Jane's 5 point oral surgery articles Flashcards
1
Q
Tuohy JL, Selmic LE, Worley DR, Ehrhart NP, Withrow SJ. Outcome following curative-intent surgery for oral melanoma in dogs: 70 cases (1998-2011). Journal of the American Veterinary Medical Association. 2014;245(11):1266.
A
- Retrospective of oral melanoma treated at CSU with surgery +/- adjuvant therapies, goal was to evaluate progression free interval and survival time
- Information gathered included signalment, oral location of tumor, staging results, type of surgery, type of adjuvant therapy, findings on histologic evaluation, and outcome.
- There is no supporting evidence to suggest that there are oral cavity location differences in biological behaviors of oral melanoma in dogs
- The overall median PFI (508 days or 16 months) and the overall median ST (723 days or 23 months) in this retrospective series were longer than what have been previously reported
- In this study, dogs that had surgery as the sole treatment had a longer-than-expected PFI (>567d or 18.5 months, median not reached) and median ST (874d or 28 months).
- Administration of adjuvant treatment INCREASED risk of progression by 2.3x (also stated as increased by 130%) (other significant factors were presence of mets at diagnosis, higher tumor stage and increased tumor size >3cm) – suspect adjuvant rel’d to selection bias – worse cases got adjuvant therapy
- Presence of metastasis at time of diagnosis INCREASED risk of death by 3.8 times (also stated as increased by 280%)
2
Q
Clinical, Histologic, and Computed Tomographic Features of Oral Papillary Squamous Cell Carcinoma in Dogs: 9 cases (2008 – 2011)
Jason W. Soukup, DVM; Christopher J. Snyder, DVM; Betsie T. Simmons, DVM; Marie E. Pinkerton, DVM; Ruthanne Chun, DVM
A
- Prognosis is very good to excellent – wide surgical excision appears to be curative and no metastases in any of the dogs seen. 1 dog died of aspiration secondary to an ONF, but one dog treated with piroxicam and no sx was stable at 26 months
- The most common CT features were:
- 1) visible mass lesion (100%),
- 2) osteolysis +/- osteoproliferation (75%)
- 3) contrast enhancement of the mass lesion (75%),
- 4) regional ymphadenomegaly (62.5%)
- Histologic features found in all cases included
well differentiated stratified squamous epithelium arranged in surface papillary structures and broad anastomosing trabeculae, with prominent acanthosis and orderly maturation from basal to apical layers
- Other features included exophytic and/or endophytic papillary growth patterns, simple versus complex papillary structures,
- abrupt transition from normal gingival epithelium,
- lakes of neutrophilic inflammation +/- acantholysis within the neoplastic epithelium, and
- All tumors lacked keratin pearls and only 3 cases had keratinization, which was limited to scant superficial parakeratosis
- Most lesions were located in the rostral maxilla, trauma may play a role.
3
Q
Soukup JW, Mulherin BL, Snyder CJ. Prevalence and nature of dentoalveolar injuries among patients with maxillofacial fractures. Journal of Small Animal Practice. 2013;54(1):9-14.
A
- Retrospective of 43 dogs and cats with maxillofacial trauma and looking at the prevalence of TDI’s in that population; Attempted to quantify the number of TDI’s in patients with maxillofacial trauma and look for association between type of trauma and injury
- Cause
- Altercation with another animal – 35%
- Unknown – 23%
- MVA – 16%
- More likely to have TDI’s if the trauma was from a MVA or hit by an object (100%) than an altercation with another animal
- Trauma locations/injuries
- 72% had lower third (mandible anywhere)
- In general, the location of the MF fracture predicted the location but not the nature of the concurrent DAI.
- 72% had concurrent DAI, most has 1-2, some four or more
- Most common injuries
- Root fracuture (30%)
- Crown Fracture (29%)
- Mandibular teeth more commonly affected (55%)
- Mandible most common: Root fractures, displacements and concussions
- Maxilla most common: Crown fractures, and avulsions
- Most affected tooth group were incisors in the maxilla and molars in the mandible
4
Q
Comparison of Dorsal and Buccal Approaches for Surgical Extraction of the Mandibular Canine Tooth in Cat specimens Using Radiographic and Computed Tomographic Analysis
Amy J. Somrak, MBA, DVM; Stephen Joslyn, BVMS, MRCVS; David J. Schaeffer, PhD; Sandra Manfra Marretta, DVM; Jodi Matheson, DVM
A
- Cadaveric study in 12 cats to compare time to extract and volume of bone removed with CT using 2 approaches to the mandibular canine tooth – dorsal and buccal
- NO significant difference in overall surgery time (extraction plus closure), but closure was quicker for the dorsal approach
- NO significant difference in volume of hard tissue removed between the two approaches
- No complications seen. Either approach is acceptable, but dorsal approach will not be supported by bone
5
Q
Successful Treatment of Mandibular Nonunion With Cortical Allograft, Cancellous Autograft, and Locking
Titanium Miniplates in a Dog
Christopher J. Snyder, DVM, DAVDC1, Jason A. Bleedorn, DVM, DACVS2,
and Jason W. Soukup, DVM, DAVDC1
A
- Case report describing a methodology for treating defect non-union following mandibular fracture and failed repair attempt with intraosseous wires
- Used 2 miniplates, 2mm locking, cortical strut and an autograft of corticocancellous bone from the ulna – this gives a degree of structural stability not seen with other repairs
- Relies on the process of ‘creeping substitution’ whereby the graft is remodeled and replaces with host bone over time
- Recommend using only on small to medium defects, as larger defects may not heal as reliably
- Implant usually not removed, but removed per O request (O of attacking dog was paying, so they wanted to remove possibility of future complications they would have to pay for), and done gradually to increase load sharing between segments
6
Q
Assessment of the Role of the Mandibular First Molar Tooth in Mandibular Fracture Patterns of 29 Dogs
Ellen Scherer, DVM1, Scott Hetzel, MS2, and Christopher J. Snyder, DVM, DAVDC1
A
- Retrospective analysis of mandibular fractures in the M1 region, characterizing the fractures in 2 planes, and using the maretta schloss system for looking at the involvement of the roots
- The mesial root was involved in 10 (34.5%) fractures, and the distal root was involved in 16 (55.2%) fractures – NSD
- Fractures tended to occur in a caudoventral (unfavourable) direction (52% - not significant) in the dorsoventral plane and in the caudolingual direction (60%) in the buccolingual plane (THIS WAS SIGNIFICANT)
- Maretta/Schloss
- type A fracture patterns occurred significantly more often in either mesial (P < .001) or distal roots (P < .001), while no instances of type C or E patterns occurred in either root
- Patient population was average 2 years, fewer MVA and hit by object than other studies, and hence fewer comminuted fractures (tend to be caused by impact with force. Most common cause was altercation with another animal
7
Q
Morphological evaluation of clefts of the lip, palate, or both in dogs
Santiago Peralta dvm Nadine Fiani bvsc Kimi H. Kan-Rohrer bsdh Frank J. M. Verstraete dr med vet, bvsc, mmedvet
A
- Retrospective of clefts (32 cases – 5 lip, 23 palate, 4 both) where a CT or CBCT performed. Classified in each dog as CL, CP, or CLP; Anatomic forms of the clefts were also characterized by use of the LAHSHAL classification system – subcategorized by * for microform or submucous defect; Overall shape also recorded
- Cleft palate:
- equivalent brachycephalic and mesaticephalic;
- 48% are moderate width (25-50% of the palate);
- most common shape is pyriform (43%);
- vomer malformed in 74%;
- 2 LAHSHAL forms represented
- Cleft lip and palate:
- all brachycephalic;
- 3/4 moderate;
- alveolar clefts always b/w I2 and I3;
- shape of cleft most commonly pyriform;
- all had malformed vomer, deviated teeth and/or retained deciduous in all, as were non-fused incisivomaxillary and vomeroincisive sutures;
- all distinct LAHSHAL types
- Cleft Lip:
- 4/5 brachycephalic;
- All alveolar clefts were between the second and third incisor teeth;
- 1 abnormal vomer; deviated teeth and/or retained deciduous in all, as werewere nonfused incisivomaxillary and vomeroincisive sutures;
- 3 distinct LAHSHAL types
- OVERALL: LAHSHAL classification doesn’t account for severity; more malformed Vomers in CP and CLP, but not CL; Incisive abnormalities in CL and CLP but not in CP; Four of the 5 unilateral clefts of the lip and alveolus in the study dogs were on the left side consistent with reports in people – palatal shelf on the left elevates later in embryology; CL and CLP may be associated with brachycephalism, but not necessarily CP
8
Q
Nemec A, Murphy BG, Jordan RC, Kass PH, Verstraete FJM. Oral Papillary Squamous Cell Carcinoma in Twelve Dogs. Journal of Comparative Pathology. 2014;150(2-3):155-161.
A
- UC davis retrospective on papillary SCC; 12 cases in 22 years
- Oral PSCC exhibits a predominantly papillary growth pattern, with thin fibrovascular stalks covered by neoplastic basaloid cells with a low mitotic index and localized neoplastic invasion into the adjacent stroma or subepithelium.
- The neoplastic squamous epithelium may develop a normal maturation sequence, with atypia observed in some areas. Keratinization is usually minimal
- Median age 9 years, older than prev. reported
- All tumors derived from gingiva of dentate jaws, 66% in the rostral location
- No metastases found in any patient, despite most of lesions being T2 or T3
- 2 microscopic patterns,
- (1) invasion of bone forming a cup shaped indentation in the bone or a deeply cavitating cyst within the bone (cavitating pattern),
- (2) histologically malignant growth, but lack of apparent bone invasion (non-cavitating pattern)
- Imaging findings correlated well with microscopy:
- cavitating forms presenting with a cyst-like pattern of bone loss or an expansile mass on imaging
- non-cavitating forms showing an infiltrative pattern of bone destruction on imaging. These features suggest two distinct biological behaviours of COPSCC.
9
Q
Losinski SL, Stanley BJ, Schallberger SP, Nelson LL, Millard HAMT. Versatility of the Angularis Oris Axial Pattern Flap for Facial Reconstruction. Veterinary Surgery. 2015;44(8):930-938.
A
- This article is discussing a skin flap for facial reconstruction in 8 cases (one bilateral) – not the mucosal flap for closing palatal defects. Based on the arborization of the angularis oris artery with the masseteric and transverse facial artery in the superficial skin of the face.
- This is a caudally derived flap from neck skin, which can be rotated for coverage of wounds on the face/intermandibular region
- 3 flaps dehiscence at distal edge Because of concurrent distal necrosis in 2/3 cases, we suspect that the caudal border of the flaps (both at the level of the wing of the atlas) extended beyond the limits of the vascular supply.
- Additional complications were minor and included mild flap edema in 3 flaps and moderate flap edema in 5 flaps
- No seroma formation, drain placed in 4/9
- Long hair growth but directed away from the eyes
10
Q
Hoffer M, Manfra Marretta S, Kurath P, et al. Evaluation of composite resin materials for maxillomandibular fixation in cats for treatment of jaw fractures and temporomandibular joint luxations. Veterinary surgery : VS. 2011;40(3):357.
A
- Had 4 groups of 22 feline cadavers and looking at product for MMF fixation and amount of crown surface acid etched.
- acid etch whole tooth plus protemp;
- acid etch whole tooth plus bonding agent then protemp;
- Acid etch gingival half of the tooth, and use flowable composite resin (no bonding agent);
- Acid etch the whole tooth and use flowable composite (no bonding agent);
- Mechanically tested 7 specimens from each group, and 15 used for removal testing
- Took way longer to apply flowable composite (probably light curing time) than for protemp. Flowable composite had a higher load to failure, but took longer to remove than either protemp, and took longer still when whole crown acid etched (all significant). Bond strength significantly higher in the flowable and etch groups
- Failure data
- Protemp usually failed by bond failure(7/7 in one group, 5/7 in the other group; 2/7 had crown fracture)
- Partial etch and flowable failed by bond in 5/6 (only one crown fracture)
- Whole etch 13/15 failed by crown fracture
- Complications with removal
- Protemp had 0% complication rate in either group;
- 27% (4/15) complications in half etch and flowable group; (2 crown fractures, 2 palate punctures)
- 93% (14/15) complications in whole etched and flowable resin, 13/15 had crown fractures (28 fractures), 2 had lip puncture
•Conclusion: They liked the bond strength and minimal removal complication rate of the half etch and flowable composite group. It had an intermediate removal time.
11
Q
Modified Labial Button Technique for Maintaining Occlusion After Caudal Mandibular Fracture/Temporomandibular Joint Luxation in the Cat
Alice E. Goodman, DVM1, and Daniel T. Carmichael, DVM, DAVDC1
A
- Non rigid MMF
- Quick and easy to apply
- Appropriate in cases with minimally displaced subcondylar and pericondylar fractures without joint involvement, the labial button technique can provide sufficient stabilization for healing.
- “modification” to the technique is using a single line of suture
12
Q
Kitshoff AM, De Rooster H, Ferreira SM, Steenkamp G. A retrospective study of 109 dogs with mandibular fractures. 2013.
A
- Retrospective in south Africa of jaw fractures at university of pretoria.
- Population
- Agreement with other studies, <12 months over represented; Of patients >12 months, MI dogs over represented
- Small breed dogs overrepresented
- Yorkie, dachshund, Jack russel, maltese, Pekingese
- Etiology
- Dog fight/animal bite most common etiology (62%),
- idiopathic (16%),
- MVA (11%),
- Pathologic (4%)
- Almost 75% of fractures involved an alveolus, 124 teeth involved.
- M1 region was the most common tooth for fracture (~55), followed by the canine (~19)
- 77% of fractures open, ESP in dentulous region. No open condylar and fewer open ramus fractures
- Molar/premolar region followed by canine region were most common regions
13
Q
Gatineau M, El-Warrak AO, Marretta SM, Kamiya D, Moreau M. Locked jaw syndrome in dogs and cats: 37 cases (1998-2005). J Vet Dent. 2008;25(1):16-22.
A
- Took cases of couldn’t open mouth and couldn’t close mouth – these are included in locked jaw syndrome
- Diagnoses:
- 10 dogs had fractures (32%)
- 7 dogs had MMM (23%)
- 4 had trigeminal nerve paralysis (13%)
- 4 had OSA (13%)
- In results sort of split locked jaw syndrome into “TMJ ankylosis and trismus”
- They defined ankylosis as defined as intra or extraarticular lesions that prevented opening of the mouth – included fractures of zygomatic, coronoid, neoplasia etc.)
- They defined trismus as a muscular lesion preventing closure – maybe
- Most common cause of locked jaw syndrome was TMJ ankylosis in 54% of dogs
- 90% of these were false ankylosis and only 2 (10%) were true, intraarticular ankylosis.
- Also looked at ‘trismus’ which included neuropathies and MMM
- Most common cause of trismus was MMM (41% of trismus categories)
- The numbers in this paper are hard to interpret – not outlined neatly how cases were assigned to various categories
14
Q
Maxillofacial Injuries and Diseases That Cause an Open Mouth in Cats
Marika E. Constantaras, DVM; Cynthia J. Charlier, DVM
A
- Differential diagnoses include:
- luxation of the temporomandibular joint
- fracture of the temporomandibular joint
- caudal mandibular fracture
- impingement of the coronoid process of the mandible on the zygomatic arch,
- mechanical obstruction
- Neuropathy
15
Q
Umphlet RC, Johnson A. Mandibular fractures in the cat a retrospective study. Veterinary surgery. 1988;17(6):333-337.
A
- Retrospective of mandibular fractures in the cat
- Mandibular fractures comprised 14 % of fractures in cats
- 75 fractures in 62 cats. Out of a total of 517 cats with fractures
- NB – does not say how fractures were diagnosed, or imaged.
- Most common etiology was
- MVA (53%)
- Fight or fall (30%)
- Most common injuries
- symphyseal fracture (73%)
- Body of the mandible (16%)
- Condyle (6.7%)
- Coronoid (4%)
- Most cats had a single fracture (79%)
