100. Palate

Question 1

differentiation of the nasal and oral epithelium

Answer 1

nasal: pseudo stratified ciliated columnaroral: stratified squamous

Question 2

what bones make up the hard palate

Answer 2

palatineincisivemaxillary

Question 3

blood supply to the palate

Answer 3

maxillary artery—major palatine artery that travels through major palatine foramen (feeds hard palate)maxillary artery–minor palatine artery (feeds soft palate)

Question 4

innervation of palate

Answer 4

major palatine branch (hard palate) and minor palatine branch (soft palate) of the maxillary division of the TRIGEMINAL NERVE (sensory information)motor comes from glossopharyngeal (9) and vagus (10)

Question 5

muscle responsible for elevating the caudal soft palate to protect the nasopharynx during eating, swallowing, or vomiting

Answer 5

levator veli palatine muscle

Question 6

two functions of the soft palate

Answer 6

1. prevents aspiration by elevating the caudal soft palate to protect the nasopharynx during eating, swallowing, or vomiting2. stimulates sensory nerves to help trigger swallow mx

Question 7

typical side of unilateral cleft lip and hard palate clefts

Answer 7

unilateral cleft lips: often left sided with or without defects in the secondary palatehard palatal defects: midline usually associated with soft palate cleft

Question 8

at what stage in gestation/fetal development can intrauterine stress or insult result in cleft defects

Answer 8

25-28th day in dogs

Question 9

ideal age for surgical repair of a congenital cleft palate

Answer 9

3-4 monthstoo young and the tissues are too friable and delicatetoo old and the defects are too largebest chance to repair is at FIRST surgical intervention

Question 10

surgical goals of closing cleft defects

Answer 10

–tension free (two layer, closure not over the middle of defect)–well vascularized–separation of oral and nasopharyngeal mucosa

Question 11

recommended length of flaps created to close palatal defects

Answer 11

1.5 times larger than the defect itself

Question 12

techniques for defect repair

Answer 12

1. simple sliding procedures (rarely done bc no underlying support)2. local advancement, transposition, rotation flaps from labial or buccal mucosa +/- tooth extraction3. overlapping flap technique4. medially positioned flap technique (soft vs hard palate)5. split palatal U flap technique (caudal defects)6. prosthetics—temporary or permanent palatal obturators, titanium plate7. distant axial pattern flaps (angularis oris, caudal auricular, superficial cervical)8. free tissue transfer (auricular cartilage)9. tongue flap

Question 13

if repair fails, how long should you ideally wait before next attempt

Answer 13

wait until all healing has ceased ~4-8 weeks

Question 14

which is reported to be more reliable to repair a midline hard palate defect: the overlapping flap technique or the medial positioned glad technique

Answer 14

overlapping flap technique is more reliable bc with the medially positioned flap technique the suture line is over the defectalso a lateral oronasal fistula may result with a medially positioned flap technique

Question 15

best example to use a labial based mucoperiosteum flap

Answer 15

oronasal fistula repair from previous dental extraction or severe dental disease

Question 16

common side effect with palatal prosthetic obturators

Answer 16

halitosis

Question 17

factors leading to dehiscence

Answer 17

–poor preservation of the blood supply–too much tension–inadequate tissue mobilization–traumatic tissue handling or from initial injury–inadequate flap size–did not close in two or more layers–poor suture or needle choice

Question 18

airway resistance met in a normal dog

Answer 18

75-80% NOSE15-20% lower airways5% larynx

Question 19

breathing pattern assessed by tidal breaking flow volume loops were consistent with……..

Answer 19

FIXED upper airway obstruction in brachycephalic dogs

Question 20

poiseuille’s law

Answer 20

increased resistance due to decreased airway radiuslaw = Q=( pi(pressure change) r ^4)/8 nLQ= flowr = radius of airwayn = viscosity of gasL - length of airwayFLOW IS PROPORTIONAL TO RADIUS TO THE FOURTH POWERincrease radius, increase flowflow is inversely related to resistanceincrease flow decrease airway resistance resistance is inversely related to radiusincrease radius decrease airway resistance

Question 21

pathophysiology changes in response to upper airway obstruction or increased resistence

Answer 21

1. hering breuer reflex (increase vagal stimulation to control resp rate and depth–muscle contract longer, prolonging inspiration)2. decr PaO2 and incr PaCO2 chemical feedback to increase respiration effort (previous studies of laryngeal paralysis show chronic hypoxia but not hypercapnia)3. noncardiogenic pulmonary edema4. GI signs (>80-90%) brachycephalic dogs have GI signs

Question 22

concurrent cardiac abN common in BCAS english bulldogs

Answer 22

pulmonic stenosis

Question 23

tracheal diameter to thoracic inlet ratio in normal vs brachy breeds

Answer 23

english bull dogs 13% (0.13)nonbrachy breeds 20%abN if < 16% (0.16)

Question 24

proposed level of planned staphylectomy

Answer 24

1. mid to caudal border of palatine tonsil2. tip of epiglottis

Question 25

surgical options for repair of an elongated soft palate

Answer 25

1. cut and sew2. bipolar VSD3. CO2 laser4. fold palatoplasty