Head & Neck

Question 1

The blood supply to the pinna runes _____. why is this important to know?

Answer 1

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.

Question 2

true or false: when you have a pinna laceration, it’s quite easy for cosmetic restoration for erect ears

Answer 2

false. it is difficult or impossible for erect ears to stand up again after this trauma

Question 3

true or false: the perichondrium of the pinna holds suture well.

Answer 3

true

Question 4

how do you manage pinna lacerations?

Answer 4

basic wound management
close my primary intention if you can

Question 5

what is the general pathogenesis of aural hemotomas?

Answer 5

underlying issue –> head shaking and scratching –> burst blood vessels

Question 6

how do you treat aural hematoma?

Answer 6

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

Question 7

what is a feline inflammatory polyp? what is the typical signalment?

Answer 7

pedunculated non-neoplastic mass in the ear canal or nasopharynx

young cats (although can be any age)

Question 8

what are the C/S of feline inflammatory polyps?

Answer 8

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

Question 9

how do you diagnose feline inflammatory polyps?

Answer 9

imaging, endoscopy, histopath (!!!!)
also digital palpation if in the mouth

Question 10

how can you treat feline inflammatory polyps?

Answer 10

• 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

Question 11

what are the constituents of Horner’s syndrome?

Answer 11

miosis, ptosis, enopthalmos, protruding 3rd eyelid

eyelids closed, eye sunken, constricted pupil

Question 12

what are some complications of feline inflammatory polyp treatment?

Answer 12

Horner’s syndrome, vestibular syndrome, facial nerve paralysis, chronic otitis media and/or interna

recurrence of polyp also possible (less so with VBO)

Question 13

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?

Answer 13

neoplasia

Question 14

what are your surgical options for treating an end stage ear?

Answer 14

• lateral ear canal resection AKA Zepp procedure
• Vertical canal ablation
• total ear canal ablation and lateral bulla osteotomy (TECA-BO)
• Ventral bulla osteotomy (VBO)

Question 15

does McConkey like the lateral ear canal resection (Zepp) procedure?

Answer 15

nope. she can’t think of a good reason to do this surgery. the failure rate is >65%

Question 16

when would you perform a vertical canal ablation?

Answer 16

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

Question 17

when should you perform the TECA-BO?

Answer 17

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 ****

Question 18

true or false: the goal of the TECA-BO surgery is to help the owner not have to deal with stinky ears any more

Answer 18

false!!! it’s to improve patient QOL

Question 19

true or false: animals are deaf in the ear that received the TECA-BO

Answer 19

true… although they can probably still hear through bone conduction. just deaf to air waves

Question 20

what is a sialocele?

Answer 20

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)

Question 21

how do you diagnose a sialocele?

Answer 21

• pt is NON PAINFUL
• FNA of mass: viscous, honey coloured, clear or blood tinged fluid

Question 22

how do you treat a sialocele?

Answer 22

• surgical excision of offending gland and duct complete
• drainage alone unlikely to result in resolution… risk of asbcessation!

Question 23

congenital palate defects are typically surgically treated by age ____.

Answer 23

3-4mo

Question 24

acquired palate defects are usually surgically treated when?

Answer 24

after waiting for the injury to fully declare itself, slough, or for bare bone to granulate

Question 25

what is the main risk with a palate defect?

Answer 25

aspiration pneumonia

Question 26

what are some techniques for surgically fixing a palate defect?

Answer 26

overlapping flap, bipedicle flaps, labial based mucoperiosteal flap, split u-flap, combinations

Question 27

what is the goal of palate defect surgery?

Answer 27

closure of defect with well vascularized tissue and no tension

Question 28

what is the primary cause of oronasal fistulas?

Answer 28

caused by vet

or by loss of incisive or maxillary bone typically assoc with severe periodontal disease or tooth extraction

Question 29

what is the typical signalment/PE of an animal with hyperthyroidism?

Answer 29

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

Question 30

how do you diagnose hyperthyroidism?

Answer 30

C/S, hx, PE, measure T4 (will be high)

Question 31

which organs are most affected by hyperthyroidism?

Answer 31

heart and kidney

Question 32

true or false: surgery is the treatment of choice for hyperthyroidism

Answer 32

false. it used to be, but now it’s radioactive iodine

surgery still available but not done as much.

thyroidectomy

Question 33

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.

Answer 33

true. carcinomas are the ones that are found clinically even though they are rarer than adenomas

Question 34

what Is the prognosis of a dog with a thyroid tumor?

Answer 34

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

Question 35

you have a dog with hyperthyroidism. what is the most likely inciting cause?

Answer 35

thyroid carcinoma

Question 36

what helps determine the prognosis of a thyroid tumor in dogs?

Answer 36

mobility of mass.

more mobile = better prognosis