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CB - Soft Tissue - Digestive System > 87 - Oral Cavity > Flashcards

87 - Oral Cavity Flashcards

1
Q

What is the function of the lips

A

Retain saliva
Express emotion

NOT involved in prehension

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2
Q

Which salivary ducts enter into the vestibule?

What are the landmarks for the papillae?

A

Parotid
(Carnassial tooth/4th maxillary premolar)

Zygomatic
(1cm caudal to parotid, last molar)

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3
Q

What is the motor and sensory innervation of the lips

A

Motor = Facial n.

Sensory = Trigeminal

Remember trigemiinal has 3 main branches
- Ophthalmic
- Maxillary
- Mandibular

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4
Q

Which blood vessels supply the lips

A

Upper = Infraorbital a.

Lower = Facial a.

This book doesn’t mention this but remember from other chapters and skin flaps in literature:

Remember fracial branches = Inferior labial, angularis oris, superior labial

Inferior = Supplys lower lip
Angularis oris = Supplys commisure
Superior = Supplys upper lip (with infraorbital a.)

Infraorbital branches into lateral nasal and rostral dorsal nasal

Rostral lower lip supplied by caudal, rostral and middle mental arteries (branches of the maxillary artery => mandibular artery once enters mandibular foramen => Exits via mental foramen)

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5
Q

What are the main functions of the tongue

A
  • Prehension (Lapping, suckling, mastication)
  • Taste
  • Swallowing
  • Grooming
  • Thermoregulation
  • Vocalisation
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6
Q

What are the three anatomic regions of the tongue

A

Root: Anchors to oropharynx

Body: From root and along attachment of frenulum

Apex: Distal free portion

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7
Q

Which three paired extrinsic muscles make up the root of the tongue?

What action does each muscle have on tongue movement?

A

STYLOGLOSSUS
- Inserts on the stylohyoid
- Draws caudally and depresses the tongue

HYOGLOSSUS
- Inserts on the basihyoid
- Retracts and depresses the tongue

GENIOGLOSSUS
- Inserts on medial mandible
- Depresses and PROTRUDES tongue
- Three bands (vertical, oblique, straight)
- Straight inserts onto tongue, basihyoid and certohyoid

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8
Q

What nerve supplies the extrinsic muscle of the tongue

A

Hypoglossal nerve (XII)

MOTOR ONLY!

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9
Q

What is the function of the intrinsic muscles of the tongue?

A

Intricate movement
Tongue protrusion

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10
Q

How are the intrinsic muscle of the tongue organised?

A

Fibre units

  • Superficial longitudinal
  • Deep longitudinal
  • Transverse
  • Perpendicular

Innervated by hypoglossal nerve

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11
Q

What is the name for the bundle of connective tissue, muscle and fat in the median plane of the ventral tongue?

What is suspected to be its function?

A

The Lyssa

Function = Stretch receptor?

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12
Q

What epithelium lines the dorsal tongue

A

Cornified squamous epithelium

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13
Q

Name the different types of papillae

A

Gustatory (contain taste buds)
- Fungiform
- Vallate
- Foliate

Non-gustatory
- Filiform
- Conical

Conical = grooming in cats

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14
Q

Innervation from which nerves control taste, pain, heat and sensation

A

Trigeminal
Facial
Glossopharnygeal

Hypoglossal is MOTOR FUNCTION ONLY

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15
Q

What is the arterial supply to the tongue

A

External carotid => Lingual artery

Right and left lingual arteries anastomose throughout
(Damage to one artery does not affect other regions of tongue)

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16
Q

What is the venous drainage from the tongue?

A

Lingual vein => Empties into facial vein

Vessels run longitudinally on ventral aspect of tongue

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17
Q

What muscles lie within the soft palate

A

Palatinus (Shortens)
Tenor veli palatini (Taughtens)
Levator veli palatini (Elevates caudally)
Pterygopharyngeal
Palatopharyngeal (Sphincter between pharynxes)

Paired muscles

Palatinus = Palatine process of palatine bone to caudal border of palate. Shortens the palate rostrocaudally.

Tensor veli palatinin = Rostral to tympanic bulla, over hamular process of pterygoid inserts diffusely onto palatine aponeurosis. Stretches palate between pterygoid bones

Levator veli palatini = Similar origin to tensor, courses caudally and ventrally to insert on caudal half of the soft palate. Elevates the caudal palate, protecting the nasopharynx during swallowing/vomiting

Palatopharnygeus = Extend laterally ot make up palatopharyngeal arches which form the rim of the interpharyngeal ostium to act as a sphincter between oro, naso and laryngopharynx

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18
Q

Which nerves supply the soft palate?

A

Glossopharyngeal (IX)
&
Vagus (X)

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19
Q

Blood supply to the soft pallate

A

Maxillary artery => Minor palatine foramen => Minor palatine artery

Note hard palate = Maxillary though major palatine = Major palatine artery

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20
Q

How may tonsils does a dog have?

What are they?

A

Dogs tonsils = 4

2 x Palatine = Paired, within the palatine fossa (tonsillar crypt)

1 x Lingual = Base of the tongue

1 x Pharygeal = Roof of the nasopharynx

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21
Q

How may tonsils does a cat have?

A

Cats = 6 tonsils

2 x Palatine = Paired, within the palatine fossa (tonsillar crypt)

1 x Lingual = Base of the tongue

1 x Pharygeal = Roof of the nasopharynx

PLUS

2 x Paraepiglottic tonsils = Craniolateral to the base of the epiglottis

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22
Q

Vascular supply to the palatine tonsils?

A

Tonsillar artery

= Branch of the lingual artery
(which is a branch of the external carotid)

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23
Q

What is the lymphatic drainage for the tonsils?

A

Parotid LN

Mandibular LN

Medial retropharyngeal LN

(Which can drain to superficial cervical LN)

** Can drain to ipsilateral or contralateral LN**

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24
Q

Label the image

A

1 = Vestibule

2 = Canine

3 = Hard Palate

4 = Soft palate

5 = Root of the tongue

6 = Sublingual caruncle

7 = Pataoglossal arch

8 = Palatine tonsil

9 = Frenulum

10 = Philtrum

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25
Q

What are the three phases of Deglutition

A

Oropharyngeal phase
- Oral phase
- Pharyngeal phase
- Pharyngoesophageal phase

Oesophageal phase

Gastroesophageal phase

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26
Q

Which phase if voluntary?

Which CN are involved?

A

**Oral phase **
(First part of the oropharnygeal phase)

Food bolus formed
Propelled to the base of the tongue

Trigeminal, Facial and Hypoglossal
Innervation to masticatory muscles, soft palate and tongue
(V, VII, XII)

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27
Q

Which cranial nerves are termed the ‘swallowing centre’?

A

Glossopharyngeal and Vagus
(XII and X)

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28
Q

Give an overview of the orophangeal phase
(First phase of deglutition)

A

1) Voluntary oral phase -
Food bolus formed and propelled to the base of the tongue. CN V, VII and XII

2) Involuntary pharyngeal phase -
Bolus transfered to the phraynx. Peristaltic like waves of the tongue and pharnygeal constrictors. Coverage of the glottis by the epiglottis and nasopharynx by the palate. CN IX and X

3) Involuntary pharyngoesophageal phase -
Bolus passess through cricopharnygeal sphincter which relaxes when pharyngeal muscles contract. Terminates when sphincter closes and pharynx relaxes. CN IX and X

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29
Q

Give an overview of the oesophageal phase of deglutition

A

Involuntary

Food bolus in cranial oesophagus is propelled aborally by primary peristaltic wave.

If the primary wave failes, then a secondary wave triggered by oesophageal distension

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30
Q

Give an overview of the gastroesophageal phase of deglutition

A

Muscularis ahead of the bolus relaxes
Results in propulsion of the bolus through the GEJ

Note, the bolus will occasionally ‘wait’ for the next one to join in before passing into the stomach

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31
Q

What causes dysphagia?

A

Abnormal
- Retention
- Prehension
- Swallowing

May lead to aspiration or dinished gag reflex

Issues with swallowing (pharyngeal or pharyngoesophageal phases) will not be resolved with postural feeding or placing food at base of tongue

32
Q

DDx for dysphagia

A

Structural congenital abnormalities
* Ankyloglossia
* Palate defect
* Macro-/microglossia
* Tight lip syndrome
* Congenital hyoid bone abnormalities

Space occupying masses
* Pharyngeal sialocoele (or lingual)
* Thyroglossal cyst
* Abcess
* Neoplasia
* Enlarged LN

Functional abnormalities
* Idiopathic
* Neuro disorder; MG, peripheral neuropathy, brainstem lesion
* Crichopharyngeal achalasia or asychrony

33
Q

Investigation of Dysphagia

A

Fluoroscopy
CT
Oral Exam

Pharyngeal phase abnormality = Attempt to swallow but fails to move past contristor muscles so bolus remains in pharynx

Pharyngoesophageal phase abnormality = Bolus moves into pharynx but fails to pass through cricopharyngeal sphincter into oesophagus so remains in pharynx or larynx

34
Q

Give 5 considerations for general anaesthesia for patients with compromise in the oral cavity, pharynx or those presenting with dysphagia?

A

Prep ready for trach tube

Use stylet for intubation

Inflate the ETT cuff

Pack the pharynx

Use of mouth gags (not spring loaded in cats)

35
Q

Why should spring loaded mouth gags NOT be used in cats

A

Causes occlusion of the maxillary artery

Maxillary artery forms a network of vessels called the RETE MIRIBILE MAXILLARIS in the pterygoid fossa
This passess through the orbital fissure into the cranium to form the cranial arterial circle

Occlusion of the maxillary artery => Blindness and neurological abnormalities

36
Q

Why are antibiotics generally not indicated for oral surgery?

A

Excellent blood supply

Antibacterial properties of saliva

37
Q

What is tight lip syndrome
What are the sequelae to it?

and what breed is affected?

A

Rostral lip pulled over the mandibular dental arcade

Sequelae =
Trauma to the lip
Inhibition of mandibular growth
Disruption of Tooth Eruption

Breed =
SHAR PEI

38
Q

How it tight lip syndrome treated?

A

1 - Incision into the lip mucosa at the gingival margin allowing the lip to retraction

2 - Excision of the skin on the chin to pull lip ventrally

3 - Deepening of the rostral and lateral vestibule

39
Q

How should redundancy and eversion of the lower lip be treated?

A

Antidrool Cheiloplasty

or

Full thickness wedge resection of the redundant tissue

Large and giant breeds

40
Q

Describe the technique for anti-drool cheiloplasty

A
  • The lip is elevated dorsally until it is taught with the dogs mouth closed
  • 2.5-3 cm full thickness horizontal incision through maxillay skin at the region where taughtness was achieved (near 4th upper premolar)
  • The caudal end of the incisio should be on the line between the medial canthus and labial commissure
  • 2mm strip of mucosa removed from the mucocutaneous junction of the lower lip
  • 2 x flaps created in skin of lower lip (0.5-0.75cm)
  • Sutures placed to evert flaps through to the skin incision
  • Secured with vertical mattress sutures
41
Q
A
42
Q

Name 4 methods of treating lip evulsion

A

Second intention healing if small

Subgingival sutures around incisors

Interrupted mattress pattern through Pre-drilled holes in mandible (if incisors abscent)

Apposition of the mucosa to the gingiva with simple continous sutures

+/- drain exiting ventrally

2/0-4/0- PDS

43
Q

What are the most common types of lip tumour in dogs and cats?

A

Dogs =
- Melanoma
- SCC

Cats =
- SCC
- MCT
- Fibrosarcoma

Tx wide excision and reconstruction with local or axial patern flaps

Buttons or stents at commissure to reduce tension

44
Q

What % of cases with canine lip melanoma have mets?

A

12-60%

MST 34 months

45
Q

What % of dogs and cats with SCC of the lips have mets?

A

Dogs = 0-40%

Cats = ~31%

46
Q

How should lip fold dermatitis be treated?

A

If medical management fails

Excision of diseased skin parallel ot the body of the mandible, sparing the underlying muscle

Closed in 2 layers

47
Q

Diagnosis and treatment?

A

Dx = Bilateral primary cleft palate

Tx = Excision of dissociated incisive bone
Bilateral, full thickness labial advancement flaps
Closure of the buccal mucosa and skin

48
Q

What is ankyloglosia
What breed is predisposed?
and how should it be treated?

A

‘Tongue-tied’
(Short and thick frenulum - inability to suckle, swallow, lick - puppies with stunted growth, poor feeding and ptyalism)

Breed = Alantolian shepherd dogs

Tx = Frenuloplasty
(Immediate response after resection of tight band)

49
Q

What can cause calcinosis circumscripta in the tongue?

Ectopic mineralisation

A
  • Dystrophic mineralisation due to trauma
  • Metastatic mineralisation due to ionized hypercalcaemia
  • Idiopathic mineralisation

Tx = Excision if dysphagic

50
Q

Clinical signs associated with lingual abscess?

Which bacteria are commonly implicated?

Treatment?

A

Macrogossia, pain, cervical swelling, dysphagia

Pasteurella Multocida and E.coli

Tx = Drainage +/- marsupialisation
C&S and ABs

51
Q

What’s the diagnosis?

What age of dogs is usually affected?

Investigations?

Treatment?

A

Oral Papillomatosis (Viral)

Normally < 1 year of age

If adult investigate for immunosuppressive diseases

Tx = Self resolving in 4-8 weeks
If not, Azithromycin, Recombinant vaccine or palliative excision

Recurrence high after excision

52
Q

Which breed of cats are most commonly affected by Feline Oral Pain Syndrome

What is it and what can trigger it?

How is it treated?

A

Burmese cats

Neuropathic pain disorder triggered by
-Dental eruption
-Oral lesions
- Environmental anxiety

Tx = Antiepileptic drugs!
(Pheno)

53
Q

How do chemical burns appear in the oral cavity?

What can cause them?

A

Horseshoe shaped ulcerations
(Tongue and gingiva)

Acids, alkalis, bleach, petrol

54
Q

Treatment for tongue trauma

A

Feeding tube
Consider delayed necrosis
Lavage and debride
Appose deeper layer then epithelium to maintain conformation

55
Q

What are the most common forms of tongue neoplasia in dogs

Any predispositions?

Rough met and MST rate

A

Melanoma (Chow chows, Shar peis) -
11-71% mets, MST 241 days

SCC (Poodles, labs, samoyed - female > male)
6-43 % mets, MST 216 days

Fibrosarcoma

Melanoma = Pigmented tongue
SCC = White coats

56
Q

What % of malignant melanomas are amelanotic?

A

33%

57
Q

What are the most common forms of tongue neoplasia in cats?

A

SCC (70-80%)

Fibrosarcoma

As for lips, cats dont seem to get melanoma of the oral cavity as much as dogs

58
Q

What is the most common location for cavity neoplasia in cats?

A

The tongue and gingiva

(24% are lingual)

Tongue is onl y 3-4 % of oral cavity neoplasia in dogs!

59
Q

Name 3 risk factors for oral SCC in cats

MST?

A
  • Canned food
  • Flea collar
  • Smokers household

MST 44-203 days

60
Q

What % of tongue neoplasias are malignant?

A

64-93%

61
Q

Name one prognostic factor for malignant melanoma and SCC in dogs

A

Tumour size

< 2 cm = MST 818 days

> 2cm = MST 207 days

Shorter survival if feeding tube needed after glossectomy too

62
Q

% Recurrence after glossectomy

A

28%

63
Q

What margin is recommended for glossectomy for Tx of neoplasia?

A

Ideally 2 cm

But > 1cm had increased chance of complete excision, reduced recurrence rate and increased survival

64
Q

Name 5 types of glossectomy

A
  • Wedge (indicated for small or benign lesions) = removal of up to 50% width

Transverse (4 types)
- Partal = rostral to frenulum
- Subtotal = free tongue plus genioglossus/hypodeus
- Near total = > 75% of tongue
- Total = 100% of tongue amputated

65
Q

Describe the technique for wedge glossectomy

A

Wedge remove of up to 50% of the tongue

Rostral portion of contralateral side is rotated by 90° to close the defect

66
Q

Describe the technique for transverse glossectomy

A

Horizontal mattess sutures placed outside of the margin before excision
Tongue transected rostral to sutures
Haemostasis with electrosurgery or laser transection
Mucosa at the rostral edge reapposed with simple interrupted or continous

67
Q

What environmental management strategies are recommended after glossectomy?

A

Feed chilled meatballed food
Deep water bowls
Hanging water bottles
Syringing water

68
Q

What % of tongue resection is tolerated in dogs?

Concerns

A

50%

Heat stroke - Loss of thermoregulation
Hyperptyalism - Sialoadenectomy

69
Q

Glossectomy Concerns for cats

A

Unwilling or unable to adapt to altered feeding

Compromised grooming

72% had poor post op recovery and 43% had poor long term outcome

Median time for feeding tube = 74 days!

70
Q

Treatment for oropharyngeal penetrating FBs

A
  • Endoscopic retrieval
  • Wound explore, debride, lavage, drain
  • Ventral midline approach

PLUS ABs based on C&S

71
Q

Name 6 causes of tonsillitis

A
  • Primary (< 1 year old)
  • Secondary bacterial
  • BOAS
  • Cleft Palate
  • Periodontal disease
  • Any Chornic atigenic stimulation

Tx if recurrent and primary - Tonsillectomy
Otherwise ABs and analgesia

72
Q

Most common form of tonsilar neoplasia?

A

SCC

(Others = Melanoma, Lymphoma, Adenocarcinoma, Polyps, Cysts)

Primary may be quiescent. Oral exam in any patients with cervical swelling

72
Q

% Mets at presentation in tonsillar SCC

A

Local = 75%

Distant 42%

73
Q

MST for Tonsillar SCC?

A

Dogs = 2 months

Cats = 2-14 weeks

:(

74
Q

What factors can increase the risk of tonsillar SCC

A

Atmospheric pollution

75
Q

Treatment for tonsillar SCC?

A

Tonsillectomy
(Palliative and diagnostic)

Adjunctive Chemo/Radio or both

MST chemo = 212 d; Radio = 110 d, Both = 355 d

CB - Soft Tissue - Digestive System (5 decks)

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