Exam III: Respiratory and Ear Surgery, Reconstruction, and Laparoscopy Flashcards
Surgery, Dental, Opthalmology
What are the primary components of brachycephalic obstructive airway syndrome?
- Stenotic Nares
- Elongated (+/- thickened) Soft Palate
- Everted Saccules
- Hypoplastic Trachea
- Aberrant Nasal Turbinates
- Laryngeal Collapse
- Redundant Pharyngeal Folds
- Everted Tonsils
- Macroglossia
Primary components that characterize brachycephalic obstructive airway syndrome.
What are the secondary components of brachycephalic obstructive airway syndrome?
- GI disease
- Regurgitation
- Sliding Hiatal Hernias
- Gastritis
- Inflammatory GI Disease inflammation
Secondary components that may occur alongside the primary ones.
Which components of brachycephalic obstructive airway syndrome are most commonly treated surgically?
- Elongated soft palate
- Stenotic nares
These components are often targeted for surgical intervention.
What surgeries are contraindicated for the surgical treatment of brachycephalic obstructive airway syndrome?
- Sacculectomy
- Tonsillectomy
Sacculectomy comes with major complications, while tonsillectomy does not significantly improve breathing quality.
What is a reason why dogs with brachycephalic obstructive airway syndrome can present with gastrointestinal signs?
The work it takes to breathe and aspiration pneumonia from a poorly working airway
These factors can lead to gastrointestinal symptoms.
What is the ideal time to surgically treat dogs with brachycephalic obstructive airway syndrome?
Early
Early intervention is recommended for better outcomes.
What anatomic landmarks are used to determine if the soft palate is an appropriate length?
Soft palate should barely touch epiglottis
This assessment is crucial in determining the need for surgical intervention.
How do you prevent laryngeal collapse in dogs with brachycephalic obstructive airway syndrome?
Treat the treatable, elongated soft palate and stenotic nares
Proper treatment of these conditions can prevent laryngeal collapse.
What are the most common causes of laryngeal paralysis?
Congenital, Central neurologic lesion, Acquired (Trauma, Compressive masses, Iatrogenic, Polyneuropathy), Idiopathic polyneuropathy is the main cause
Breeds commonly affected include husky, bouvier de flandres, rottweiler, dalmatian.
What nerve is primarily affected in laryngeal paralysis?
Recurrent laryngeal nerve
Multiple nerves can be affected, but this nerve specifically impacts the larynx.
Name the important anatomic structures involved in laryngeal paralysis.
- Larynx
- Thyroid cartilage
- Arytenoid cartilage
- Cricoid cartilage
Surgery is typically performed caudal to the larynx.
What is the common surgical treatment for laryngeal paralysis?
(Unilateral) Arytenoid lateralization, also called ‘tie-back’
This procedure helps to alleviate airway obstruction.
What are two clinical presentations for dogs with laryngeal paralysis?
- Inspiratory stridor
- Upper airway sounds
- Cough
- Hyperthermia
- Abnormalities on neuro exam
Signs may include gag reflex, muscle wasting, weakness, CP deficits in pelvic limbs, cranial tibial muscle atrophy.
What routine diagnostic workup is recommended for laryngeal paralysis?
- Routine blood work
- Endocrine Function tests
- Thoracic Radiographs
- +/- Esophagram
Routine blood work may show WBC elevation due to pneumonia and tests for hypothyroidism are common.
What is the prognosis for laryngeal paralysis?
Good to excellent results unless a permanent tracheostomy is required
Risk factors include aspiration pneumonia, suture failure, and seroma.
What complications can arise from cricoarytenoid lateralization?
Over abduction can cause aspiration pneumonia
The risk of aspiration pneumonia exists regardless of procedure.
What increases the risk of post-op complications in laryngeal paralysis?
Pre-op pneumonia increases risk by 2.75 times
Other potential complications include pulmonary edema and mediastinal masses.
Fill in the blank: The main cause of laryngeal paralysis is _______.
Idiopathic polyneuropathy
True or False: Laryngeal collapse is a common differential diagnosis for laryngeal paralysis in all breeds.
False
Laryngeal collapse is unlikely in certain breeds and is lower on the differential list for labs.
What is the composition of the external ear canal?
The external ear canal is composed of the pinna
The pinna is the outer part of the ear that helps capture sound.
What are common injuries of the pinna?
Common injuries of the pinna include:
* Aural hematoma
* Wounds of the pinna
* Lacerations
Aural hematomas occur due to blood accumulation between the cartilage and skin.
What are the conservative treatment options for aural hematomas?
Conservative treatments include:
* Aspiration
* Steroid injection
Advantages include no anesthesia, outpatient treatment, and no ear disfigurement.
What are the advantages of surgical treatment for aural hematomas?
Advantages include:
* Easy clot removal
* Low recurrence
* Bandage for 48 hours
Surgical treatment involves incision, drainage, and suture.
What are the disadvantages of surgical treatment for aural hematomas?
Disadvantages include:
* Anesthesia required
* Potential scar
* Possible deformity
An erect ear may become floppy after surgery.
What is the occurrence rate of malignant tumors in neoplasia of the external ear canal?
88% of tumors are malignant
Neoplasia occurs more frequently in unilateral cases than bilateral.
What are the indications for surgery in cases of infection in the external ear canal?
Indications for surgery include:
* Medical therapy failed
* Aural integument irreversibly diseased
* Development of cutaneous fistulas
* Par-aural abscess
* Otitis media or otitis interna
Surgery may involve lateral wall resection and possible ventral bulla osteotomy.
What is the success rate of total ear canal ablation (TECA-LBO) in dogs?
90-95% success rate in dogs
TECA-LBO is indicated for chronic disease and end-stage external ear disease.
What are the potential complications associated with total ear canal ablation?
Complications primarily in cats include:
* Facial nerve paralysis (56%, 28% permanent)
* Horner syndrome (42%, 14-27% permanent)
Complications are less common in dogs.
What is the main difference between skin flaps and skin grafts?
Skin flaps have a blood supply, while skin grafts are free skin without vascular attachment
Skin grafts survive the first 48 hours by absorbing tissue fluid.
What are the types of subdermal plexus flaps?
Types include:
* Advancement
* Rotational
* Transposition
* Skin fold flaps
These flaps have terminal branches of direct cutaneous arteries.
What are the general principles of skin flap surgery?
Preserve the blood supply
This is essential for the viability of the flap.
What are some basic laparoscopic procedures that can be performed in general practice?
Basic laparoscopic procedures include:
* Biopsy (Liver, Pancreas)
* Ovariectomy
* Ovarian Remnant
* Cryptorchidectomy
Laparoscopy provides minimally invasive options for surgical intervention.
What are some advantages of laparoscopy?
Advantages include:
* Simple procedure
* Well tolerated
* Smaller incision
* Visualization/magnification
These benefits enhance surgical precision and recovery.
What are contraindications to laparoscopy?
Contraindications include:
* Hemodynamic instability
* Respiratory comorbidities
* Previous abdominal surgery/adhesions
* Diaphragmatic hernia
* Large abdominal mass
* Septic peritonitis
* Intra-abdominal malignancy
* Increased intracranial pressure
* Pregnancy
* Portal hypertension
* Coagulopathies
These conditions may increase risk during laparoscopic procedures.
What are common complications of laparoscopy?
Common complications include:
* Hemorrhage
* Equipment malfunctions
* Organ trauma
Hemorrhage is typically manageable, and spleen injuries are rare.
What techniques can be used for creating a capnoperitoneum?
Techniques include:
* Veress Needle
* Hasson Technique
* SILS port
These techniques facilitate the introduction of carbon dioxide into the abdominal cavity.
What are reasons for conversion from a laparoscopic procedure to an open procedure?
Reasons for conversion include:
* Time constraints
* Realized issues
Conversion may be necessary for patient safety.
