Head And Neck Surgery

Question 1

In what breeds do you more commonly see lip fold pyoderma in?

Answer 1

Pendulous lipped breeds

- spaniels, retrievers, setters

Question 2

Why are lip fold pyoderma usually located on the lower lip?

Answer 2

Have a lower lip frenulum (skin fold) that traps moisture and allows dermatitis to develop

Question 3

What is the treatment for lip fold pyoderma?

Answer 3

Conservative management

Surgical resection

Question 4

What is a labial avulsion?

Answer 4

Shearing trauma (usually to lower lip) along the mucogivival line that leaves very little soft tissue for reattachment

Question 5

Treatment for labial avulsion?

Answer 5

Suture reconstruction is usually effective for maxillary lesions

Question 6

Lower lip with suture reconstruction often fails because of..

Answer 6

— 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**

Question 7

How will you reconstruct a bilateral labial avulsion on the lower jaw?

Answer 7

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

Question 8

What must you take into consideration before doing a lip reconstruction?

Answer 8

Species/breed differences

Location and size — proximity to mucocuteanous junction

Question 9

How will you suture a lip reconstruction to avoid step deformity?

Answer 9

Start suturing at the lip margin with a figure of eight pattern— apposes margins and avoids mucosal inversion

Question 10

What are options for reconstruction of the lip?

Answer 10

Direct apposition
Labial advancement flap
Labial rotation flap

Question 11

What is the most common disorder of the salivary gland? Is it a surgical disorder

Answer 11

Mucocele

YES it is surgical — removal is the only definitive treatment for mucoceles

Question 12

There are several causes of salivary gland enlargement.. which of the following conditions will NOT benifit from surgical removal?

Sialadenitis
Sialadenosis
Necrotizing sialometaplasia

Answer 12

Sialadenosis —> signs often persists because it is a neurological disorder, responds to phenobarbital therapy

Question 13

How can you tell sialadenosis from necrotizing sialometaplasia?

Answer 13

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

Question 14

Your patient has siladentitis.. clinical signs include fever, depression, and painful swollen salivary glands

What are possible therapies?

Answer 14

Abcessaiton can cause acute and severe pain

Drainage
Removal of gland

Question 15

What are the 4 major salivary glands in the dog? What additional one is in cat?

Answer 15

Parotid

Mandibular

Sublingual

Zygomatic

Cat also has a molar salivary glland

Question 16

On physical exam, you find a nonpainful fluctuant swelling of the sublingual gland. What do you suspect this is?

Answer 16

Mucocele

Question 17

On physical exam you find a swelling and enlarged sublingual gland. What do you suspect this is?

Answer 17

Primary gland disorder

Question 18

On physical exam you find a swelling and enlarged sublingual gland. How will you diagnose this lesion?

Answer 18

Decompress mucocele?

Confirm substance is saliva
Cytology to rule out infection/neoplasia

Culture and sensitivity if infection is present

Question 19

What is a salivary mucocele?

Answer 19

Accumulation of saliva within a nonepitheial, nonsecretory lining

Question 20

What are the most common locations of a salivary mucocele??

Answer 20

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)

Question 21

What are clinical signs of a zygomatic salivary gland mucocele?

What other ddx would you have for these clinical signs?

Answer 21

Consistent with retrobulbuar disease — exopthalamus, protrusion of 3rd eyelid, subconjunctival saliva

Retrobulbar cellulitis/ abscess but usually not painful

Question 22

What are possible treatments for salivary mucocele and what is the only definitive treatment?

Answer 22

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

Question 23

T/F: sublingual and mandibular salivary glands are always removed together

Answer 23

True

The gland and ducts are too close together to only remove one of them

Question 24

What is the definitive surgical treatment for cervical mucocele, ranula, or pharyngeal mucocele of sublingual gland?

Answer 24

Sublingual salivary gland adenectomy

Question 25

What is the traditional approach to excision of the salivary and mandibular salivary glands?

Answer 25

Incision under ramus of mandible and then extending back over the sublingual gland, between the jugular and the linguofacial veins

Question 26

What is the alternative approach to excision of the sublingual and mandibular salivary glands?

Answer 26

Ventral under the chin along the inner mandible, across the diagastricus muscle and and casually across the gland

Question 27

You had a salivary mucocele with a cervical presentation. You removed the sublingual and mandibular glands… do you now also remove the mucocele?

Answer 27

No

— can drain contents but will resolve once the affected gland is removed

Question 28

What is the prognosis for a salivary mucocele?

Answer 28

Excellent

Recurrence is less than 5%

Question 29

Why can you have recurrence of salivary mucocele?

Answer 29

Inadequate excision

Operation on wrong side :O

Removed wrong structure :O

Question 30

What are the treatment options for a parotid sialocele/fistula

Answer 30

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