Oral surgical conditions Flashcards
1
Q
Principles of oral surgery
A
- Control haemorrhage using pressure, ligation or appropriate electrosurgery
- Prevent tension; make flaps 2 to 4 mm larger than the defect
- Support flaps; do not suture over defects
- Use appositional sutures (e.g., simple interrupted, simple continuous, cruciate – consider locked horizontal mattress or vertical mattress)
2
Q
Why do repairs of the mouth often breakdown?
A
- mucosal sutures are under too much tension or if have air-air interface
3
Q
Choice of suture materials for oral surgery
A
- may can be used
- significant surgeon preference
- Commonly used materials include:
- Monofilament, absorbable materials providing wound support for between 14-28 days (e.g., poliglecaprone,
glycolide, polygytone, etc.) - Multifilament, absorbable materials providing wound support for between 10-21 days (e.g., glycomer 910, Lactomer 9-1, glycolic acid, etc.)
4
Q
Multi- vs monofilament sutures
A
- Infection in the mouth generally resolves itself so argument against using multifilament due to wickering bug property not good argument
- Monofilament - ‘spiky’ - can be irritant
- often comes down to personal preference
5
Q
Congenital palatine defects – cleft palate
A
= Birth defect leading to abnormal opening between the mouth and nose
- Can be primary, seconday=ry or both
6
Q
Primary cleft palate
A
- Lip (cleft lip, harelip)
– Unilateral
– Bilateral
7
Q
Secondary cleft palate
A
- Along roof of the mouth
– Affecting hard palate only
– Affecting soft palate only
– Affecting both hard and soft palate
8
Q
Palatine defects
A
- cleft palate
- palatine hypoplasia
9
Q
Hypopalatine hyperplasia - cause, what is looks like
A
- Bilateral palatine hypoplasia = failure of the soft palate to fuse properly on 1 or both side
- Looks like it has a uvula
–Dogs and cats shouldn’t have one - pseudo uvula
10
Q
Cleft palate CS
A
- Stunted growth due to poor weight gain
- Breathing difficulties upon exertion
- Coughing or gagging especially when eating or drinking
- Nasal discharge that may include food
- Infection or pneumonia due to food aspiration
- Abnormal visual appearance with cleft lip defect
11
Q
Cleft palate management
A
- Breeders commonly euthanase affected individuals
- Management usually surgical
- Usually wait until affected individual is 3-6 months old
– The later into the 6m window the better -> older for GA and wound healing better - Numerous ways on surgical management dependent on type of cleft, etc.
- Prone to dehiscence and requirement for repeat surgery
12
Q
Aftercare and outcome of cleft palate surgery
A
- Give antibiotics for individuals with pneumonia or nasal infection
- Elizabethan collar for 2-3 weeks to stop self-trauma
- Soft food for 3-4 weeks
- No hard chews or toys, etc. that can be chewed
- Use of oesophagostomy feeding tube appears to make little or no difference to likelihood of dehiscence
– but cats are less likely to eat after oral surgery so O tube good idea - Do not breed from affected individuals, etc.
13
Q
Complications of cleft palate surgery
A
- Partial or complete dehiscence
- Nasal discharge or sneezing
- Continue coughing or gagging due to short soft palate
14
Q
Traumatic injuries - symphyseal separation (what spp does it most commonly happen in? why? tx)
A
- most common in cats
- if knocks head, e.g. RTA, fall
- dental acrylic splint to stabilise the fracture
- tx:
– suture around it (big bore needle in through under the chin, comes out just lateral to the canine tooth, used to pass the suture through)
– loop suture around the jaw to stabilise it for ~1w for it to reform
– wanting reformation of the normal dental arcade
– can also use a dental acrylic splint to stabilise the fracture for 4wks
15
Q
Traumatic injuries - rostral maxillary fracture repair
A
- suture defect
- place orthodontic buttons and elastics for apposition and realignment
- an acrylic splint is placed over buttons and elastics
16
Q
Traumatic injuries - rostral mandibular fracture repair
A
- mandibullectomy (ensure canine roots removed (if part of amputation) and stitch over buccomucosa
- acrylic splint placed until healed also good
17
Q
What is an oronasal fistula?
A
- a communication between the oral cavity and the nasal cavity i.e. hole in the hard palate (roof of mouth)
– a maxillary fracture
18
Q
An example for need of surgery on the lips
A
- tumours, e.g. melanoma
19
Q
Surgical diseases of the salivary glands
A
- Salivary gland and duct injury
- Salivary fistula
- Sialoliths
- Salivary gland neoplasia
- Mucocoeles
20
Q
Which salivary glands empty under the tongue?
A
- the submandibular and sublingual glands
21
Q
What is the most likely neoplasia to be found in the salivary glands?
A
- carcinoma
– as it is an epithelial structure - mostly highly malignant in salivary glands so guarded prognosis
22
Q
Which salivary gland empties on the upper lip, adjacent to the carnassial teeth?
A
- the parotid
23
Q
Where do most mucocoeles in dogs occur?
A
- in the sublingual
– in the polystomatic section of the sublingual
24
Q
What is a ranula?
A
- a sublingual mucocoele, under the tongue
- probably won’t cause great problems, but a dog may make it bleed or chew on it
25
Why might a pharyngeal mucocoele cause problems?
- can occlude the airway
26
Salivary mucocoele contents
- pink mucoid consistent with stagnant saliva
27
Ranula tx
- marsupialisation
-- Stitch the internal lining surface to the external mucosal surface
-- Often reform but thought process being saliva being formed now empties into the mouth
28
Management - cleft of primary palate
- Reform soft tissue between the nasal and oral cavities
- + cosmetic reformation of the lip
29
