Head And Neck Surgery Flashcards
In what breeds do you more commonly see lip fold pyoderma in?
Pendulous lipped breeds
- spaniels, retrievers, setters
Why are lip fold pyoderma usually located on the lower lip?
Have a lower lip frenulum (skin fold) that traps moisture and allows dermatitis to develop
What is the treatment for lip fold pyoderma?
Conservative management
Surgical resection
What is a labial avulsion?
Shearing trauma (usually to lower lip) along the mucogivival line that leaves very little soft tissue for reattachment
Treatment for labial avulsion?
Suture reconstruction is usually effective for maxillary lesions
Lower lip with suture reconstruction often fails because of..
— limited soft tissue to suture on gingival side
—edema and swelling of lip increases weight
— suture subjected to movement, etc, when eating and drinking
** esp with bilateral injury**
How will you reconstruct a bilateral labial avulsion on the lower jaw?
Place interdental stent sutures to support the weight of lip
Suture mucogingival junction at interdental papillae between teeth
If involving the body of mandible.. may need suture through the mandible but avoid tooth roots
What must you take into consideration before doing a lip reconstruction?
Species/breed differences
Location and size — proximity to mucocuteanous junction
How will you suture a lip reconstruction to avoid step deformity?
Start suturing at the lip margin with a figure of eight pattern— apposes margins and avoids mucosal inversion
What are options for reconstruction of the lip?
Direct apposition
Labial advancement flap
Labial rotation flap
What is the most common disorder of the salivary gland? Is it a surgical disorder
Mucocele
YES it is surgical — removal is the only definitive treatment for mucoceles
There are several causes of salivary gland enlargement.. which of the following conditions will NOT benifit from surgical removal?
Sialadenitis
Sialadenosis
Necrotizing sialometaplasia
Sialadenosis —> signs often persists because it is a neurological disorder, responds to phenobarbital therapy
How can you tell sialadenosis from necrotizing sialometaplasia?
Both have similar signs.. retching, gulping, lip smacking, hypersalivation, and poor appetite
Necrotizing sialometaplasia is a painful enlargement
Both disorders can benefit from phenobarbital therapy but necrotizing may need gland excision
Your patient has siladentitis.. clinical signs include fever, depression, and painful swollen salivary glands
What are possible therapies?
Abcessaiton can cause acute and severe pain
Drainage
Removal of gland
What are the 4 major salivary glands in the dog? What additional one is in cat?
Parotid
Mandibular
Sublingual
Zygomatic
Cat also has a molar salivary glland
On physical exam, you find a nonpainful fluctuant swelling of the sublingual gland. What do you suspect this is?
Mucocele
On physical exam you find a swelling and enlarged sublingual gland. What do you suspect this is?
Primary gland disorder
On physical exam you find a swelling and enlarged sublingual gland. How will you diagnose this lesion?
Decompress mucocele?
Confirm substance is saliva
Cytology to rule out infection/neoplasia
Culture and sensitivity if infection is present
What is a salivary mucocele?
Accumulation of saliva within a nonepitheial, nonsecretory lining
What are the most common locations of a salivary mucocele??
Cervical mucocele (most common)
Ranula => sublingual (submucosal) swelling
Pharyngeal == can cause respiratory distress and dysphagia (less common presentation but imp DDX for patients with pharyngeal mass)
What are clinical signs of a zygomatic salivary gland mucocele?
What other ddx would you have for these clinical signs?
Consistent with retrobulbuar disease — exopthalamus, protrusion of 3rd eyelid, subconjunctival saliva
Retrobulbar cellulitis/ abscess but usually not painful
What are possible treatments for salivary mucocele and what is the only definitive treatment?
Surgical removal of gland (definative, except for parotid)
Percutaneous aspiration of accumulated saliava in combo with above
Marsupialization of ranula (salvage procedure)
Lancing pharyngeal mucocele
Prior to definitive surgery to relieve respiratory distress
T/F: sublingual and mandibular salivary glands are always removed together
True
The gland and ducts are too close together to only remove one of them
What is the definitive surgical treatment for cervical mucocele, ranula, or pharyngeal mucocele of sublingual gland?
Sublingual salivary gland adenectomy
What is the traditional approach to excision of the salivary and mandibular salivary glands?
Incision under ramus of mandible and then extending back over the sublingual gland, between the jugular and the linguofacial veins
What is the alternative approach to excision of the sublingual and mandibular salivary glands?
Ventral under the chin along the inner mandible, across the diagastricus muscle and and casually across the gland
You had a salivary mucocele with a cervical presentation. You removed the sublingual and mandibular glands… do you now also remove the mucocele?
No
— can drain contents but will resolve once the affected gland is removed
What is the prognosis for a salivary mucocele?
Excellent
Recurrence is less than 5%
Why can you have recurrence of salivary mucocele?
Inadequate excision
Operation on wrong side :O
Removed wrong structure :O
What are the treatment options for a parotid sialocele/fistula
Ligation of parotid duct proximal to defect —> atrophy of the gland
Excision of gland if duct injury cannot be isolated or involves gland directly — technically challenging
