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

Question 1

What was the purpose of the case report?

Answer 1

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.

Question 2

Describe the typical signs of an oronasal fistula?

Answer 2

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

Question 3

What is the suspected rate of failure of repair of cleft palates base soley on data from human literature?

Answer 3

65%

Question 4

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?

Answer 4

vest over pants suture pattern

Question 5

How far did the auricular graft extend beyond the edges of the oronasal fistula?

Answer 5

2mm

Question 6

Describe the suture pattern seen

Question 7

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?

Answer 7

95%

Question 8

What particular problem may affect healing of particularly thin mucoperiosteal flaps in cats?

Answer 8

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.

Question 9

What principles have been suggested to guide surgical management of palatal defects?

Answer 9

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.

Question 10

The buccal mucoperiosteal flap relies on the vascular supply from which artery?

Answer 10

The lateral nasal branch of the infraorbital artery

Question 11

Bilateral mucoperiosteal advancement flaps are also known as what technique?

What is the principal weakness of this technique?

Answer 11

Von - Langenbeck technique.

the principal weakness is that the suture line is not supported by bone or any other tissue.

Question 12

According to this report what percentage of animals receiving the von-Langenbeck procedure required a 2nd or third proceudure?

Answer 12

58%

Question 13

What percentage of patients receiving only a von langenbeck procedure achieved successful closure?

Answer 13

33%

Question 14

In this report what was the most significant advantage of using a dopuble mucoperiosteal flap technique?

Answer 14

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.

Question 15

According to this report when are axial pattern and island flaps most commonly advocated?

Answer 15

These flaps have particularly been advocated for closure of palatal defects impacted by the use of radiation therapy because of their robust vascular supply

Question 16

An angularis oris axial pattern flap is based on which artery?

Answer 16

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.

Question 17

A modified superficial cervical axial pattern flap is based on which artery?

What were the major complications of using this flap?

Answer 17

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 %

Question 18

A rostral tongue flap has been used to repair a palatal defect. How much does this flap decrease the length of the tongue by?

Answer 18

1/3rd

Question 19

What are the four potential reasons for failure of a free auricular cartilage graft?

Answer 19

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