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Oral, Pharyngeal and Aural surgery > Mandibulectomy and Maxillectomy > Flashcards

Mandibulectomy and Maxillectomy Flashcards

1
Q

Maxillectomy and mandibulectomy are what type of procedure? (clean etc?)

A

Clean contaminated

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2
Q

Why is surgical infection rate rare? (2)

A

Rich vascular supply
Prescence of saliva

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3
Q

What local analgesia agent?
- onset time?
- Action length?

A

Bupivacaine (0.5 – 1 ml, 0.5%)
- 8-30 mins
- lasts: 4-10hr

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4
Q

Which LA block blocks the following:
- Rostral maxilla?

A

Intraorbital

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5
Q

Which LA block blocks the following:
Body of mandible for more extensive sx?

A

mandibular nerve block near the mandibular foramen

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6
Q

Which LA block blocks the following:
Rostral mandible

A

mental foramen block

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7
Q

Which LA block blocks the following:
Entire maxilla

A

maxillary nerve block

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8
Q

For the maxillary nerve block, the needle is introduced where?

A

Rostral to the ramus and ventral to the zygomatic arch, just caudal to the lateral canthus of the eye.

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9
Q

How to control bleeding? (5)

A

Electrocautery,
Ice cold saline,
gelatin sponges,
bone wax
local application of epinephrine

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10
Q

When performing a mandibulectomy, ligation of what a. is needed?

A

Inferior alveolar a.

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11
Q

When performing a maxillectomy, ligation of what a. is needed? (2)

A

major palatine artery or infraorbital artery

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12
Q

Significant haemorrhage is expected with maxillectomy; why?

A

Nasal cavity is often entered, significant turbinate haemorrhage

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13
Q

Temporary or permanent occlusion of what a. may be required in a caudal maxillectomy?

A

Temporary or permanent carotid artery

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14
Q

How to position for:
Central and caudal maxillectomy

A

Oblique lateral recumbency

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15
Q

How to position for:
Segmental removal of body or ramus of mandible

A

Lateral recumbency

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16
Q

How to position for:
Bilateral rostral mandibulectomy and rostral maxillectomy

A

Dorsal recumbency

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17
Q

What should be placed to improve visualisation?

A

Mouth gag

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18
Q

Where should bone be cut in relation to teeth? and how far from tumours?

A

Between teeth roots.
1cm from tumours.

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19
Q

What teeth are involved with Rostral mandibulectomy?

A

Excision of bone including some or all incisors and one or more canine teeth.

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20
Q

Define Central mandibulectomy

A

Removal of a segment of one mandibular body.

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21
Q

Define Caudal mandibulectomy

A

Removal of all or a portion of ramus.

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22
Q

Define Total hemimandibulectomy

A

Removal form the symphysis including all of one body and the ramus.

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23
Q

Define three quarter mandibulectomy

A

Removal of one hemimandible and the rostral portion of the other hemimandible.

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24
Q

Define Pre-maxillectomy

A

Removal of the bone surrounding the incisors (may include the nasal planum).

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25
Q

Define Rostral hemimaxillectomy

A

Removal of the bone surrounding the canines and incisors.

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26
Q

Define Central hemimaxillectomy

A

Removal of the bone surrounding the pre-molars.

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27
Q

Define Caudal hemimaxillectomy

A

Removal of the bone surrounding the molars. This may include the zygomatic arch and the bone of the ventral orbit.

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28
Q

How to position for rostral mandibulectomy or lateral recumbency for segmental hemimandibulectomy?

A

Position the patient in dorsal recumbency

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29
Q

Rostral and central mandibulectomy;
Where is gingiva incised?

A

The gingiva is incised 0.5 cm beyond the level of planned bone transection and is elevated from the bone using a periosteal elevator, preserving a cuff of gingival tissue for closure.

30
Q

What 3 attachements are transected in Rostral and central mandibulectomy; to give the 1cm margins?

A

Oral mucosa, labial mucosa and muscular attachments

31
Q

How to control haemorrhage in Rostral and central mandibulectomy

A

Electrocautery

32
Q

Rostral and central mandibulectomy;
A) How to transect bone? (3)
B) How to split longitudinally

A

A) n oscillating saw, air drill or burr
B) Osteotome

33
Q

Rostral and central mandibulectomy;
What artery is ligated/cauterised?

A

Inferior alveolar a.

34
Q

Rostral and central mandibulectomy;
How to split the symphysis

A

Osteotome

35
Q

How to close Rostral and central mandibulectomy? Including skin

A

Closure is achieved by suturing labial mucosa to the gingival and sublingual mucosa.
Following rostral mandibulectomy, the skin can be sutured directly to the sublingual mucosa.

36
Q

Caudal mandibulectomy and hemimandibulectomy
How to position

A

Lateral

37
Q

Caudal mandibulectomy and hemimandibulectomy
What incision may help improve exposure?

A

A full-thickness incision in the cheek from the commissure to the level of the caudal border of the ramus may help improve exposure.

38
Q

Caudal mandibulectomy and hemimandibulectomy
What removal facilitates visualisation of the dorsal ramus and TMJ and is necessary if it is involved in the pathology.

A

Zygomatic arch

39
Q

How to replace zygomatic arch in Caudal mandibulectomy and hemimandibulectomy? Is this needed?

A

Stabilisation with orthopaedic wire

Not necc; more for post op cosmesis

40
Q

Caudal mandibulectomy and hemimandibulectomy;
Soft tissues are transected at least 1 cm from the edges of the tumour. What muscles (4) and capsule (1) does this include?

A

masseter, digastricus, temporalis and pterygoid muscles and the TMJ capsule.

41
Q

Caudal mandibulectomy and hemimandibulectomy;
What vessel is ligated and where?

A

The inferior alveolar artery is ligated and transected at the mandibular foramen.

42
Q

Caudal mandibulectomy and hemimandibulectomy;
Mucosa closure?

A

For closure, the labial mucosa is sutured to the gingival and sublingual mucosa.

43
Q

Caudal mandibulectomy and hemimandibulectomy;
How to suture to prevent the tongue hanging out the mouth?

A

The commissure of the lip can be advanced to the level of PM1 or 2

44
Q

When is Mandibular rim excision appropriate?

A

For tumours that do not invade the ventral cortical bone and that lie next to the pre-molars or molars

45
Q

Rostral and central maxillectomy
How to position?

A

Oblique lateral

46
Q

Rostral and central maxillectomy;
What 3 structures need to be incised at the site of transection?

A

Labial mucosa
Gingiva
Palate

47
Q

Does the major palate a. and infraorbtal a. need to be ligated in a central or rostral maxillectomy?

A

Central

48
Q

Rostral and central maxillectomy
What is used for bone resection; why this?

A

Osteotome; bone is thin

49
Q

Rostral and central maxillectomy; its challenging to control bleeding until what is fully removed?

A

Maxillary segment

50
Q

What osteotomy should be left until the end to minimise bleeding with Rostral and central maxillectomy?

A

Caudal

51
Q

How to suture mucosa in Rostral and central maxillectomy? What flap might be needed?

A

Labial mucosa suture to gingival and palatine mucosa

Dorsally based labial advancement flap.

52
Q

What can be used to reduce breakdown of dorsally based labial advancement flaps?

A

Pre-placing drill holes into the hard palate and suturing through these

53
Q

Rostral and central maxillectomy
How to prevent drooping of noce?

A

dorsal cartilage can be sutured via drill holes in the nasal bone

54
Q

Rostral maxillectomy
How far from tumour is incision?

A

1cm

55
Q

Caudal maxillectomy
How to position?

A

Oblique lateral

56
Q

Caudal maxillectomy
Where is the cheek incised to increase exposure?

A

From the commissure to the caudal border of the ramus to increase exposure.

57
Q

What incision will improve exposure of the dorsal osteotomy site, ventral orbit and zygomatic arch with Caudal maxillectomy?

A

Dorsolateral

58
Q

What 3 structures are incised with Caudal maxillectomy?

A

Labial, gingival and palatine

59
Q

Caudal maxillectomy; what osteotomy is left util the end to reduce haemorrhage?

A

caudal osteotomy is left until last to allow ligation of the major palatine a

60
Q

When can food/water be introduced after surgery?

A

day after soft for 10-14 d

61
Q

What should be avoided chewing after?

A

Hard food
Chew toys

62
Q

Wat tube should be placed in any cat that is undergoing a mandibulectomy or maxillectomy procedure?

A

Oesophagostomy

63
Q

What may occur following maxillectomy, if the patient is asymptomatic monitoring may be appropriate, otherwise repair is recommended?

A

Oro nasal fistula

64
Q

What may occur during mandibulectomy or maxillectomy. If tooth death occurs, extraction may be required?

A

Tooth root damage

65
Q

When may the tongue may fall to one side, potentially increasing the rate of drooling (2)

A

Following hemimandibulectomy or rostral mandibulectomy

66
Q

Mandibular drift may also follow a?

A

hemimandibulectomy

67
Q

Mandibular drift usually have no problems; but when is it a problem and what helps?

A

canine tooth impinges on the hard palate. Extraction or crown reduction of the canine tooth may improve signs associated with this.

68
Q

What may be used to prevent drift?

A

Orthodontic chains from the canine tooth of the intact mandible running to the ipsilateral fourth pre-molar

69
Q

In dogs, removal of what length of both mandibular bodies may have difficulty with prehension of food in the initial stages, but usually adapt over time.

A

At least half

70
Q

Removal of both mandibular bodies means what for feeding?

A

hand feeding for life

Oral, Pharyngeal and Aural surgery (10 decks)

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