JVD 2009 2 Free Auricular Cartilage Autograft for Repair of an Oronasal Fistula in a Dog Jason W. Soukup, Christopher J. Snyder, William R. Gengler Flashcards
What was the purpose of the case report?
This case report describes the successful surgical treatment of an acquired oronasal
fistula with a free auricular cartilage autograft and reviews techniques described for oronasal fistula repair, including free auricular cartilage autografts.
Describe the typical signs of an oronasal fistula?
Signs typically include sneezing and serous to mucopurulent nasal discharge. Coughing may be a clinical sign in patients with cleft palates that have developed aspiration pneumonia
What is the suspected rate of failure of repair of cleft palates base soley on data from human literature?
65%
In the picture below a specific suture pattern is used to attach the auricular cartilage graft to the oral mucoperiosteum, what is that suture pattern?
vest over pants suture pattern
How far did the auricular graft extend beyond the edges of the oronasal fistula?
2mm
Describe the suture pattern seen
In this report a study using Japanese white rabbits closing 10mm palatal defects
inserting a conchal cartilage graft with the associated perichondrium within a compartment between the oral mucoperiosteum and the underlying bone.
What was the succss rate as determined by gross & histological observation?
95%
What particular problem may affect healing of particularly thin mucoperiosteal flaps in cats?
Changes in intranasal air pressure during physiologic respiration or sneezing may further compromise the stability of healing oral wounds, especially when relatively thin
mucosal flaps are used.
What principles have been suggested to guide surgical management of palatal defects?
Treat only those animals that are clinically affected
Use the technique most likely to achieve success even if a more radical technique is needed.
Create flaps large enough to cover the defect without tension
Always appose clean, healthy, cut tissue edges with connective tissue
Consider two-layer closure when appropriate.
Locate suture lines over supportive bony tissue.
Ensure appropriate vascular supply; and, avoid the use of electrosurgery.
The buccal mucoperiosteal flap relies on the vascular supply from which artery?
The lateral nasal branch of the infraorbital artery
Bilateral mucoperiosteal advancement flaps are also known as what technique?
What is the principal weakness of this technique?
Von - Langenbeck technique.
the principal weakness is that the suture line is not supported by bone or any other tissue.
According to this report what percentage of animals receiving the von-Langenbeck procedure required a 2nd or third proceudure?
58%
What percentage of patients receiving only a von langenbeck procedure achieved successful closure?
33%
In this report what was the most significant advantage of using a dopuble mucoperiosteal flap technique?
The most significant advantage of this technique is that it provides a wide area of connective tissue contact without tension and bony support of the suture wound.
According to this report when are axial pattern and island flaps most commonly advocated?
These flaps have particularly been advocated for closure of palatal defects impacted by the use of radiation therapy because of their robust vascular supply
An angularis oris axial pattern flap is based on which artery?
This flap is based on the angularis oris artery, which arises from the facial artery to provide vascularity to the cheek tissue just caudal to the commissure of the mouth.
A modified superficial cervical axial pattern flap is based on which artery?
What were the major complications of using this flap?
This flap is based on the superficial cervical artery, which branches from the subclavian
artery at the angle between the shoulder and neck, coursing dorsally to arborize and perfuse the skin overlying the scapula and dorsal neck
Major complications include ischemia and loss of pliability of the flap leading to flap shortening by approximately 25 %, the requirement of multiple anesthetic events, infection at
the parapharyngeal tunnel, patient regurgitation, diffuse subcutaneous emphysema of the head and neck, hair growth on the oral portion of the flap, reverse sneezing, and a dehiscence rate of 33 %
A rostral tongue flap has been used to repair a palatal defect. How much does this flap decrease the length of the tongue by?
1/3rd
What are the four potential reasons for failure of a free auricular cartilage graft?
1) use of a cartilage graft that is too small for the defect
2) infection
3) inadequate preparation of the compartment to receive the cartilage graft
4) improper fixation of the cartilage graft to the mucoperiosteum
