3 - Oral Cavity & Oropharynx Flashcards
How is the healing of the oral mucosa?
Good
Oral mucosa heals more rapidly than _____.
skin
Oral mucosa has _____ blood supply.
excellent
Oral mucosa has _____ phagocytic activity.
high
Oral mucosa has extensive early _____.
epithelialization
What is the temperature of the oral mucosa?
warm
Oral mucosa has ____ metabolic activity and a _____ mitotic rate.
high, high
Oral mucosa has a _____ incidence of infection, so antibiotics _____ generally indicated.
low, are not
How does the oral mucosa heal?
by second intention
What type of closure is best for the oral cavity?
tension free
How can tension free closure be achieved in the oral cavity?
by use of flaps
What 3 things do flaps do?
- Preserve blood supply
- Minimize trauma
- Mobilization
With flaps, suture lines should be placed _____ whenever possible.
over supporting underlying tissue
How big should a flap be?
2-4 mm larger than defect
How many suture layers is preferable for a flap?
double layer
What should the suture be anchored to whenever possible with a flap?
to bone
What type of suture is most commonly used in the oral cavity and what pattern?
Monofilament absorbable; appositional
What should be considered to protect surgical site in the oral cavity?
use of feeding tubes
What is a pharyngotomy or transmylohyoid orotracheal intubation?
ET tube bypasses oral cavity
What are the regional nerve blocks for the oran cavity?
- Infraorbital
- Maxillary
- Rostral mandibular
- Inferior alveolar (blocks entire mandible)
What are types of soft tissue trauma that can happen to the mouth?
- Lip laceration
- Lip avulsion
What is a glossectomy usually performed for?
neoplasia
What is the most common tongue tumor in dogs and cats?
Dogs = melanoma, SCC
Cats = SCC
What is a partial glossectomy?
Taking only free part of tongue
What is a subtotal glossectomy?
Taking free part and parts of genioglossus and geniohyoid mm.
What is a near total glossectomy?
Taking >75% of the tongue
What is a total glossectomy?
Taking 100% of the tongue
How much of a tongue amputation is well tolerated in dogs?
40-60%
What is the “sciency” term for a cleft palate and what is it?
Congenital oronasal fistula;
Abnormal communication between oral and nasal cavities
What makes up the primary palate?
Lip and premaxilla
What makes up the secondary palate?
hard palate and soft palate
What are clinical signs of a congenital cleft palate?
Neonates gagging, failure to thrive, death, rhinitis, respiratory tract infection
Why should you take chest rads with a cleft palate?
To detect penumonia
How should animals with a cleft palate be fed?
Via tube
Until when should surgical treatment of a cleft palate be delayed and why?
Until at least 8-12 weeks of age;
Less risk of dehiscence, early repair can –> abnormal maxillary development
Animals with a cleft palate should always be _____.
sterilized
What should you recommend if a cleft palate case shows up in general practice?
refer it
Cleft palate is repaired with reconstruction of _____.
nasal floor
When would both the hard and soft palates be repaired first in a cleft palate case?
If both primary and secondary cleft exist
What are the 3 principles to remember for cleft palate repair?
- Tension free closure
- Support suture lines
- Flaps typically used - flap harvest sites heal by second intention
What are the 2 most common procedures to repair a cleft palate?
- Sliding bipedicle flaps (con Lagenbeck) technique
- Overlapping flap technique
What must be preserved in the overlapping flap technique for cleft palate repair?
Major palatine artery and hinge
What are causes of acquired oronasal fistula?
Trauma, dental disease, dehiscence after surgery, neoplasia, radiation therapy
What type of closure should be done when possible in an acquired oronasal fistula?
double flap closure
What are typical clinical signs of an oral mass?
Ptyalism, dysphagia, inappetance, halitosis, weight loss, pain, hemorrhage, mass visualization
What are the 8 diagnostics that can be done to evaluate an oral mass?
- Sedated oral exam
- CBC/chem/UA
- Coag times, blood type
- FNA or biopsy
- LN aspirate +/- removal
- Thoracic rads
- CT >>> dental rads
- CT lymphangiogram
Why is CT superior to dental rads?
60-80% of gingival tumors will have bony lysis and >40% destruction is needed to be seen with rads
What is a CT lymphangiogram used for?
Sentinel LN mapping
What are prognostic factors for oral neoplasia staging?
Rostral > caudal
Movable > fixed
Nonulcerated > ulcerated
Small > large
What should be done with all masses prior to definitive surgery?
biopsy
T/F: LN size is an unpredictable predictor of metastasis
true
What is the main regional LN that should be evaluated with an oral mass?
Mandibular;
Usually there is no access to the parotid, medial RP, and tonsils
What can an FNA tell us about an oral mass?
If the cells are tumor cells (neoplasic vs. non-neoplastic)
What can an incisional biopsy tell us about an oral mass?
tumor type and grade
What can an excisional biopsy tell us about an oral mass?
Tumor type, grade, and surgical margins
What is the most common type of biopsy performed on oral masses?
incisional
What are the treatment options for oral masses?
Surgical excision, radiation therapy, chemo, immunothrapy, combo
What are the 3 treatment intents for oral masses?
- Curative
- Debulking
- Palliative
What margins would be needed for an oral mass removed with a maxillectomy or mandibulectomy?
1-2 cm based on advanced imaging
What is the most common indication for a maxillectomy/mandibulectomy? What are some others?
- Neoplasia = most common
- Trauma
- Infection
- Periodontal disease
- Oronasal fistula
What are common indications in dogs for a maxillectomy/mandibulectomy and what is the MOST common?
- Malignant melanoma = most common
- SCC
- Fibrosarcoma
- Epulides/Ameloblastoma
What are common indications in cats for a maxillectomy/mandibulectomy and what is the MOST common?
- SCC = most common
- Fibrosarcoma
What spp tolerates removal of nasal turbinates?
dogs
What are the 5 types of mandibulectomies?
- Rostral: unilateral/bilateral
- Central/segmental
- Caudal
- 3/4 (total and contralateral rostral)
- Hemimandibulectomy (R/L)
What spp tolerates mandibulectomy well?
dogs
What effect can mandibulectomies have in cats?
They may not eat (72% inappetent following sx, 12% never regain the ability to eat)
What can an intracapsular surgical margin be used for?
Benign tumor (EX: odontoma)
What can a marginal surgical margin be used for?
Benign tumors except ameloblastoma (goes just beyond the tumor)
What is considered a wide margin and what tumors is it used for?
>1-2 cm;
Used for malignant tumors and ameloblastomas
What are radical margins used for?
hemimandibulectomy
T/F: Recurrence/regrowth is not a complication of oral surgery.
False
What types of dehiscence are possible complications of oral surgery?
Oronasal fistula, commisurotomy, skin flaps
T/F: Epistaxis is a complication of oral surgery
True
A complication of oral surgery can be stenosis of _____.
nasal orifice
T/F: Osteomyelitis is not a complication of oral surgery.
False
What can happen to the mandible as a result/complication of oral surgery?
mandibular drift/malocclusion
What are the common malignant oral masses of dogs in order from most to least malignant?
Malignant melanoma > SCC > fibrosarcoma > osteosarcoma
What are the common malignant oral masses of cats in order from most to least malignant?
SCC >>>>> fibrosarcoma
Where can malignant melanoma be found in the dog mouth?
Gingiva, buccal/labial mucosa
What is the appearance of malignant melanoma in dog mouths?
firm and black
33% of oral malignant melanomas in dogs are _____.
non-pigmented
Malignant melanomas in dog mouths have a _____ rate of metastasis.
high
What should you do with LNs when you see an oral mass that you suspect is malignant melanoma?
Always aspirate L & R mandibular nodes
What is the surgical treatment for malignant melanoma in dog mouths?
Aggressive resection followed by chemo and immunotherapy to u=improve survival time
What are 2 treatments other than surgery for oral malignant melanoma?
Radiation and melanoma vaccine
What sites are prone to SCC in dog mouths?
Gingiva, buccal/labial mucosa, hard palate, tongue, tonsils
What is the chance for bony lysis with an oral SCC in dogs?
77%
Where can oral SCC in dogs metastasize to? What primary locations have a higher metastasis rate?
LNs and lungs;
Tongue and tonsillar tissue
What are the 3 types of benign oral masses dogs can get?
- POF (peripheral odontogenic fibromas)
- FFH (focal fibrous hyperplasia)
- CAA (canine acanthomatous ameloblastoma)
Where do POFs in the dog occur?
Premaxilla/maxillary PM teeth
What type of excision is used for POFs in dogs?
Conservative - narrow margin of bone
What should be treated when a dog has an FFH?
Underlying dental disease (plaque/gingivitis)
Where does a canine CAA arise from?
odontogenic tissue
What teeth are involved in a CAA in dogs?
mandibular canines and incisors
CAAs are _____ but not _____. There is ____% evidence of bony lysis.
locally invasive, metastatic, 80-90%
How should CAAs be removed?
By aggressive resection (partial madibulectomy or maxillectomy with 1 cm margins)
What are risk factors for oral SCC in cats?
Flea collars, canned food, tuna, smoking
What are common sites for oral SCC in cats and what is the most common?
- Tonsils = most common
- Mandible
- Maxilla
- Tongue, pharynx
_____ is rare for oral SCC in cats, but highly _____ with a _____ prognosis.
Metastasis, invasive, poor
Other than SCC and fibrosarcoma, what is an oral mass cats can get?
Eosinophilic granuloma - benign allergic/autoimmune
