SASx Final Exam - Head Surgery (Dentistry, Oral, Ear) Flashcards
What are some complications associated with mandibulectomies?
- Swelling
- Wound dehisceince (more common with rostral mandibulectomy)
- Mandibular drifting -‘clicking’ sounds when the jaw is closed
- Decrease ability to prehend food
Using the Triadan tooth numbering system, what number would identify the right maxillary middle incisor?
102
What is the most common malignant oral tumor seen in the cat?
squamous cell carcinoma
What are the surgical options for lip reconstruction?
- Direct apposition
- Labial advancement flap
- Labial rotation flap
The most common Class 1 malocclusions that we see are:
Base Narrow Canines
- This is typically the result of retained deciduous canines. Once it impacts the soft tissues on the hard palate, it is locked in place! So if we don’t recognize this early, even if we extract the deciduous teeth, it will have no effect.*
- If we’re going to create space, we need to do it before the soft tissue is contacted. These can become so severe that they can create oronasal fistulas*
- ***
What is the dental formula for deciduous teeth in the dog?
The periodontal ligament isolates the tooth from the surrounding bone and, importantly, the ________ that remodel the surrounding bone
osteoclasts
The periodontal ligament isolates the tooth from the surrounding bone and, importantly, the _osteoclasts_ that remodel the surrounding bone
Collection of blood within the cartilage plate of the ear is termed:
aural hematoma
Where do we typically see SCC in the oral cavity cats?
gingiva and under the tongue
- Gingiva and under tongue
- Extensive bone involvement common
- Often advanced before diagnosis is made
Of the viral diseases in cats, which one is known to exacerbate periodontal disease?
Calicivirus
What is the treatment for a tooth fracture?
-
Enamel fracture, Uncomplicated fractures
- +/- indirect pulp capping
- Crown restoration
-
Complicated fractures
- Vital pulpotomy or root canal
- Crown restoration OR Extract tooth
At what age do we expect to see eruption of deciduous molars in cats and dogs?
the premise is false.
- There are no deciduous molars in cats and dogs.*
- Permanent molars should be expected around 5-7 months*
What is the most important thing to remember for oral cavity surgery to prevent dehiscence?
avoid tension on oral closure
What is the goal of treatment for periodontal disease?
to prevent development of new lesions at other sites and to prevent further tissue destruction at sites that are already affected
A space or gap between two teeth is termed:
diastema
What is the dental formula for adult teeth in the dog?
Removal of primary teeth to avoid or correct the problem describes what malocclusion treatment?
interceptive orthodontics
The potential space between the tooth and the gingiva is termed:
gingival sulcus
when you have an overgrowth of bacteria in the gingival sulcus and get destruction of the junctional epithelium (base of the gingiva that attaches to the tooth), the disease process changes from gingivitis to periodontitis
The treatment of choice for a ranula is:
- Marsupialization into the oral cavity
- Ligation of the affected duct
- Placement of a drain through the intermandibular space
- Excision of the sublingual and mandibular salivary glands
Excision of the sublingual and mandibular salivary glands
What is your diagnosis?
amelanotic melanoma
What lip construction technique has been performed here?
labial rotation flap
What procedure is illustrated below?
Single Flap Technique for oronasal fistula repair
Bonus question: what type of flap is present in the illustration? (Single pedicle advancement flap)
T/F: Surgical removal of the involved gland is the definitive treatment for all mucoceles
True!
There are other procedures you can do depending on the patient or the condition, but they’re usually associated with a higher likelihood of recurrence… just remove the gland, don’t be a p***y
What is the name of this treatment for base narrow canines?
incline plane
If they’ve been on there for a while, often times it will look like this (picture below) when you take it off. Food debris, bacteria, etc. will build up under there and cause a fairly significant mucositis. These tend to resolve very quickly once the appliance is removed.
Treatments for this: pain relievers, decaffeinated tea rinses. It will usually heal with time
What are the treatment options for pulpitis?
monitor for progression, root canal, or extraction
This oral tumor arises from remnants of epithelial cells that produce periodontal ligament. It is benign, but locally invasive:
acanthomatous ameloblastoma
Which of the following tumors commonly occurs in the vertical ramus of the mandible
- Complex odontoma
- Undifferentiated malignant oral tumor
- Multilobular osteochondrosarcoma
- Central ameloblastoma
Multilobular osteochondrosarcoma
What’s the main difference between a scaler and a curette?
A scaler has a sharp point. A curette does not.
What is the minimal sulcus depth in the normal dog? Normal cat?
- Dog: 1-3 mm
- Cat: 0-1 mm
Mandibular adult canines erupt ________ to deciduous canines
lingual
Mandibular adult canines erupt lingual to deciduous canines
T/F: In dogs, there is no deciduous 1st premolar
True
T/F: Benign oral tumors can be differentiated from malignant tumors because benign tumors do not invade the bone
False
Example: Acanthomatous ameloblastoma is a benign lesion that is locally invasive into bone
This is a benign proliferation of fibrous connective tissue containing displaced cells of dental supporting structures. Identify the tumor:
Peripheral Odontogenic Fibroma
Local excision is curative, if complete
What prognosis is associated with undifferentiated malignant oral tumors?
grave
Survival is often one month or less
In what age group of dogs do we typically see undifferentiated malignant oral tumor?
YOUNG DOGS (6-24 months)
These are VERY AGGRESSIVE tumors - rapid growth with early metastasis
They tend to grow on the maxilla, caudal to the canine tooth (~the same spot we normally see fibrosarcomas)
T/F: Oral plaque is initially Gram [+], aerobic, and non-motile cocci in the normal mouth, but as periodontitis progresses, the bacterial population changes to Gram [-], motile, anaerobic rods and spirochetes
True
What are the characteristics of a tonsilar squamous cell carcinoma (SCC)?
- Highly malignant
- Usually unilateral
-
Early metastasis
- > 90% to distant sites at diagnosis
An angled or curved root tip of a tooth is termed:
dilaceration
Identify the area(s) of periapical lucency:
What are the clinical signs associated with undifferentiated malignant oral tumors?
external swelling, loose teeth, pain, periorbital swelling, exophthalmos
If a dog has malpositioned teeth, but the jaw length is normal, this would be classified as a ________ malocclusion
Class 1
What modality is used to determine the type of tooth resorption lesion present?
radiographs
- Type 1
- Focal or multifocal radiolucencies
- Periodontal ligament remains intact
- Moderate to severe gingivitis and periodontitis
- Type 2
- Focal or multifocal radiolucencies in tooth
- Disappearance of the periodontal ligament with varying degrees of root resorption
- No or minimal evidence of periodontitis
- Type 3
- Features of type 1 and 2 in same tooth (especially multi-rooted teeth)
Salivary gland neoplasia is pretty rare, but adenocarcinoma is the most common. In dogs, it usually occurs in the ________ gland. In cats, it usually occurs in the ________ gland
Salivary gland neoplasia is pretty rare, but adenocarcinoma is the most common. In dogs, it usually occurs in the parotid gland. In cats, it usually occurs in the mandibular gland
T/F: Retained deciduous teeth are most commonly seen with canines and premolars
False
- Retained deciduous teeth are most commonly seen with canines and incisors*
- Retained deciduous teeth are seen most frequently in toy breed dogs and cats*
What is the most common malignant oral tumor in the dog?
melanoma
-
In general, with melanoma:
- If it’s on a mucocutaneous junction or nail bed - think MALIGNANT
- If it’s on haired skin, think BENIGN
What age is typically ideal for performing a complete root canal?
mature tooth (>24 months)
<24 months the apex may not be closed or pulp chamber is still very wide, increasing risk of failure
Identify the malocclusion present in this image:
wry mouth
Wry bite develops when the two sides of the maxilla (typically) are not growing at the same rate
Which of the following pairs of oral tumors occurs most commonly in maxilla caudal to canine tooth?
- Squamous cell carcinoma, undifferentiated malignant oral tumor
- Fibrosarcoma, acanthomatous ameloblastoma
- Squamous cell carcinoma, acanthomatous ameloblastoma
- Fibrosarcoma, squamous cell carcinoma
- Fibrosarcoma, undifferentiated malignant oral tumor
Fibrosarcoma, undifferentiated malignant oral tumor
Impacted or malformed teeth can result in abscess or ________ cyst formation and should be extracted in most cases
dentigerous cyst
Impacted or malformed teeth can result in abscess or dentigerous cyst formation and should be extracted in most cases
If a tooth is partially dislocated from the alveolus but retains some attachment, this is termed:
tooth luxation
Of the crown root fractures, what type do we see most commonly?
slab fracture
very commonly on the upper 4th premolar
What type of tooth resorption lesion is present here?
Type 3
- In general, don’t make your judgement completely off the radiographs
-
Features of type 1 and type 2 in same tooth
- Most often seen in multi-rooted teeth, where one root shows type 1 features and the other root shows type 2 features
This is the canine equivalent to feline gingivostomatitis:
CUPS
- (Canine Ulcerative Paradental Stomatitis)
-
Treatment:
- Similar to feline gingivostomatitis
- Home care: 1-2x daily brushing
- May require total mouth extractions to control
What type of mandibulectomy is shown here?
bilateral rostral
Gingival recession with 25-50% bone loss and slight to moderate mobility is categorized as Stage ____ periodontal disease
Stage 3 - Moderate Periodontitis
What age is typically ideal for performing a vital pulpotomy?
young animals (<18-24 months)
can attempt in older animals, but success rate lower because pulp less resilient (<5 years)
What is the most common treatment for oral neoplasia?
surgical resection
When using a dental scaler, the most important thing to remember is to never use sharp tip below __________
When using a dental scaler, the most important thing to remember is to never use sharp tip below the gingival margin
You don’t want to risk traumatizing the junctional epithelium at the base. So these are only used supra-gingivally (ABOVE the gum line)
Cats have the same salivary glands as dogs, but because cats are jackasses sometimes, they have an extra salivary gland. What is it called?
molar salivary gland
What prognosis is associated with SCC in cats?
guarded to poor
- Results with surgery not as good as in dogs
- Radiation therapy can cause significant side‐effects
- Chemotherapy: Piroxicam
- Because these tumors tend to be more advanced by the time the diagnosis is made, achieving adequate margins is more difficult compared to dogs and local recurrence is more common than in dogs
Dentin is formed by ________ throughout the life of the tooth
odontoblasts
Dentin is formed by _odontoblasts_ throughout the life of the tooth
What’s going on in this tooth?
enamel infraction (abraction)
- Tooth is a dynamic structure, so it flexes and cracks. These cracks are just in the enamel
- There is no loss of structure with this abnormality
What are the goals of a complete root canal?
remove pulp contents and seal the apex
complete removal of pulp contents and seal apex to prevent bacteria from escaping from tooth
What type of mandibulectomy is shown here?
unilateral rostral
T/F: Salivary mucoceles do not need to be removed. They will go away after you remove the affected salivary glands
True
Shortening of the oral commissure is most commonly performed in conjunction with which the following surgical procedures?
- Bilateral rostral mandibulectomy
- Unilateral caudal maxillectomy
- Total unilateral mandibulectomy (hemimandibulectomy)
- Unilateral central mandibulectomy
Total unilateral mandibulectomy (hemimandibulectomy)
What critical step of the dental cleaning process is being performed here?
subgingival calculus removal
The only visible part of the periodontium in a normal mouth is the ________
gingiva
What is the purpose of shortening the lip commissure in a total mandibulectomy?
- Improves ability to prehend food and drink water
- Prevents the tongue from lolling out to the side
__________ resorption is the predominant activity in tooth resorption
osteoclastic (odontoclastic)
odontoblasts do not play an active role in attempts at repair in most cases
T/F: If caught early enough, periodontitis is reversible with proper treatment and home care
False
Periodontitis can be controlled, but not completely reversed
What is the cingulum?
The shelf on the inside (palatal) surface of the maxillary incisors where the mandibular incisors occlude or “rest”
How would you treat this?
remove excessive tissue to return sulcus depth to normal
-
The image shows gingival hyperplasia
-
Etiology:
- Focal: due to periodontal disease
- Generalized: often seen in boxers
- Drugs: cyclosporine, calcium channel blockers, anticonvulsants
-
Etiology:
Shown below is a double flap technique for oronasal fistula repair. The “hinge” flap receives its blood supply from the __________ so elevation of this flap toward the fistula must be done carefully to avoid damaging the blood supply
nasal mucosa
The “hinge” flap receives its blood supply from the nasal mucosa so elevation of this flap toward the fistula must be done carefully to avoid damaging the blood supply
What anatomic landmark is used to determine where to section a multi-rooted tooth prior to extraction?
furcation
T/F: Dental scalers are used for supra- or sub-gingival calculus removal and root cleaning
False!
- A curette is used for supra- or sub-gingival calculus removal and root cleaning*
- You don’t want to risk traumatizing the junctional epithelium at the base. So dental scalers are only used supra-gingivally (ABOVE the gum line)*
Draining tract associated with the teeth is called a:
parulis
This type of opening at the mucogingival line or beyond it is most likely caused by endodontic disease. If you see it and it is coronal, it is more likely to be caused by periodontal disease
This illustration shows excision of the mandibular and sublingual salivary glands. What structure is indicated by the pink arrow? What about the cyan arrow?
digastricus muscle and lingual nerve
Retained tooth root tips usually should be removed. What are the two primary exceptions?
Type II and III tooth resorptive lesions
Root tips may be intentionally left in these cases but owner should be informed
Level bite is a Class 3 malocclusion and leads to abnormal wear on incisors commonly repaired by tertiary dentin. This type of wear is called:
attrition
What type of mandibulectomy is shown here?
central
When is a double flap technique used for oronasal fistula repair?
congenital defects and chronic fistulas where the oral mucoperiosteum has healed to nasal mucosa
What is considered the best treatment for gingivostomatitis?
Tooth extraction
the sooner, the better - and must get ALL of the tooth including the entire root(s)
What is the recommended treatment for Type 2 tooth resorption lesions?
amputate the crown and superficial root structure and leave ankylosed part of the root since it is being absorbed anyway
You can extract the entire tooth if root structure and pulp chamber are still discernable, but this is very difficult
Periodontal index of 4 means there is >____% gingival attachment loss
>50%
- Periodontal index of 4 means there is >50% gingival attachment loss*
- At this level, undoubtedly there is some pathologic tooth mobility and it is imminent that the tooth will be lost*
What diagnostic modality is required for diagnosing impacted teeth?
dental radiographs
What type of mandibulectomy is shown here?
caudal mandibulectomy
The portion of the pulp that is below the crown is the ________
root canal
Is this draining tract more likely caused by endodontic disease or periodontal disease?
endodontic disease
This type of opening at the mucogingival line or beyond it is most likely caused by endodontic disease. If you see it and it is coronal, it is more likely to be caused by periodontal disease
The most common tumor of the middle ear, inner ear, and pinna in cats is:
squamous cell carcinoma (SCC)
Gingivitis is stage ____ periodontal disease
Stage 1
Identify the area(s) of root resorption:
Identify the tragus
Most likely diagnosis?
oral melanoma
- Locally invasive
- Metastasize early to regional lymph nodes and lungs
- Gingiva > labial and buccal mucosa > palate > tongue
- Melanotic and amelanotic
What malocclusion is present in this image?
posterior cross bite
maxillary premolars are lingual to mandibular premolars or molars (they shouldn’t be)
T/F: Periodontitis is a site-specific disease
True!
T/F: There is a vaccine that is approved for the treatment of melanoma
True
When using the Triadan tooth numbering system, the canine teeth will always end with _____ and the 1st molar will always end with ____
When using the Triadan tooth numbering system, the canine teeth will always end with 04 and the 1st molar will always end with 09
The most common oral disease that we deal with in dogs and cats is:
periodontal disease
- Most common oral disease
- Present in >70-85% of dogs and cats over 3 years of age
- Number 1 cause of tooth loss
- More common now due to diet, malocclusion
What is wrong with this tooth?
pulpitis
- tooth has a purple discoloration. May be reversible, but not often. The older the patient, the less likelihood the pulp will survive.*
- Radiographs are used to determine whether the tooth is viable*
Using the Triadan tooth numbering system, what number would identify the left mandibular 4th premolar?
308
What type of mandibulectomy is shown here?
total mandibulectomy
What is the most frequent location for oral fibrosarcoma in the dog?
maxilla - caudal to the canine tooth
In this image, the mandible is too long. This is a Class ___ malocclusion
Class 3
A client comes in all flustered and freaking out. You’re all like, “Calm down, what’s going on?” and they’re all like, “YOU WON’T BE TELLING ME TO CALM DOWN WHEN YOU SEE THIS THING IN MY DOG’S MOUTH!” Then they show you this image below and you’re all like:
“Please stop speaking in all CAPS. It’s a normal structure called the incisive papilla”
What is tight lip syndrome? What breed is most commonly affected?
The lower lip is so tight that it may cover the incisors and cause trauma when the mouth is closed.
Most common in Shar Pei
What are the ‘big three’ malignant oral tumors in the dog?
- Malignant melanoma
- Squamous cell carcinoma
- Fibrosarcoma
What important anatomic structure is shown below?
mucogingival line
area where alveolar mucosa and attached gingival tissues meet
In this image, the mandible is too short. This is a Class ___ malocclusion
Class 2
Actinic keratosis is caused by actinic damage to lightly pigmented or non-pigmented, sparsely haired skin on the nose or trunk. If medical treatment fails, what treatment is indicated?
pinnectomy
Using the Triadan tooth numbering system, what number would identify the right mandibular 1st molar?
409
Disappearance of the periodontal ligament with varying degrees of root resorption occurs with Type ____ tooth resorption lesions
Type 2
- Focal or multifocal radiolucencies in tooth
- Disappearance of the periodontal ligament with varying degrees of root resorption
- No or minimal evidence of periodontitis
What is the second most common malignant oral tumor in dogs?
squamous cell carcinoma
-
Biological behavior varies with location
- Tonsillar vs. Nontonsillar
- Nontonsillar – the further caudal in the mouth the worse the prognosis
An 8 year old Doberman presents with this lesion on the maxilla, caudal to the canine tooth. What is the most likely diagnosis?
fibrosarcoma
What is the recommended treatment for Type 1 tooth resorption lesions?
extract entire tooth
Since often associated with periodontitis and endodontic disease, complete extraction is indicated
When is a lateral ear canal resection indicated in a case of otitis externa?
- When skin changes are reversible
- Tumor involving tragus or lateral wall of vertical canal
A central ameloblastoma is a non-inductive odontogenic tumor that arises from __________
dental laminar epithelium
May be cystic or multiloculated with considerable bone destruction
Gingival recession with >50% bone loss and advanced tooth mobility is categorized as Stage ____ periodontal disease
Stage 4 - Advanced Periodontitis
Crowding is seen most commonly in brachycephalic breeds. Which teeth are most frequently affected?
maxillary 3rd premolars
If this is not interfering with closing the mouth, eating, etc. and it is not causing any discomfort, this does not need to be specifically addressed
Name three treatment options for attrition
- orthodontic correction
- crown reduction
- extraction
T/F: Maxillectomies are typically associated with more hemorrhage than mandibulectomies
True
especially if nasal turbinates are affected
Dryness of the mouth is termed:
xerostomia
Using the Triadan tooth numbering system, what number would identify the left maxillary canine?
204
Abrasions are caused by abnormal contact with crown surface by foreign object (tennis balls, cages, rocks, etc.). How do you treat this?
remove offending objects and monitor pulp exposure and crown fractures
- You must establish if there is endodontic exposure! Probe with explorer. If it enters the chamber, then you must extract or do a root canal!*
- Reparative dentin is brown and hard*
You note this abnormality in your patient’s mouth. It has a soft leathery appearance and a brownish color. What is your diagnosis?
dental caries
-
Treatment:
- Indirect or direct pulp capping
- Root canal
- Extraction
Anterior cross bite is considered a Class ___ malocclusion
Class 1
This cat presented with ptyalism, halitosis, dysphagia, anorexia, and weight loss. What is your diagnosis?
gingivostomatitis
-
Etiology: unknown
- Calicivirus, bacterial, or immunological - “allergic to plaque”
- Siamese, Abyssinians, Persians, Himalayans, Burmese
-
Signs
- Ptyalism, halitosis, dysphagia, anorexia, weight loss
- Diagnosis: Histopathology, clinical signs, typical history
What are the four major salivary glands in the dog?
parotid, mandibular, sublingual, zygomatic
Which salivary gland is most commonly affected with salivary mucocele?
sublingual
removing the polystomatic portion of the sublingual salivary gland is an important part to consider for treatment
What instrument is used to assess access into the pulp cavity and assess for dental caries lesions?
periodontal probe/explorer
What type of mandibulectomy is shown here?
3/4 mandibulectomy
This radiograph shows ________ formation due to an un-erupted canine tooth
cyst
What are the top four systemic antibiotics that are used for treatment of periodontal disease?
- Clindamycin
- Clavamox
- Metronidazole
- Doxycycline
Keep in mind that we don’t always use antibiotics!
Would you say this is a very young animal or a very old animal?
very young animal
The pulp chamber is huge and the wall of the tooth is very narrow
T/F: Marsupialization is the treatment of choice for ranulas
False
- Marsupialization is a salvage procedure for high risk patients (poor anesthesia candidates, etc.).*
- The treatment of choice for a ranula is surgical excision of the mandibular and sublingual salivary glands*
The periodontal ligament remains intact with what type of tooth resorption lesion?
Type 1
- Focal or multifocal radiolucencies
- Periodontal ligament remains intact
- Moderate to severe gingivitis and periodontitis
- Very frequently associated with periodontal disease
Subcutaneous (submucosal) accumulation of saliva within a nonepithelial, nonsecretory lining is descriptive of:
salivary mucocele
What is the difference between a complicated and an uncomplicated tooth fracture?
- Complicated: pulp exposed
- Uncomplicated: pulp not exposed
The picture shows a 3.5 month dog with a fractured canine tooth resulting in exposure of the pulp chamber. The most appropriate treatment for this case is:
extraction
What type of tooth resorption lesion is present here?
Type 2
- Focal or multifocal radiolucencies in tooth
- Disappearance of the periodontal ligament with varying degrees of root resorption
- No or minimal evidence of periodontitis
T/F: With regard to non-tonsilar squamous cell carcinoma, the more caudal the tumor is in the mouth, the better the prognosis
False
The more caudal the tumor is in the mouth, the worse the prognosis. Tumors in the caudal part of the mouth are often larger at Dx making it more difficult to get adequate margins.
T/F: Supernumerary teeth are most often incisors and/or premolars
True
- More commonly seen in the premolars*
- **Remove supernumerary teeth if causing malocclusions***
Identify the areas of horizontal bone loss:
An odontoma is an inductive odontogenic tumor and can be classified as compound or complex. How would you classify the odontoma shown below?
compound odontoma
- Compound odontomas contain tooth structures in various stages of development. With complex odontomas, dental tissues are not differentiated enough to resemble teeth*
- (I would be able to ID this picture)*
What is the most common site for a lip avulsion?
mucogingival junction
- Suture reconstruction is effective for maxillary lesions*
- Reconstruction of lower lip often fails because of the weight of lip (in this case, place interdental stent sutures to support weight of lip first, then suture mucogingival junction*
Name two salvage procedures for uncorrectable palatal defects:
acrylic appliances and nasal septal button
T/F: Enamel is not replaced if it is damaged
True
How do you manage inflammatory polyps?
traction extraction or ventral bulla osteotomy
-
Traction extraction
- Although traction has been used to remove masses when there is no evidence of otitis media, performing a ventral bulla osteotomy in conjunction with this procedure is recommended to decrease the recurrence rate.
- If traction-avulsion alone is used, concurrent treat- ment with an antiinflammatory
-
Ventral bulla osteotomy
- Most commonly done in cats for polyps
- The best results are seen when a ventral bulla osteotomy is performed; with this procedure, the recurrence rate is less than 2%. Ventral bulla osteotomy should always be performed if middle ear disease is evident on radiography or CT.
Tetracycline given when teeth are developing will stain them ________
yellow
dentin is the affected layer
No treatment is needed except for cosmetics - can be bleached or resin bonded. Doxycycline is much less of a problem than tetracycline
What is the most common complication associated with gingivectomy?
generation of excess heat, causing alveolar necrosis
this is the result of not fully understanding the surgical method (electrosurgery, radiosurgery)
This cat presented to the emergency room with episodes of severe oral bleeding. What structure are we concerned about in this area of the mouth when we see ulceration?
greater palatine artery
this is where the greater palatine artery comes into the oral cavity, so watch out for erosion through this artery!
Identify the anthelix
Using the Triadan tooth numbering system, what number would identify the right maxillary carnassial tooth?
108
