Chapter 29 - Oraly cavity soft tissue trauma and salivary glands Flashcards
What causes self-inflicted lingual trauma in horses?
Inadvertent desensitization of the tongue due to diffusion of local anesthetic to the lingual nerve during an inferior alveolar nerve block.
How does the soft tissue of the face and oral cavity typically heal?
It heals well by second intention, usually within two weeks.
What are some non-surgical management strategies for minor oral soft tissue injuries?
Flushing the oral cavity with antiseptic solution, warm salt water, or clean water, and using NSAIDs.
What muscles anchor the tongue to the mandible and hyoid apparatus?
The genioglossus, hyoglossus, and styloglossus muscles.
What nerve provides motor innervation to the tongue?
The hypoglossal nerve (XII).
Which sensory nerves supplies the tongue for regular and special sensory innervation?
The lingual nerve branches from the facial nerve (VII), glossopharyngeal nerve (IX), and vagus nerve (X).
Which part of the tongue is most often involved in lacerations?
The free portion of the tongue.
What clinical signs are associated with tongue lacerations?
Oral hemorrhage, ptyalism, inappetence, anorexia, dysphagia, malodorous breath, and tongue protrusion.
What is a partial glossectomy?
The surgical removal of devitalized sections of the tongue.
How can tissue viability be assessed during tongue surgery?
By evaluating tissue color, temperature, bleeding at an incision, and observing fluorescence after intravenous administration of sodium fluorescein.
What technique is used to assist dorsal-ventral apposition during partial glossectomy?
Removing a wedge of intervening musculature and closing the space with multiple rows of interrupted absorbable sutures.
What type of sutures are recommended for multilayer closure in tongue laceration repair?
Absorbable or nonabsorbable size 0 or 1 monofilament sutures for deep layers and simple interrupted sutures for muscle apposition.
When is second-intention healing considered for tongue lacerations?
In chronic, less extensive lacerations or when economic constraints preclude surgical repair.
How can healed tongue lacerations with poor functionality be managed?
By primary closure techniques after sharp débridement of scar tissue.
What dietary adjustments may be needed post-tongue surgery?
Gruels of pelleted feeds, bran mashes, and wetted hay before transitioning to drier feeds.
How soon after lingual surgery do horses usually begin prehending food adequately?
Within hours to a few days.
What complications can arise after partial glossectomy?
Excessive swelling of the tongue and suture dehiscence.
What functional issue may occur after removing a large part of the tongue?
Involuntary dripping of saliva from the mouth.
What is the cosmetic outcome usually like after partial glossectomy?
The cosmetic appearance is usually highly acceptable.
What performance expectations can be met after partial glossectomy?
Return to full riding performance with the use of a bit is practical.
What structures form the blood supply to the tongue?
The lingual artery, which branches from the linguofacial trunk and supplies the tongue via dorsal lingual branches.
What surgical technique can be used for exposure and traction of the tongue during surgery?
Placing towel clamps or a gauze snare caudal to the laceration.
What role do tension-relieving sutures play in tongue laceration repair?
They reduce tension on the wound margins to support healing.
What is a potential long-term complication of tongue amputation?
Slower eating times and an adaptive phase for prehending food.
How are tongue lacerations with devitalized tissue managed surgically?
By débridement of nonviable tissue and multilayer sutured closure.
What is the function of the lingual frenulum?
It attaches the caudal aspect of the apex of the tongue to the oral cavity floor.
What complication may occur during recovery from general anesthesia in horses?
Soft tissue trauma in the oral cavity.
How can necrotic tissue be treated during surgical repair of tongue lacerations?
By vigorous débridement and lavage of the wound.
What are the two types of sutures used to close the muscular body of the tongue?
Vertical mattress sutures for deep closure and simple interrupted sutures for apposing the muscles.
What technique is used if the majority of the free portion of the tongue is amputated?
Gruels and soft feeds are introduced before transitioning to harder foods.
Which part of the tongue contains large vallate papillae?
At the approximate division of the tongue body and root.
What are the key postoperative care measures after tongue surgery?
NSAIDs, antimicrobial therapy, dietary adjustments, and monitoring for complications like swelling or suture dehiscence.
Describe partial glossectomy
Correct dorsal-ventral apposition is assisted by removing a wedge of intervening musculature and closing the created space with multiple rows of interrupted absorbable 2-0 or 0 sutures (walking sutures, see Figure 16-11, E). If considered necessary, full-thickness tension-relieving mattress sutures may be placed caudal to the mucosal edges to provide additional support to the wound margins, with care being taken not to disrupt the blood supply. The mucosal edges are subsequently closed with exposed or buried 2-0 or 0 absorbable sutures
(Figure 29-49) Mucosal-to-mucosal closure of the stump is not imperative, but is encouraged to aid hemostasis, to reduce postoperative discomfort associated with an exposed tongue stump, and to hasten wound healing.
Figure 29-49. Closing the tongue stump after partial glossectomy. After amputation of the severely lacerated tongue (A), a wedge of intervening musculature is removed (B). The created space is closed with multiple interrupted rows of sutures (C and D) before closing the mucosa (D
and E).
Figure 29-50. Tongue laceration repair. After vigorous lavage of the wound (A) and débridement of devitalized tissues (B), the laceration is closed with multiple layers of interrupted sutures (C and D). The large vertical mattress tension-relieving sutures are placed first, deep in the tongue musculature.
Primary closure of severe tongue lacerations is obtained how?
A multilayer closure to eliminate dead space is recommended. To relieve tension on the closure, vertical mattress sutures are preplaced deep in the muscular body of the tongue with absorbable or nonabsorbable size 0 or 1 monofilament suture material. Buried rows of simple interrupted 2-0 to 0 monofilament absorbable sutures are subsequently used to appose the muscles, obliterating dead space. The vertical mattress sutures are tied, and the lingual mucosa is apposed with simple continuous or interrupted vertical mattress sutures (Figure 29-50).
Figure 29-51. Repair of a laceration involving the commissure of the lips. (A and B) After appropriate débridement and lavage of the laceration, the skin and mucous membrane margins of the laceration are undermined 1.0 to 1.5 cm (stippled area in [A]). (B) Cross-sectional view with (a) skin; and (b) mucous membrane. Next, vertical mattress sutures tied over stent material are preplaced through the lip musculature before closing the mucous membrane and skin layers to reduce motion at the suture lines (C and D). Extra vertical mattress sutures can be placed rostral to the repair to further stabilize the site (C).
What types of trauma can cause lip injuries in horses?
Protruding objects like metal buckets, nails, bolts, hooks, and iatrogenic bit damage.
What type of injury may require surgery to preserve lip function and cosmetic appearance?
Mandibular degloving injuries with extensive avulsion of oral soft tissues.
What surgical technique is used for injuries with extensive tissue contusion and devitalization?
Delayed primary closure to optimize the amount of healthy tissue for suturing.
Why is general anesthesia preferred for lip trauma repairs?
It facilitates a meticulous repair.
Important steps of lips closure
Preplacing vertical mattress sutures and undermining the wound margins.
How is motion at the lip suture line reduced during repair?
By sharply undermining the skin and mucosa margins for 1 to 1.5 cm from the wound edges.
What type of sutures is recommended for lip repairs?
Vertical mattress nonabsorbable sutures tied over quills or buttons.
What is the suture pattern used at the mucocutaneous junction?
Vertical mattress pattern.
What additional sutures are recommended for lip commissure injuries?
Vertical mattress tension-relieving sutures rostral to the primary repair.
Figure 29-55. (A) Photograph of a horse with a sialolith located in the left parotid duct near the rostral edge of the facial crest. (B) Sialolith removed from a parotid salivary duct. ([B] With permission, Schumacher J, Schumacher J. Diseases of the salivary glands and ducts of the horse.
Figure 29-56. Severely dilated parotid salivary duct and gland of a 1-year-old Quarter Horse gelding with congenital atresia of the parotid duct. The duct ended blindly approximately 1.4 cm from the normal site for the buccal ostium. Line arrows mark the course of the duct. (With permission, Fowler ME. Congenital atresia of the parotid duct in a horse.
