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Small Animal Surgery > 3 - Oral Cavity & Oropharynx > Flashcards

3 - Oral Cavity & Oropharynx Flashcards

1
Q

How is the healing of the oral mucosa?

A

Good

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2
Q

Oral mucosa heals more rapidly than _____.

A

skin

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3
Q

Oral mucosa has _____ blood supply.

A

excellent

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4
Q

Oral mucosa has _____ phagocytic activity.

A

high

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5
Q

Oral mucosa has extensive early _____.

A

epithelialization

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6
Q

What is the temperature of the oral mucosa?

A

warm

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7
Q

Oral mucosa has ____ metabolic activity and a _____ mitotic rate.

A

high, high

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8
Q

Oral mucosa has a _____ incidence of infection, so antibiotics _____ generally indicated.

A

low, are not

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9
Q

How does the oral mucosa heal?

A

by second intention

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10
Q

What type of closure is best for the oral cavity?

A

tension free

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11
Q

How can tension free closure be achieved in the oral cavity?

A

by use of flaps

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12
Q

What 3 things do flaps do?

A
  1. Preserve blood supply
  2. Minimize trauma
  3. Mobilization
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13
Q

With flaps, suture lines should be placed _____ whenever possible.

A

over supporting underlying tissue

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14
Q

How big should a flap be?

A

2-4 mm larger than defect

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15
Q

How many suture layers is preferable for a flap?

A

double layer

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16
Q

What should the suture be anchored to whenever possible with a flap?

A

to bone

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17
Q

What type of suture is most commonly used in the oral cavity and what pattern?

A

Monofilament absorbable; appositional

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18
Q

What should be considered to protect surgical site in the oral cavity?

A

use of feeding tubes

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19
Q

What is a pharyngotomy or transmylohyoid orotracheal intubation?

A

ET tube bypasses oral cavity

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20
Q

What are the regional nerve blocks for the oran cavity?

A
  1. Infraorbital
  2. Maxillary
  3. Rostral mandibular
  4. Inferior alveolar (blocks entire mandible)
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21
Q

What are types of soft tissue trauma that can happen to the mouth?

A
  1. Lip laceration
  2. Lip avulsion
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22
Q

What is a glossectomy usually performed for?

A

neoplasia

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23
Q

What is the most common tongue tumor in dogs and cats?

A

Dogs = melanoma, SCC

Cats = SCC

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24
Q

What is a partial glossectomy?

A

Taking only free part of tongue

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25
Q

What is a subtotal glossectomy?

A

Taking free part and parts of genioglossus and geniohyoid mm.

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26
Q

What is a near total glossectomy?

A

Taking >75% of the tongue

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27
Q

What is a total glossectomy?

A

Taking 100% of the tongue

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28
Q

How much of a tongue amputation is well tolerated in dogs?

A

40-60%

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29
Q

What is the “sciency” term for a cleft palate and what is it?

A

Congenital oronasal fistula;

Abnormal communication between oral and nasal cavities

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30
Q

What makes up the primary palate?

A

Lip and premaxilla

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31
Q

What makes up the secondary palate?

A

hard palate and soft palate

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32
Q

What are clinical signs of a congenital cleft palate?

A

Neonates gagging, failure to thrive, death, rhinitis, respiratory tract infection

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33
Q

Why should you take chest rads with a cleft palate?

A

To detect penumonia

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34
Q

How should animals with a cleft palate be fed?

A

Via tube

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35
Q

Until when should surgical treatment of a cleft palate be delayed and why?

A

Until at least 8-12 weeks of age;

Less risk of dehiscence, early repair can –> abnormal maxillary development

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36
Q

Animals with a cleft palate should always be _____.

A

sterilized

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37
Q

What should you recommend if a cleft palate case shows up in general practice?

A

refer it

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38
Q

Cleft palate is repaired with reconstruction of _____.

A

nasal floor

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39
Q

When would both the hard and soft palates be repaired first in a cleft palate case?

A

If both primary and secondary cleft exist

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40
Q

What are the 3 principles to remember for cleft palate repair?

A
  1. Tension free closure
  2. Support suture lines
  3. Flaps typically used - flap harvest sites heal by second intention
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41
Q

What are the 2 most common procedures to repair a cleft palate?

A
  1. Sliding bipedicle flaps (con Lagenbeck) technique
  2. Overlapping flap technique
42
Q

What must be preserved in the overlapping flap technique for cleft palate repair?

A

Major palatine artery and hinge

43
Q

What are causes of acquired oronasal fistula?

A

Trauma, dental disease, dehiscence after surgery, neoplasia, radiation therapy

44
Q

What type of closure should be done when possible in an acquired oronasal fistula?

A

double flap closure

45
Q

What are typical clinical signs of an oral mass?

A

Ptyalism, dysphagia, inappetance, halitosis, weight loss, pain, hemorrhage, mass visualization

46
Q

What are the 8 diagnostics that can be done to evaluate an oral mass?

A
  1. Sedated oral exam
  2. CBC/chem/UA
  3. Coag times, blood type
  4. FNA or biopsy
  5. LN aspirate +/- removal
  6. Thoracic rads
  7. CT >>> dental rads
  8. CT lymphangiogram
47
Q

Why is CT superior to dental rads?

A

60-80% of gingival tumors will have bony lysis and >40% destruction is needed to be seen with rads

48
Q

What is a CT lymphangiogram used for?

A

Sentinel LN mapping

49
Q

What are prognostic factors for oral neoplasia staging?

A

Rostral > caudal

Movable > fixed

Nonulcerated > ulcerated

Small > large

50
Q

What should be done with all masses prior to definitive surgery?

A

biopsy

51
Q

T/F: LN size is an unpredictable predictor of metastasis

A

true

52
Q

What is the main regional LN that should be evaluated with an oral mass?

A

Mandibular;

Usually there is no access to the parotid, medial RP, and tonsils

53
Q

What can an FNA tell us about an oral mass?

A

If the cells are tumor cells (neoplasic vs. non-neoplastic)

54
Q

What can an incisional biopsy tell us about an oral mass?

A

tumor type and grade

55
Q

What can an excisional biopsy tell us about an oral mass?

A

Tumor type, grade, and surgical margins

56
Q

What is the most common type of biopsy performed on oral masses?

A

incisional

57
Q

What are the treatment options for oral masses?

A

Surgical excision, radiation therapy, chemo, immunothrapy, combo

58
Q

What are the 3 treatment intents for oral masses?

A
  1. Curative
  2. Debulking
  3. Palliative
59
Q

What margins would be needed for an oral mass removed with a maxillectomy or mandibulectomy?

A

1-2 cm based on advanced imaging

60
Q

What is the most common indication for a maxillectomy/mandibulectomy? What are some others?

A
  1. Neoplasia = most common
  2. Trauma
  3. Infection
  4. Periodontal disease
  5. Oronasal fistula
61
Q

What are common indications in dogs for a maxillectomy/mandibulectomy and what is the MOST common?

A
  1. Malignant melanoma = most common
  2. SCC
  3. Fibrosarcoma
  4. Epulides/Ameloblastoma
62
Q

What are common indications in cats for a maxillectomy/mandibulectomy and what is the MOST common?

A
  1. SCC = most common
  2. Fibrosarcoma
63
Q

What spp tolerates removal of nasal turbinates?

A

dogs

64
Q

What are the 5 types of mandibulectomies?

A
  1. Rostral: unilateral/bilateral
  2. Central/segmental
  3. Caudal
  4. 3/4 (total and contralateral rostral)
  5. Hemimandibulectomy (R/L)
65
Q

What spp tolerates mandibulectomy well?

A

dogs

66
Q

What effect can mandibulectomies have in cats?

A

They may not eat (72% inappetent following sx, 12% never regain the ability to eat)

67
Q

What can an intracapsular surgical margin be used for?

A

Benign tumor (EX: odontoma)

68
Q

What can a marginal surgical margin be used for?

A

Benign tumors except ameloblastoma (goes just beyond the tumor)

69
Q

What is considered a wide margin and what tumors is it used for?

A

>1-2 cm;

Used for malignant tumors and ameloblastomas

70
Q

What are radical margins used for?

A

hemimandibulectomy

71
Q

T/F: Recurrence/regrowth is not a complication of oral surgery.

A

False

72
Q

What types of dehiscence are possible complications of oral surgery?

A

Oronasal fistula, commisurotomy, skin flaps

73
Q

T/F: Epistaxis is a complication of oral surgery

A

True

74
Q

A complication of oral surgery can be stenosis of _____.

A

nasal orifice

75
Q

T/F: Osteomyelitis is not a complication of oral surgery.

A

False

76
Q

What can happen to the mandible as a result/complication of oral surgery?

A

mandibular drift/malocclusion

77
Q

What are the common malignant oral masses of dogs in order from most to least malignant?

A

Malignant melanoma > SCC > fibrosarcoma > osteosarcoma

78
Q

What are the common malignant oral masses of cats in order from most to least malignant?

A

SCC >>>>> fibrosarcoma

79
Q

Where can malignant melanoma be found in the dog mouth?

A

Gingiva, buccal/labial mucosa

80
Q

What is the appearance of malignant melanoma in dog mouths?

A

firm and black

81
Q

33% of oral malignant melanomas in dogs are _____.

A

non-pigmented

82
Q

Malignant melanomas in dog mouths have a _____ rate of metastasis.

A

high

83
Q

What should you do with LNs when you see an oral mass that you suspect is malignant melanoma?

A

Always aspirate L & R mandibular nodes

84
Q

What is the surgical treatment for malignant melanoma in dog mouths?

A

Aggressive resection followed by chemo and immunotherapy to u=improve survival time

85
Q

What are 2 treatments other than surgery for oral malignant melanoma?

A

Radiation and melanoma vaccine

86
Q

What sites are prone to SCC in dog mouths?

A

Gingiva, buccal/labial mucosa, hard palate, tongue, tonsils

87
Q

What is the chance for bony lysis with an oral SCC in dogs?

A

77%

88
Q

Where can oral SCC in dogs metastasize to? What primary locations have a higher metastasis rate?

A

LNs and lungs;

Tongue and tonsillar tissue

89
Q

What are the 3 types of benign oral masses dogs can get?

A
  1. POF (peripheral odontogenic fibromas)
  2. FFH (focal fibrous hyperplasia)
  3. CAA (canine acanthomatous ameloblastoma)
90
Q

Where do POFs in the dog occur?

A

Premaxilla/maxillary PM teeth

91
Q

What type of excision is used for POFs in dogs?

A

Conservative - narrow margin of bone

92
Q

What should be treated when a dog has an FFH?

A

Underlying dental disease (plaque/gingivitis)

93
Q

Where does a canine CAA arise from?

A

odontogenic tissue

94
Q

What teeth are involved in a CAA in dogs?

A

mandibular canines and incisors

95
Q

CAAs are _____ but not _____. There is ____% evidence of bony lysis.

A

locally invasive, metastatic, 80-90%

96
Q

How should CAAs be removed?

A

By aggressive resection (partial madibulectomy or maxillectomy with 1 cm margins)

97
Q

What are risk factors for oral SCC in cats?

A

Flea collars, canned food, tuna, smoking

98
Q

What are common sites for oral SCC in cats and what is the most common?

A
  1. Tonsils = most common
  2. Mandible
  3. Maxilla
  4. Tongue, pharynx
99
Q

_____ is rare for oral SCC in cats, but highly _____ with a _____ prognosis.

A

Metastasis, invasive, poor

100
Q

Other than SCC and fibrosarcoma, what is an oral mass cats can get?

A

Eosinophilic granuloma - benign allergic/autoimmune

Small Animal Surgery (17 decks)

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