Oropharyngeal stick injuries Flashcards
Are any specific breeds associated with oropharyngeal stick injuries?
Medium to large breeds – collies, GSD, GRet’s, Springer spaniels and cross breeds
What are the differences between the acute and chronic presentations of the injury?
Acute – hypersalivation, dysphagia, oral pain, <7d, blood stained saliva
Chronic – abscessation formation, discharging sinuses of the head and neck, cervical swelling
If you are presented with a dog suffering from an oropharyngeal stick injury, why is it useful to see and examine of the offending stick?
- determine whether any parts stripped off or obviously broken i.e. still inside dog
- stick fragments less likely to be missed - know colour, rough shape & size, etc
Why might chronic cases of stick injury occur?
- O not realised injury occurred if dog shook stick out of mouth
- operated on and not all the material removed
Is it better for O to leave stick in situ for oropharyngeal stick injury case, or remove it?
- leave in situ if possible
What diagnostic tests may be indicated to determine whether any stick is still in the body following an oropharnygal stick injury?
- survey radiographs or skull/cervical region + thorax
- US
- CT/MRI
- flexible endoscopy
- rigid endoscopy
- anaesthetise and visually observe/examine where the penetrating wound is
Where are penetrating wounds from oropharyngeal stick injuries usually found?
- under tongue or back of pharynx
Pharyngeal stick injury presentation
- very painl
- lame and lump above scapular
Where do sticks tend to sit following oropharnygeal injury, and why does this mean they can go unnoticed until chronic signs begin to show?
- subcut fascial planes
How might an oropharyngeal stick injury cause severe resp signs?
- down neck + penetration of thorax
What could you use to investigate the hole left in oropharyngeal cavity once a stick is removed?
- pass rigid endoscope down
– can instil saline down channel + distend structures to determine whether any material is left
Why might an abscess form cutaneously at site far from FB position with oropharyngeal stick injury?
- discharging sinus developed + trying to find path of least resistance
How might you determine the position of a FB from a discharging tract from a cutaneous abscess?
- put cannula through hole & inject positive contrast into abscess cavity -> forces contrast down fistulous tract towards where FB is
If you are presented with a dog with a chronic abscess with a discharging tract that was treated 5w ago with AB that didn’t resolve the issue, what would your top differential be?
- FB
Ddx for stick injury FB with cutaneous mass
- thorn in local region
- bite injury (esp cat)
What are you likely to see with a stick behind the eye?
- eye will be protruding
How long should O administer AB following surgical tx for stick injury?
- 7-14d
What management would you advise following surgical tx for a stick injury?
- analgesia
- no collar and lead for 2-3w
- feed as normal but consider moistened kibble
Why is it essential to treat dogs with enough AB/full AB coverage following surgical tx for stick injury? What AB would you prescribe?
- they can die from septicaemia
- amixoclav for gram positive
- enrofloxacin for gram negative
- metronidazole for anaerobic
If pt doesn’t appear to be responding to AB therapy following surgical tx of stick injury, what should you do?
- assume you’re not covering gram negatives
- prescribe more than will hit hard immediately
What are the potential complications following surgical tx of stick injury?
- recurrent/development of discharging sinus
- pyrexia
- neck pain
- bacteraemia
- nerve damage
- dysphagia
What can chronically lodged sticks in the buccal mucosa cause?
- oronasal fistula
CS of oronasal fistula/stick lodged in buccal mucosa
- halitosis
- head shy
- hypersalivation
- hyporexia
What could be a secondary consequence of an oropharyngeal stick injury penetrating into the cervical region?
- cervical emphysema
How do wood fragments appear on CT that enables them to be differentiated from muscle?
- hypoattenuating as low water content
Why is performing appropriate diagnostic investigations for oropharyngeal stick injuries so important, esp in cases with chronic presentation?
- some large FBs not palpable if converted by chronic inflammatory tissue
- fragmentation of foreign material and formation of chronic inflammatory tissue over the top may make removal of all affected tissue difficult
What advice would you give O about throwing stick for dogs to retrieve?
- avoid throwing sticks
- discourage O from allowing pets to play with or chew stick
What antibiotic regime might you consider appropriate in cases with an acute presentation and why?
- 7d amoxiclav 2x daily, +/- metronidazole
