Surgery of the Oral Cavity - Exam 1

Question 1

What are surgical features of a Flap in oral surgery?

Answer 1

Preserve blood supply

Movilization

Minimize trauma

Place suture lines over supporting underlying tissue whenever possible

Flap needs to be 2-4mm larger than the defect

Dobule layer closure is preferable

anchor to bone whenever possible

Question 2

What type of suture is most commonly used in oral surgery?

Answer 2

Monofilament absorbalbe suture

Question 3

What are some general postoperative considerations of Oral surgery?

Answer 3

AVoid aspiration of blood

Monitor for signs of airway obstruction

Delay oral intake for 12-24 hours

Soft food for some time

Alway warn owners that dehiscence can occur

Question 4

What is the term for an endotracheal tube that bypasses the oral cavity

Answer 4

Pharyngototomy intubation

Pharyngostomy- placed caudal to epihyoid bone

Question 5

What are common regional nerve blocks?

Answer 5

Infraorbital nerve blocks

Maxillary nerve block

Rostral Mandibular nerve block

Inferior alveolar nerve block

Question 6

Lip laceration repair

Answer 6

Primary repair

Convert to a triangular defect

2 layer closure

Question 7

What is Lip avulsion?

Answer 7

this is the separation of the soft tissue from the mandible often secondary to a HBC case

Question 8

How to fix lip avulsions?

Answer 8

Small- heal by secondary intention

Large avulstions- primary repair

AChor around incisors or make bone tunnels

2-0 to 4-0 monofilament absorbalbe

Question 9

How much of a glossectomy is tolerated in dogs? Cats?

Answer 9

40-60% amputation will be tolerated in dogs

Cats are much less tolerated

Animals can learn how to eat and drink with some assistance, should use a feeding tube for post op period

• apposition of mucosa

Question 10

Congenital oronasal fistula- Cleft palate

Answer 10

This is an abnormal communication between oral and nasal cavities

Question 11

What is a congenetal oronassal fistula that is considered Primary Palate?

Answer 11

Lip+ premaxilla

Question 12

What is a congenital oronasal fistula that is considered secondary palate?

Answer 12

This includes the hard and soft palate

Question 13

What is the critical time period for a congenital cleft palate?

Answer 13

25-28d of gestation is the critical time.

this is poorly understood if it is inherited, nutritional etc.

primary and secondary clefts can occur together

Question 14

How to treat a Congenital cleft Palate?

Answer 14

Chest radiographs to detect pneumonia

Dedicated nursing care via tube feeding

Surgical treatment needed in most cases- delay until 8-12 w if possible

Question 15

What are the principles of a Cleft palate repair

Answer 15

Tension- free closure

Support suture lines

Flaps typically used

• Flap harvest sites heal by secondary intention

Question 16

What is the techniques utilized when repairing a cleft palate?

Answer 16

Sliding bipedicle flaps (one flap on each side of defect)

Overlapping flap - create flap on one side and oppose it with the margin of the defect on the opposite side

Question 17

What are surgical repair techniques utilized in soft palate repair

Answer 17

Incision at each margin.

Separation of muscle from mucosal layers

Lateral release incisions

3 layer closure - nasal mucosal, palatal muscle, oral mucosa

Question 18

What are common causes of an acquired oronasal fistula?

Answer 18

Trauma

dental disease - tooth root abscess, dental extraction

Dehiscence followign surgery

Neoplasia

Radiation therapy

Question 19

What are principles of surgical repair of acquired oronasal fistula

Answer 19

Tension free closure

Support suture lines

Flaps typically used - preserve blood supply

Utilize a double flap closure when possible similar to cleft palate repair.

Question 20

What are indications for a Mandibulectomy/Maxillectomy in a dog?

Answer 20

Malignant melanoma

SCC

Fibrosarcoma

Epulides/Ameloblastoma

Question 21

What are indications of a Maxillectomy/Mandibulectomy in a cat

Answer 21

Squamous Cell carcinoma

Fibrosarcoma

Question 22

When doing a maxillectomy, what do you anchor the deep layer of the suture to?

Answer 22

Anchor the deep layer to the hard palate

Question 23

What do cats tolerate more: Mandibulectomy or Maxilectomy?

Answer 23

Maxelectomy

Question 24

What are examples of malignant canine oral masses?

Answer 24

Malignant melanoma 30-40%

Squamous Cell Carcinoma 17-25%

Fibrosarcoma 7.5-25%

Osteosarcoma 6-18%

Question 25

What are examples of a malignant oral mass in Cats?

Answer 25

Squamous Cell Carcinoma!

Fibrosarcoma

Question 26

Explain the incidence/severity of an Oral Malignant Melanoma

Answer 26

Most common oral tumor in a dog

High rate of metastasis

Treatment: Aggressive resection in surgery

Radiation- responds very well

Question 27

Oral Masses SCC in a dog

Answer 27

2nd most common oral tumor in dogs

Large breeds overrepresented

Common in: gingiva, bucal or labial mucosa, hard palate, tongue, tonsils

Bony lysis common 77% of the time

Metastasis to lymph nodes <10% lung 3-36%

Tongue and tonsillar SCC have a higher metastasis rate

Question 28

Benign Oral masses in canine

Answer 28

Peripheral odontogenic fibroma

Focal Fibrous Hyperplasia

Canine Acanthomatous Ameloblastoma (locally invasive but not metastatic)

Question 29

Oral masses in a cat

Both metastatic and benign

Answer 29

Squamous Cell Carcinoma is the most common oral tumor

• metastasis is rare, but is hgihly invasive
• Extensive bone involvement

Fibrosarcomas are the 2nd most common oral tumor in cats

Eosinophilic granuloma - benign allergic/autoimmune