Mouth&Esophagus Flashcards
Main types of Mandibular and maxilla fractures
Incisive/ rostral region
Interdental space
Caudal horizontal ramus
Vertical ramus
What causes fractures in the incisive and interdental space?
Thin bones and minimal soft tissue coverage
Direct trauma from other horses or objects
Why are fractures of the caudal horizontal ramus (molars/ temporomandibular joint) less common?
Greater bone and muscle mass (masseter muscle)
Higher morbidity
Acute clinical signs of mandibular and maxilla fractures
Displacements
Pytalism
Swelling
Prehensile difficulties
Dysphasia
Oral/ cutaneous wounds
Chronic clinical signs of mandibular and maxilla fractures
Debilitation
Difficult prehension
Malodorous breath
Loss of normal occlusal alignment of dental structures
Diagnosing mandibular and maxilla fractures
Clinical signs
Radiographs
Cross bite (cd. mandible, vertical ramus, temporomandibular joint fractures/ luxations)
Treatment for incisive fractures
Orthopedic wires
Interdigitate on reduction
Eat normal diet
Heal within 4-8 weeks
Treatments for interdental space fractures
Interdigated: orthopedic wires
Long oblique fractures: cortical screws
Treatments for unstable fractures of the interdental space
Acrylic splints
Dynamic compression plates
Kirschner- Ehmer appliances
Treatment for unilateral non-displaced ramification fractures
Non surgical
Soft diets
Analgesics (non steroidal anti inflammatory drugs)
4-6 weeks (good prog)
Where are caudal angle mandibles fractured?
From the junction of the vertical and horizontal ramus as a free fragment (uncommon)
Treatment of caudal angle mandible
Excision of fragments
With molar involvement: internal fixation with plates/ screws
Treatment for the temporomandibular area fracture
Rare and difficult to repair
Mandibular condylectomy
Treatment for the coronoid process
Excision (preferred if dental abnormalities result) or conservative management
Prognosis for mandibular and maxilla fractures
Incisive region/ interdental area: good
Horizontal and vertical rami: guarded to fair
Temporomandibular and coronoid: guarded
What are the predisposing causes of esophageal impaction (choke)
Communal feeding
Post exercise (after feeding)
Esophageal lesions
Dental problems
What is the most common site of esophageal obstruction?
Second cervical vertebra
Causes of esophageal impaction
Feeds, pellets, sugar beet pulp, wood shavings, rough hay
Clinical signs of esophageal impaction
Food, mucous, saliva from nostrils
Retching
Nasal cough
Aspiration pneumonia
How do you dx esophageal impaction?
CS
Radiographs (radiodense or solid fluid and gas proximal to site of impaction)
Endoscopy (obstruction and esophageal mucosa)
When are contrast esophagrams necessary?
Chronic recurrent choke
Treatment of esophageal impaction
Nasogastric tube
Tranquilization
Anesthesia and endotracheal intubation (lateral recumbency)
How does nasogatric tube for impaction work?
Blow air into esophagus to induce secondary peristalsis then advance obstruction
If fails then sedate with xylazine
What is considered a risky tx for impaction?
Esophagostomy
Longitudinal incision —> feed through incision —> 4-6w recovery
Aftercare of impaction
Confirm if entire esophageal lumen is patent with nasogastric tube
Endoscopic evaluation
Scurried diet for a few days (pelleted feeds, bran mashes)
Prognosis for esophageal impaction
Acute: good
Chronic: guarded to good
Eophageal ulceration?
Any trauma , chemical or infectious origin
Longitudinal scars expand well, circular scars don’t
What causes esophageal ulceration
Protraction esophageal impaction (acute, most common)
External trauma to neck (chronic)
__________ and __________ are the most common causes of recurrent choke
Ulceration and stricture
Conservative tx for mild cases of esophageal ulceration
Slurries diet for a few days then pelleted feed and bran mashes
Constriction worse at 30 days then normal function at 60
Surgical tx for esophageal ulceration
Esophagostomy/ Esophagplasty
Esophagomyotomy
Patch grafting
Resection and anastomosis
Why isn’t resection and anastomosis the best option for tx of esophageal ulceration?
Stricture
Doesn’t hold together (lacks serosa)
Long
Esophageal wounds
Longitudinal slits along the ventral and dorsal esophageal walls
Closed and open wounds
Why are closed esophageal wounds more dangerous?
Secretions and food material trapped in deep fascial planes
What causes esophageal wounds?
Closed: ingested wire, impacted foreign bodies, pre-existing defects
Open: blunt trauma (cervical vertebrae)
CS of open esophageal wounds
Swollen wound
Salivary discharge
Food drainage
CS of closed esophageal wounds
Cellulitis causing ventral neck swelling
Anorexia
Febrile and depression
Shock from toxic products that accumulate in tissues
What causes mediastinitis and pleuritis in closed esophageal wounds?
Cellulitis and necrosis in the neck —> causing infection and gas dissect along fascial planes to mediastinum
Dx of esophageal wounds
Acute swelling ventral neck
SQ emphysema over neck and shoulders
Endoscopy
Rads (gas through facial planes and extra luminal food)
Conservative tx for esophageal wounds
Good ventral drainage: esophagostomy and excise necrotic tissue
Second intention healing
Abx and anti- inflammatories
Tetanus prophylaxis
3-4 weeks healing
What does saliva lost via wounds and fistulas causes?
Hyponatremia, hypochloremia
Metabolic acidosis then metabolic alkalosis
Sx tx for esophageal wounds
Resection and anastomosis
Esophagostomy
Sx complications from esophageal wounds
Esophagus has no serosa surface
Constant movement
Neurological complications
What results from esophageal wounds?
Cellulitis
Laryngeal hemiplegia (left recurrent laryngeal nerve)
Horners syndrome (ptosis, miosis, enophyhalmos)
Chronic esophagocutaneous fistula
Strictures are rare
