SOFT TISSUE SX: 3, 4,5 Flashcards
What is maxillectomy?
Surgical removal of part or all of the maxilla (upper jaw)
Important surgical procedure in oral surgery
What is mandibulectomy?
Surgical removal of part or all of the mandible (lower jaw)
Key surgical procedure in oral surgery
What is glossectomy?
Surgical removal of part or all of the tongue
Significant surgical procedure in oral surgery
What is cheiloplasty?
Surgical repair of the lips
Important for addressing lip-related conditions
Define sialocele.
submucosal/subcutaneous collection of saliva from leakage of gland or duct
A common condition addressed in oral surgery
What are some common aetiologies of sialocoele?
usually idiopathic
trauma
inflammation
Important for diagnosis and treatment
What is the most common site of leakage for sialoceles?
Sublingual gland duct
Key location in understanding sialocele etiology
What are clinical signs of a sialocele?
Fluctuating swelling, dysphagia, oral bleeding, hypersalivation, respiratory obstruction
Important for diagnosis
How is a sialocele diagnosed?
Clinical signs, aspiration of honey-colored mucin, contrast radiography (sialogram)
Diagnostic techniques for sialoceles
What is the treatment for a subcutaneous sialocele?
Sialoadenectomy (surgical removal of the affected salivary gland complex)
Typically involves the submandibular salivary gland complex
What is a ranula?
What is the treatment for a ranula?
ranula: sublingual sialocele
tx: marsupialisation (creating opening to allow drainage) +/- dialoadenectomy
Define oronasal fistula.
Communication between the oral and nasal cavity
Significant condition requiring surgical intervention
What are clinical signs of an oronasal fistula?
Chronic rhinitis, nasal regurgitation of food, aspiration pneumonia, malnutrition
Symptoms indicating a serious condition
What are common causes of oronasal fistulas?
Dental disease, trauma, neoplasia
Important for understanding etiology
What is the surgical repair outlook for oronasal fistulas?
Often has high failure rates and may warrant referral
Indicates complexity of the procedure
What are the 2 types of cleft palates discussed?
Congenital and acquired
Each type has different management requirements
What is the typical surgical approach for CONGENITAL cleft palates?
Usually require referral due to complexity
Specialized care is often needed
What is the surgical management focus for ACQUIRED cleft palates?
Stabilizing maxillary fractures and closing the defect in 2 or 3 layers
More amenable to repair than congenital cases
What is the most common cause of penetrating oropharyngeal injuries?(physical object)
sticks
Other causes include hook, needle, bone, or grass awn
What are ACUTE clinical signs of penetrating oropharyngeal injuries?
CHRONIC signs?
A: Dysphagia, blood-tinged saliva, pain, pyrexia, pyothorax, mediastinitis
C: Swelling/abscess, sinus tracts(connects infection to skin surface)
Indicates urgent surgical intervention may be required
What is coeliotomy?
Any incision into the abdominal cavity
Coeliotomy is a general term that encompasses various surgical procedures involving the abdominal cavity.
What does laparotomy specifically refer to?
Incision through muscle into abdomen
flank incision or paracostal approach
Laparotomy is a more specific type of coeliotomy that involves cutting through muscle layers.
What is acute abdomen?
Sudden onset abdominal pain,,, catastrophic abdominal pathology,,, immediate stabilization followed by early surgical intervention
Acute abdomen is a critical condition that requires prompt medical attention.
What are the 2 categories of abdominal surgery?
elective and emergency
These indications cover a range of conditions that necessitate surgical intervention.
What is the linea alba?
What are the two connection points of the linea alba?
What muscle is located on either side of the linea alba?
fibrous band
extending from the xiphoid to the prepubic tendon
located between the rectus abdominis muscles
The linea alba plays a crucial role in abdominal surgeries.
Is the rectus sheath thickest cranially or caudally?
thickest caudally
This layer is essential for ensuring the strength of the surgical closure.
What are the 3 surgical approaches for a coeliotomy?
- ventral midline coeliotomy
- flank laparotomy
- paracostal laparotomy
What is the primary surgical approach discussed for coeliotomy?
Ventral midline coeliotomy
This approach is emphasized due to its effectiveness for exploratory surgeries.
What are the two approaches to a ventral midline coeliotomy?
organ centered approach & full exploratory coeliotomy
Fill in the blank: The surgical site should be clipped from the mid-sternum to beyond the _____ and up to the _______.
beyond the pubis
up to the flank folds
What are additional considerations in a ventral midline ceoliotomy in a male?
prepuce should be avoided, preputial muscle will be cut and vessels that provide blood supply to it must be ligated
Which specific vessel is present (& must be ligated?) in a ventral midline coleiotomy of a male?
preputial branches of CAUDAL SUPERFICIAL EPIGASTRIC artery and vein
What should be done if peritoneal fluid is present during a coeliotomy?
Samples should be taken for cytology and culture
This helps in diagnosing potential infections or other issues.
What organs are found in the cranial quadrant of the abdomen?
- Diaphragm
- Liver
- Gall bladder
- Stomach
Knowledge of organ locations is important for surgical navigation.
What is the first layer of closure in coeliotomy?
Layer 1: linea alba - external rectus sheath - main holding layer - simple interrupted or continuous patterns - monofilament, synthetic absorbable suture material
Proper closure technique is vital to prevent complications.
What organs are present in the right gutter of the abdomen (the mesoduodenal sling)?
right limb pancreas
kidney
adrenal
portal vein
vena cava
ureter
ovary
What organs are present in the left gutter of the abdomen? (the mesocolic sling)
kidney
ureter
ovary
adrenal gland
What organs are present in the central abdomen?
omentum
spleen
left limb of pancreas
What organs are present in the caudal quadrant of the abdomen?
colon
reproductive tract
bladder
urethra
prostate
inguinal rings
What are 4 factors to be assessed when exploring intestines in the abdomen?
color, peristalsis, pulses, mesenteric lymph nodes
What is the order of layer closures in a coeliotomy?
- linea alba (external rectus sheath)
- subcutaneous tissue
- skin
Fill in the blank: Moistened swabs and _______ are used to prevent tissue desiccation during surgery.
saline lavage with suction
What is Gastric Dilatation-Volvulus (GDV)?
The stomach is rotated on which axis?
Enlargement of the stomach associated with rotation on its mesenteric axis
GDV involves both distension and rotation.
What is Simple Dilatation?
A stomach engorged with air or froth, but without malpositioning
This differs from GDV.
What are 2 other names for GDV?
- Gastric torsion
- Bloat
What is the difference between a GDV and a simple dilatation?
GDV: enlargement AND rotation on mesenteric axis
simple dilatation: engorged with air&froth but NOT malpositioned
Why is GDV an acute abdominal CRISIS?
[keep in mind, not every volvulus/dilatation is a GDV]
can rapidly develop dyspnoea, shock, gastric necrosis and perforation,
A GDV stomach will fill with which two things?
Why?
stomach dialates with gas
stomach fills with fluid
[dont know if this is right!]
How does the stomach typically rotate in GDV?(directionally)
How many degrees? (range)
Clockwise between 90 and 360 degrees
Which direction does the pylorus typically rotate in a GDV?
ventrally & left (clockwise)
Which direction does the fundus typically rotate in a GDV?
to the right
What happens to the spleen during GDV?
The spleen is displaced in the direction of the stomach to the right dorsal due to the gastrosplenic ligament
What are local effects of GDV?
- Increased intra-gastric pressure
- Venous congestion
- Mucosal hypoxia
- Tissue ischemia and gastric wall necrosis
What type of shock does GDV cause?
obstructive
however it can cause the other ones!
What cardiovascular effects can GDV cause?
- Reduced venous return to the heart
- Reduced circulating blood volume
- Cardiac arrhythmias
- Shock
What respiratory issues can arise from GDV?
Diaphragmatic compression leads to breathing difficulties
What are intrinsic risk factors for GDV?
- Breed
- Conformation
- Genetics
What type of breed is predisposed to GDV?
deep-chested large breeds
Which small breed dog is predisposed to GDV?
Which cat breed?
basset hound
persian cat
What are 4 extrinsic risk factors for GDV?
- Diet [feeding one large meal a day]
- Familial predisposition
- Age [most commonly in >7y/o dogs]
- Previous episode [80% recurrence rate without pexy]
What dietary practices are recommended for high-risk dogs?
Which of these following dietary practices have weak supporting evidence?
- Feed several small meals a day rather than one large meal
- Avoid stress during feeding
*consider prophalactic gastropexy - Restrict exercise before and after meals
- Don’t use elevated feed bowls
last 2 have weak evidence
What is the typical clinical presentation of GDV?
- rapid onset persistent, vomiting of froth/fluid
- Tympanic abdomen
- Collapse
Should a radiograph to diagnose GDV be taken on right laterla or left lateral?
right lateral
this is a right lateral radiograph of GDV. describe the issue/abnormality
soft tissue line separating two gas-filled compartments of the stomach
should only be one compartment
should not have the soft tissue line
should not be THAT distended and gas-filled
[think popeye]
this is a radiograph of a GDV. describe the abnormality
compartmentalisation of the stomach (two gas filled bubbles instead of one. there should only be one)
Can the passage of an orogastric tube be used to differentiate GDV and GD without V?
no
What are the two immediate steps for patient stabalisation in a GDV?
fluid resuscitation
gastric decompression
What type of fluds should be administered for GDV?
crystalloid fluids
At what rate should fluids be administered for a GDV?
shock rate (not gradually)
90 mL/kg per hour
10- 20 mL/kg over 10-20 mins
What is the primary goal of surgical intervention in GDV?
Decompress and reposition the stomach
What are two techniques used for decompression in a GDV?
Which is preferred?
orogastric tube[preferred]
percutaneous decompression
What is the purpose of placing an orogastric tube in a GDV?
empty stomach: remove fluid and food from stomach
What are reasons that placement of an orogastric tube may not be possible?
patient behavior: will they bite? will they ingest the tube?
What is percutaneous decompression
placing a large wide needle in stomach to remove gas
What are four techniques used for patient stabalisation in a GDV? [other than direct treatment]
analgesia
oxygen
IV antibiotics [4 possible sepsis]
therapy for arrythmias
If you are unalble to IMMEDIATELY perform surgeyr on a GDV, what should you do instead?
focus on stabilisation and decompression. surgery can be performed later
What are the 3 goals of GDV surgery?
- decompress n reposition stomach
- assess stomach and spleen for necrosis
- prevent recurrence
Which region of the stomach is most likely to get necrosis due to GDV?
greater curvature
Is splenectomy often necessary for GDV?
no
What is a common surgical technique to prevent recurrence of GDV?
Gastropexy
Without gastropexy, what percent of GDV cases will reoccur?
50-80%
In an incisional gastropexy, an adhesion should be formed between which two GI regions?
pyloric antrum & right body wall [just behind last rib]
If a gastrostomy tube is being placed for GDV gastropexy, where should it be placed?
What if it is being placed as a stomach tube for feeding?
gastropexy for GDV: tube in pylorus
stomach tube for feeding: tube in fundus
What are the steps for a tube gastrostomy for a GDV?
pull tube through right body wall
place purse string around the area of stomach we want to incise
feed tube into gastric lumen
tie purse string
place pexy sutures
secure externally with finger trap suture
a tube gastrostomy for GDV should remain in for how long?
7 days before being removed
What are early post-operative complications of GDV surgery?
- Cardiac arrhythmias
- Gastric wall necrosis
- Peritonitis
What are long-term complications after GDV surgery?
- Gastric hypomotility
- Recurrence (5-10% after pexy)
What is the survival rate associated with gastric necrosis?
66%
What is the survival rate when the gastric wall is intact after GDV surgery? (no necrosis)
90-95%
