Head & Neck Flashcards
The blood supply to the pinna runes _____. why is this important to know?
vertically
be careful not to place things (sutures) transversely that could cut off circulation and cause ischemic necrosis. place sutures vertically so that they run in line with vessels.
true or false: when you have a pinna laceration, it’s quite easy for cosmetic restoration for erect ears
false. it is difficult or impossible for erect ears to stand up again after this trauma
true or false: the perichondrium of the pinna holds suture well.
true
how do you manage pinna lacerations?
basic wound management
close my primary intention if you can
what is the general pathogenesis of aural hemotomas?
underlying issue –> head shaking and scratching –> burst blood vessels
how do you treat aural hematoma?
Medically:
- aseptic prep, drain, aural or oral steroids (prednisone)
- can also just leave as long as you address underlying condition –> will fibrose and contract
Surgically: (gold standard)
- serpentine incision on inside of pinna, drain, flush, interrupted mattress sutures placed on either side of incision (vertically) in staggered rows
- could also just amputate pinna (extreme option)
ALWAYS REMEMBER TO ADDRESS THE UNDERLYING ISSUE OF WHY THE HEMATOMA FORMED IN THE FIRST PLACE
what is a feline inflammatory polyp? what is the typical signalment?
pedunculated non-neoplastic mass in the ear canal or nasopharynx
young cats (although can be any age)
what are the C/S of feline inflammatory polyps?
chronic and progressive C/S
aural: otitis externa, head shaking, otorrhea (waxy to purulent), visualize polyp in ear (expanded beyond a ruptured tympanic membrane and otitis media also present), neuro signs/inner ear involvement (Horner’s syndrome, etc)
nasopharyngeal: nasal d/c, stertor, reverse sneezing, sneezing
how do you diagnose feline inflammatory polyps?
imaging, endoscopy, histopath (!!!!)
also digital palpation if in the mouth
how can you treat feline inflammatory polyps?
- traction/avulsion of polyp (yank it out) + anti-inflammatory steroids [better for nasopharyngeal]
- per-endoscopic transtympanic traction with curettage of remaining tissue via endoscope guidance
- CO2 laser ablation (not really used)
- open sx removal via ventral bulla osteotomy (VBO) [treatment of choice]
listed from highest to lowest recurrence rates
what are the constituents of Horner’s syndrome?
miosis, ptosis, enopthalmos, protruding 3rd eyelid
eyelids closed, eye sunken, constricted pupil
what are some complications of feline inflammatory polyp treatment?
Horner’s syndrome, vestibular syndrome, facial nerve paralysis, chronic otitis media and/or interna
recurrence of polyp also possible (less so with VBO)
with an end stage ear, you’re doing a PE. you notice ear d/c that appears mostly bloody. what should your highest suspicion be for dx?
neoplasia
what are your surgical options for treating an end stage ear?
- lateral ear canal resection AKA Zepp procedure
- Vertical canal ablation
- total ear canal ablation and lateral bulla osteotomy (TECA-BO)
- Ventral bulla osteotomy (VBO)
does McConkey like the lateral ear canal resection (Zepp) procedure?
nope. she can’t think of a good reason to do this surgery. the failure rate is >65%
when would you perform a vertical canal ablation?
disease in the vertical canal when the horizontal canal is relatively healthy.
rarely performed
need advanced imaging to determine where the disease is and to make sure that disease is exclusively in vertical canal
when should you perform the TECA-BO?
irreversible inflammatory ear canal disease. McConkey said “don’t hesitate to recommend this surgery”
it is the surgery of choice for treating chronic end stage otitis externa ****
true or false: the goal of the TECA-BO surgery is to help the owner not have to deal with stinky ears any more
false!!! it’s to improve patient QOL
true or false: animals are deaf in the ear that received the TECA-BO
true… although they can probably still hear through bone conduction. just deaf to air waves
what is a sialocele?
salivary mucocele. soft, non-painful swelling that results from the leakage of saliva into the tissues that surround a salivary gland or salivary duct. can occur in several areas, but most commonly in the neck or between the lower jaws (cervical cialocele) or under the tongue (ranula or pharyngeal sialocele)
how do you diagnose a sialocele?
- pt is NON PAINFUL
- FNA of mass: viscous, honey coloured, clear or blood tinged fluid
how do you treat a sialocele?
- surgical excision of offending gland and duct complete
- drainage alone unlikely to result in resolution… risk of asbcessation!
congenital palate defects are typically surgically treated by age ____.
3-4mo
acquired palate defects are usually surgically treated when?
after waiting for the injury to fully declare itself, slough, or for bare bone to granulate
what is the main risk with a palate defect?
aspiration pneumonia
what are some techniques for surgically fixing a palate defect?
overlapping flap, bipedicle flaps, labial based mucoperiosteal flap, split u-flap, combinations
what is the goal of palate defect surgery?
closure of defect with well vascularized tissue and no tension
what is the primary cause of oronasal fistulas?
caused by vet
or by loss of incisive or maxillary bone typically assoc with severe periodontal disease or tooth extraction
what is the typical signalment/PE of an animal with hyperthyroidism?
older cat
polyphagia, weight loss, PU/PD, increased activity and restlessness, GI signs
palpable nodule in throat –> usually benign thyroid tumor, but sometimes thyroid carcinoma… usually bilateral
how do you diagnose hyperthyroidism?
C/S, hx, PE, measure T4 (will be high)
which organs are most affected by hyperthyroidism?
heart and kidney
true or false: surgery is the treatment of choice for hyperthyroidism
false. it used to be, but now it’s radioactive iodine
surgery still available but not done as much.
thyroidectomy
true or false: the most common thyroid tumor of dogs is thyroid adenoma, but these are not visible clinically so are often found incidentally on necropsy.
true. carcinomas are the ones that are found clinically even though they are rarer than adenomas
what Is the prognosis of a dog with a thyroid tumor?
most thyroid tumors found clinically in dogs are carcinomas, and up to 40% have mets at time of diagnosis. up to 80% will develop mets during course of disease… so not good
you have a dog with hyperthyroidism. what is the most likely inciting cause?
thyroid carcinoma
what helps determine the prognosis of a thyroid tumor in dogs?
mobility of mass.
more mobile = better prognosis
