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7: Digestive System > Chapter 87 Soft Tissues of the Oral Cavity > Flashcards

Chapter 87 Soft Tissues of the Oral Cavity Flashcards

1
Q

What is meant by the following:

Oral cavity

Oropharynx

Oral cavity proper

Oral vestibule

A

Oral cavity: Area bounded by lips, hard palate, tongue/underlying mucosa

Oropharynx: Area bounded by soft palate, root of tongue and pharyngeal wall

Oral cavity proper: Area bounded by dental arcades

Oral vestibule: Area/potential space between teeth and lips

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2
Q

List thethree most common oral tumours in dogs

And cats

A

Dogs: Malignant melanoma > SCC > Fibrosarc

Cats: SCC > Fibrosarc > Lymphoma

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3
Q

What nerve provides motor innervation to lips

And sensory

A

Motor: Facial n (VII)

Sensory: Trigeminal n (V)

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4
Q

What is main arterial supply to upper and lower lip?

A

Upper lip:

  • Infraorbital artery rostrally (from maxillary artery)
  • Superior labial caudal half (from facial artery)

Lower:

  • Inferior labial artery caudally (from facial artery)
  • Middle and rostral mental arteries rostrally (from inferior alveolar, from maxillary)

In dogs, the facial artery is a terminal branch of the external carotid artery and is approximately 3 cm long and 1.5 mm in diameter. It arises at the angle of the mandible 1cm from the lingual artery and gives rise to multiple terminal branches. The facial artery is surrounded by the masseter muscle dorsally and laterally, the digastricus muscle ventrally and the styloglossal muscle medially. The facial artery terminates in the face as multiple labial arteries. The facial artery bifurcates into the inferior labial artery and superior labial artery. The angularis oris artery branches ventrally from the superior labial artery and courses rostrally and ventrally. The superior labial artery anastomosis with the terminal branches of the infraorbital artery, the lateral nasal artery and rostral septal branches of the infraorbital artery.

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5
Q

Label the diagram

A

General view of the oral cavity of the dog.

1, Vestibule;

2, canine tooth;

3, hard palate;

4, soft palate;

5, tongue;

6, sublingual caruncle;

7, palatoglossal arch;

8, palatine tonsil;

9, frenulum;

10, philtrum.

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6
Q

Label the diagram

A
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7
Q

Which salivary gland(s) empty into the oral vestibule?

A

Parotid and zygomatic

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8
Q

What are the three ‘geogrphical’ parts of the tongue

A

Root: Anchors to oropharynx

Body: From root and along attachment of frenulum

Apex: Distal free portion

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9
Q

What are the mucosal ridges either side of the lingual frenulum called?

What is their significance

A

Sublingual fold

Ends at sublingual caruncle which is where sublingual ducts course and open

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10
Q

What are the three extrinsic muscles of the root of the tongue

What is their origin and insertion:

What nerve controls their movement?

A
  • Styloglossus (three subdivisions)
    • Origin: Stylohyoidbone
    • Insertion: Spanventral apspect of tongue
  • Genioglossus
    • Origin: Medial aspect of each mandible, immediately caudal to symphysis
    • Insertion: separates into three bundles as it fans caudodorsally
      • Rostral portion of ventral tongue (vertical bundle)
      • Ventral region of caudal tongue (oblique bundle)
      • Caudal third of tongue (straight bundle)
  • Hyoglossus
    • Origin: Basihyoid bone
    • Insertion: Caudal 2/3rds of tongue

Hypoglossal nerve (CN XII)

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11
Q

Label the diagram

A
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12
Q

How are the intrinsic muscles of the tongue classified (re units of fibre)

The intrinsic muscles are responsible for protrusion of the tongue. Which nerve controls motor function?

A
  • Superficial longitudinal
  • Deep longitudinal
  • Transverse
  • Perpendicular

Hypoglossal nerve (CV XII)

N.B. Hypoglossal is a somatic only CN

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13
Q

What is the central tubelike structure of the tongue called

A

Lyssa

(muscle, fat, sometimes cartilage)

Function unclear

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14
Q

What is the epithelium of the tongue

A

Cornified squamous

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15
Q

NAme the 5 papillae of the tongue.
Which are gustatory (i.e. tastebuds?)

A

FUn VALhalla FOLk

cant taste

FILo CONtaining pastry

Gustatory:

  • Fungiform
  • Vallate (means raised edge)
  • Foliate

Non-gustatory

  • Filiform
  • Conical
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16
Q

What is the implication of ligation of one side of lingual artery

What is lingual a. a branch of

A

None as lots of anastomoses throughout parenchyma

Lingual a. is a branch of external carotid

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17
Q

What vein does lingual vein drain into

A

(Linguo) facial

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18
Q

What are the muscles of the soft palate (5)

A
  • Tensor veli palatini (opens eustachean tube btw)
  • Levator veli palatini
  • Palatine
  • Pterygopharyngeal
  • Palatophryngeal (extend laterally and become palatopharyngel arches)
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19
Q

Which nerves control the muscles of the palate?

A

Glossopharyngal (IX) and vagus (X)

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20
Q

What is the main blood supply to the soft palate Bramch of what artery?

A

Minor palatine arery, branch of maxillary

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21
Q

How many tonsils does the dogs have (and what are they?)

And cats

A

Dogs have 4:

  • Paired palatine tonsils
  • Single lingual tonsil (not grossly appreciable)
  • Single pharyngeal tonsil (roof of nasopharynx)

Cats have 6:

  • In addition to above, paired paraepiglottic (craniolateral to base of epiglottis)
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22
Q

What is blood supply to palatine tonsis?

A

Tonsillar artery (branch of lingual artery!)

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23
Q

What LNs do tonsils drain into

And more generally speaking - which LNs shoudl be checked with oral cavity neoplasia

A

Mandibular and medial retropharyngeal

Mandibular, medial retropharyngeal, and parotid, they drain into superficial cervcal so check that too. Check bilaterally too as vessels of head and neck can cross midline

24
Q

What is another owrk for the cricopharyngeal stage of swallowing

A

Pharyngooesophageal

25
Q

What nerves provide sensory and motor to muscles of mastication, soft palate and tongue

A

V

VII

XII

26
Q

Which nerves conrtrol pharyngeal phase of swallowing?

A

IX and X

27
Q

What pre-op considerations with oral problems

A
  • Excisioon of biopsy tract
  • Difficult intubation - have airway stuff/trach tube stuff ready
  • Airway protection - cuffed tube of appropriate size and gauze + suction before removal
  • Pharyngostomy tube?
  • Feeding tube
  • Mouth gag (not spring loaded)
28
Q

Why shoudl spring loaded mouth gag not be used (esp cats)

A

Can occlude maxillary arteries –> blindness and neuro deficits

29
Q

What breed gets tight lip syndrome

3 options for management

A

Shar pei (only!)

  1. Inscise lip mucosa at gingival margin
  2. Excise segment of skin on chin to pull lip margin ventrally
  3. Deepen rostarl and lateral vestibule
30
Q

What 3 lip tumours have been remorted in cats

A

SCC, fibrosarc and MCT

31
Q

What is met rate for canine oral malignant melanoma

And non-tonsillar SCC

And SCC in cats

A

Malignant melanoma: 12.9 - 59%
SCC: 0 - 37.5%

SCC in cats: 31%

32
Q

What is ankyloglossia

Which breed

A

Tongue tie

Anatolian shepherd

33
Q

What is second most common place for calcinosis circumscripta?

What % of cases occured here?

Tx:

A

Tongue (23%)

(hind feet most common)

Tx:

Only if clinical –> excision

34
Q

How is juvenile oral papillomatosis treated

And if adult

A

Wait 4-8 weeks - usually resolves

If adult - look for immunosupression. Dont excisie - liekly to come back.

Can try azithromycin and recombinant vaccine

35
Q

DDX for Burmese cat with pawing at mouth etc but no lesions to be found

Tx?

A

Feline oral pain syndrome

(precipitated by tooth eruption, oral lesions, environmental anxiety)

Tx: Pheno

36
Q

What are the three most common oral sites of neoplasia in dogs

And in cats

A

Dogs: Gingiva > tonsils and lips

Cats: Gingiva and tongue

37
Q

What % of feline oral tumours does SCC make up

A

70 - 80%

(61% of lingual tumours)

38
Q

What dog breeds are at risk of oral malignant melanoma?

And SCC

A

Maligant melanoma: Pigmented tongues; Chow chow, Shar Pei

SCC: White haircoat; Poodles, Lab, Samoyed. Females

39
Q

List 2 non-neoplastic ddx for oral lesion in cat

A
  • Eosinophilic granuloma
  • Plasmacytic stomatitis
40
Q

List 3 environmetal risk factors for development of feline oral SCC

A
  • Fed mainly canned food diet
  • Regular canned tuna
  • Wearing flea collars
41
Q

What % of malignant melanomas are amelanotic

A

33%

42
Q

What % of canine lingual neoplasia is malgnant

A

Almost all

(64 - 93%)

43
Q

For ligual tumours managed by excision, what was met rate and MST?

Malignant melanoma

SCC

A

Malignant melanoma:

  • 29% mets
  • 241d MST

SCC

  • 10-14% mets
  • 216d MST
44
Q

What is recommended margin for lingual tumur

What was recurrence rate in dogs undergoing glossectomy

A

>2cm

28%

45
Q

Define the different types of glossectomy

A
  • Partial glossectomy: excision or amputation of any portion, or all, of the oral (free) tongue rostral to the frenulum.
  • Subtotal glossectomy: removal of the entire free tongue and a portion of the genioglossus muscles, geniohyoid muscles, or both, caudal to the frenulum.
  • Near total glossectomy: resection of > 75% of the entire tongue.
  • Total glossectomy: Amputation or excision of the entire tongue
46
Q

What % of tongue resection is tolerated in dogs without need for any management modification

A

50%

47
Q

How can dogs with oral dysphagia be assisted

A

Raise bowl, deep bowl

(wont help for pharyngeal or cricopharyngeal dysphagia)

48
Q

List the three “classifications” of things causing 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
49
Q

Aside from surgeyr, name a reported method for retrieval of penetrating stick FBs

A

Rigid endoscopy

50
Q

List 5 non-neoplastic causes of enlarged tonsils

A
  • Primary tonsillitis
  • Chronic antigenic stimulation
  • BOAS
  • Cleft palate
  • Periodontaldisease

And for mass lesion

  • Lymphangiomatous polyp
  • Cyst
51
Q

What is % metastasis in tonisllar SCC

A

73%

52
Q

Name a proposed risk factor for tonsiallr SCC development

A

Living in area of higher atmospheric pollution

53
Q

Aside from SCC, what other tonsillar neoplasias have been reported

A

Lymphoma

Melanoma

Adenocarcinoma

54
Q

What is MST in dogs with tonsillar SCC undergoing:

Tonsillectomy alone

Chemo +- surgery

Chemo + and radiation +- surgery

A
  • Tonsillectomy alone: 2-5 months
  • Chemo +- surgery: 7 months
  • Chemo + and radiation +- surgery: 12 months
55
Q

Name an approach for exploration of pterygoid muscle

A

Paramedian submandibular approach (Gettinger, JAAHA, 2017)

I.e. ventral approach medial to mandible, digastricula laterally, cut myelohyoid, avoid penetration of oral mucosa and reach pterygoid

56
Q

What is normal intramuscular compartmental pressure in dogs?

When is fasciotomy recommended?

A

Normal -4 - 0 mmHg

Fasciotomy if within 30 mmHg of diastolic BP

57
Q
A

7: Digestive System (12 decks)

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