Digestive sys Flashcards
margins for tumors of maxilla / mandible?
○ at least 2 cm (preferably 3 cm) are recommended for malignant cancers (SCC, malignant melanoma, fibrosarcoma) in the dog.
○ If possible, mandibular SCC in the cat should be treated with surgical margins greater than 2 cm because of high local recurrence rates (Northrup et al. 2006).
○ If 3 cm margins are not possible without significant risk of morbidity, 1 cm margins of normal tissue beyond either the grossly visible tumor or the extent of the tumor as determined by imaging, whichever is greater, may be acceptable for malignant oral tumors and 0.5 cm margins for benign tumors (Syrcle et al. 2008).
sx considerations for maxi/mandibulectomy / sx planning
- minimum margins include:
○ 3 cm of bone rostral and caudal to the tumor, based on either gross palpation or preferably imaging findings
○ 1 cm of soft tissue (buccal, gingival, or palatine mucosa).- if there is no evidence of rostral mandibular tumors crossing the mandibular symphysis, then excision of the symphysis, including the contralateral middle incisor, should be sufficient
- Osteotomies bw teeth
- Closure: monofil abs, PDS recc
mm of mastication?
masseter, temporalis, pterygoids, digastricus
indications for rim mandibulecotmy? Murray 2010
Rim mandibulectomy is recommended for surgical excision of benign tumors confined to the alveolar margin of the mandible (Murray et al. 2010).
complications w mandibulecotmy?
mandibular drift
eating difficulties
incisional swelling /ranula
wound dehiscence
malloculsion
vessels encountered w maxillectomy?
○ major palatine and sphenopalatine arteries for rostral maxillectomies
○ infraorbital artery and maxillary artery for caudal maxillectomies
5 sx techs for maxillecotmy
incisivecctomy
rostral maxx - uni or bi
rostral max + nasal planecotmy
radical matxillectomy
caudal maxillecomty
bilateral caudal matxillectomy
revision options for maxillectomy dehiscence?
○ angularis oris axial pattern buccal flaps
○ advancement of skin flaps into the oral cavity
○ free microvascular grafts of the rectus abdominis muscle
○ free auricular cartilage autograft
insertion of a silicone nasal septal button
complications of glossectommy?
hemorrhage
dehiscennce
prehension difficultés
ptyalsim
tongue necrosis
heat stress
local recurrence
difficulty grooming (cats)
(Tuohy et al. 2014). found tumor size > X cm was associated with MST for MM?
tumor size > 3cm was prognostic with a median survival time of 874 days for melanomas < 3 cm 396 days for melanomas > 3 cm
diff in px for oral/gingival SCC vs tonsilar or tongue SCC?
- prognosis for dogs with oral SCC is good, particularly for rostral tumor locations. - mets in ~10%
- SCC of the tonsils and base of the tongue are highly metastatic, with metastasis reported in up to 73% of dogs, and local or regional recurrence is common
MST / survival rate for dogs w SCC untreated vs sx? Fulton 2013
○ MST for untreated dogs was 54 days with a 0% 1- year survival rate (Fulton et al. 2013). 2 MONTHS!!!
○ In comparison, the 1- year survival rate for dogs with surgically excised oral SCC was 94%
oral FSA px?
guarded
locally aggressive and local control more problematic than mets
mets inn <20% dogs
local recc in 59% w mandib & 40% w maxillectommy
RT resistant
poor px factors for dogs w/ mandibular/max or calvarial OSA?
○ ALP > 140 U/L
○ increased monocyte counts
○ telangiectatic histologic subtype
○ mitotic index
○ histologic grade
local tumor recurrence
layers of esophagus
○ Mucosa
○ Submucosa
○ Muscularis
○ adventitia (NOT serosa)
BS to esophagus? (cervical, thoracic, abdominal?)
○ Segmental BS
○ Cervical esophagus – cranial /caudal thyroid aa
○ Thoracic esophagus – bronchoesophageal and dorsal intercostal aa+ esophageal br of aorta
○ Abdominal esophagus – L gastric aa
structures to avoid near cervical esophagus?
carotid sheath, recurrent laryngeal nerves, thyroid glands, and parathyroid gland
ICS for caudal esophagus vis cranial esophagus?
cranial esophagus – Left 3-4 or right 3-5
caudal esophagus– left 7-9
2 options for esophageal support (help w healing)
esophageal myotomy
esophageal patching
factors contributing to complications w esophageal healing
lack of sserosa
tension
segmental BS
lack of omentum
constant peristalssis
continual bathing of incision w food/water
o In a study of 245 cases of salivary gland disease, cats were shown to have a higher prevalence of XXX salivary gland tumors than dogs (Spangler 1991)
what was the prevalence
1.6times greater
approaches for zygomatic sialoadenecotmy?
intraoral approach
lateral approach w zygomatic osteotomy
lateral approach w/o osteotomy (dorsal or ventral)
- Bush et al, vet surg 2023. Outcomes and clinical features associated with surgically excised canine salivary gland carcinoma: A mulit-institutional, retrospective, VSSO study.
most common glands affected?
MST in this study vs Hammer 2001 study?
o Most common glands = mandibular/sublingual 54.2%; Parotid 38.9%
o overall MST associated with salivary carcinoma was 1886 days. /5y
previously reported 550 days (Hammer 2001)
- Manzoni et al, JSAP 2023. Preoperative computed tomography, surgical treatment and long term outcomes of dogs with abscesses on migrating vegetal foreign bodies and orophayngeal stick injuries: 39 cases (2010-2021)
most freq isolated bacteria?
o Pasteurella multocida
- Castejon-Gonzalez, JAVMA 2023. Surgical treatment for cleft palate in dogs yields excellent outcomes despite high rates of oronasal fistula formation: a narrative review
recc age for sx? if defect is large then which age recc?
recc age is 4mo
if defect too large or std tech / larger flaps needed then delay until 7-8mo
- Treggiari et al, JVIM 2023. Tonsillar carcinoma in dogs: treatment outcome and potential prognostic factors in 123 cases
positive prognostic factors?
overall survival time ?
o positive prognostic factors –absence of clinicals signs at presentation, surgery (tonsillectomy), use of adjuvant chemotherapy and use of NSAIDs.
o OST was 126 days (4mo) – Significantly longer survival was seen in dogs without evidence of metastatic disease (MST 381 days)
- Bobis-Villagra, JFMS 2022. Feline sialocoele: clinical presentation, treatment and outcome in 19 cases
most common gland affected and resolution rate w/ sx?
mandibular–sublingual salivary gland–duct complex was the most frequently involved.
o Surgical excision=complete resolution of CS
- Cinti et al. Vet surg 2021. Complications between ventral and lateral approach for mandibular and sublingual sialoadenectomy in dogs with sialocele
recurrence rates bw lateral approach vs ventral? which had more complications?
o Recurrences were more likely after LAT approach (7%) vs ventral (0%) but wound-related complications were more likely after VPM approach (28%)
- Arzi et al, JAVMA 2023. Contemporary management of temporomandibular joint fractures in dogs and cats: review and expert insights on diagnostic imaging, treatment strategies and long term outcomes
indications for open tx?
severe / displaced fx of mandibular fossa+/-condylar process preventing closure / opening of the mouth OR displacement of the condylar process into the auditory system
- Cray et al, JAVMA 2022. Analysis of risk factors associated with complications following mandibulectomy and maxillectomy in dogs
what 3 factors were associated with inc complications?
sx time, preop RT or chemo, & matxillectomy
tx options for lower esophageal sphincter achalasia-like syndrome (3)
mechanical dilation, functional dilation with botulinum toxin A (BTA) injections, and modified Heller myotomy with Dor fundoplication
- Beer et al, JAVMA 2022. Complications associated with and outcomes of surgical intervention for treatment of esophageal foreign bodies in dogs
% of dogs w/ esophageal perf on presentation?
survival to discharge rate?
factors associated with w non survival?
o Esophageal perforation=66% dogs
75% =survived to discharge
o nonsurvival =esophageal perforation, undergoing a thoracotomy, and whether a gastrostomy tube was placed
- Vangrinsven et al, JSAP 2021. Diagnosis and treatment of gastroesophageal junction abnormalities in dogs with brachycephalic syndrome
main conclusion?
beneficial effect of antacid treatment on the improvement of digestive clinical signs and lesions