to answer, suggest, criticize, or even speculate about a matter, in the face of previous efforts of qualified people, even specialists to resolve them, with no more familiarization with the problem than that available online, in possible opposition to others more qualified and familiar with the case (even specialists, no less!) would indicate an arrogance or stupidity of monumental proportions. But such is the nature of we who volunteer at AMHD in an effort to ease the concerns of you, our valued 'customers'.

The lack of response to antibiotics would seem to support the idea that bacterial infection is not the cause of the problem (healing). Foreign body, even malignancy, also need to be considered as a problem. Any solution to the healing problem may not be the answer to why the problem appeared to begin with, however.

An MRI is the only current imaging procedure capable of detecting many abnormal structures like heretofore invisible things (by normal X-ray), and tissue irregularities that also were often unrecognizable by X-ray. You need to communicate any financial considerations you may have,if they have not been discussed previously. Specialists are ethically bound to find the answer, first, and be considerate of the economics later. Your desires can go to the head of the list, but only if you voice them. Your call.

Here is a link to one site on cuterebra larvae. http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/71500.htm Best wishes.

Thank You, paleophlatus, for this insightful answer! I am going to research further and confirm with my (many) vets!