Surgery of the Oral Cavity - Exam 1 Flashcards
What are surgical features of a Flap in oral surgery?
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
What type of suture is most commonly used in oral surgery?
Monofilament absorbalbe suture
What are some general postoperative considerations of Oral surgery?
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
What is the term for an endotracheal tube that bypasses the oral cavity
Pharyngototomy intubation
Pharyngostomy- placed caudal to epihyoid bone
What are common regional nerve blocks?
Infraorbital nerve blocks
Maxillary nerve block
Rostral Mandibular nerve block
Inferior alveolar nerve block
Lip laceration repair
Primary repair
Convert to a triangular defect
2 layer closure
What is Lip avulsion?
this is the separation of the soft tissue from the mandible often secondary to a HBC case
How to fix lip avulsions?
Small- heal by secondary intention
Large avulstions- primary repair
AChor around incisors or make bone tunnels
2-0 to 4-0 monofilament absorbalbe
How much of a glossectomy is tolerated in dogs? Cats?
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
Congenital oronasal fistula- Cleft palate
This is an abnormal communication between oral and nasal cavities
What is a congenetal oronassal fistula that is considered Primary Palate?
Lip+ premaxilla
What is a congenital oronasal fistula that is considered secondary palate?
This includes the hard and soft palate
What is the critical time period for a congenital cleft palate?
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
How to treat a Congenital cleft Palate?
Chest radiographs to detect pneumonia
Dedicated nursing care via tube feeding
Surgical treatment needed in most cases- delay until 8-12 w if possible
What are the principles of a Cleft palate repair
Tension- free closure
Support suture lines
Flaps typically used
- Flap harvest sites heal by secondary intention
What is the techniques utilized when repairing a cleft palate?
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
What are surgical repair techniques utilized in soft palate repair
Incision at each margin.
Separation of muscle from mucosal layers
Lateral release incisions
3 layer closure - nasal mucosal, palatal muscle, oral mucosa
What are common causes of an acquired oronasal fistula?
Trauma
dental disease - tooth root abscess, dental extraction
Dehiscence followign surgery
Neoplasia
Radiation therapy
What are principles of surgical repair of acquired oronasal fistula
Tension free closure
Support suture lines
Flaps typically used - preserve blood supply
Utilize a double flap closure when possible similar to cleft palate repair.
What are indications for a Mandibulectomy/Maxillectomy in a dog?
Malignant melanoma
SCC
Fibrosarcoma
Epulides/Ameloblastoma
What are indications of a Maxillectomy/Mandibulectomy in a cat
Squamous Cell carcinoma
Fibrosarcoma
When doing a maxillectomy, what do you anchor the deep layer of the suture to?
Anchor the deep layer to the hard palate
What do cats tolerate more: Mandibulectomy or Maxilectomy?
Maxelectomy
What are examples of malignant canine oral masses?
Malignant melanoma 30-40%
Squamous Cell Carcinoma 17-25%
Fibrosarcoma 7.5-25%
Osteosarcoma 6-18%
What are examples of a malignant oral mass in Cats?
Squamous Cell Carcinoma!
Fibrosarcoma
Explain the incidence/severity of an Oral Malignant Melanoma
Most common oral tumor in a dog
High rate of metastasis
Treatment: Aggressive resection in surgery
Radiation- responds very well
Oral Masses SCC in a dog
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
Benign Oral masses in canine
Peripheral odontogenic fibroma
Focal Fibrous Hyperplasia
Canine Acanthomatous Ameloblastoma (locally invasive but not metastatic)
Oral masses in a cat
Both metastatic and benign
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
