Surgery of the oral cavity, pharynx + oesophagus

Question 1

What are primary and secondary cleft palate? What breeds are predisposed?

Answer 1

• Primary cleft palate – harelip = Failure to fuse of lips and premaxilla (primary palate)
• Secondary cleft palate = Failure to fuse of hard and soft palates (secondary palate)
• Commoner in brachycephalic dogs and Siamese cats

Question 2

What are clinical signs of secondary cleft palate?
When should surgery be carried out?

Answer 2

• Drainage of milk from nares
• Cough / sneeze / gagging while eating
• Difficulty suckling
• Aspiration pneumonia
• Delay surgery until 8-12wk old if possible
• Repair with variety of flaps

Question 3

What are complications of secondary cleft palate?

Answer 3

• Dehiscence
• May recur as animal grows
• Some animals have chronic rhinitis

Question 4

What is salivary mucocoele? Where can it form? What causes it?

Answer 4

• Commonest disease of canine salivary glands
• Sublingual gland most often affected
• Form in different locations =
• Sublingual mucocoele (ranula)
• Pharyngeal mucocoele
• Cervical mucocoele
• Due to trauma, sialolith, neoplasia, foreign body, iatrogenic: most idiopathic

Question 5

What should be done if you perform maxillectomy / mandibulectomy?

Answer 5

• Often need supportive treatment / feeding post-op

Question 6

What are clinical signs of salivary mucocoele?
What are Ddx?

Answer 6

• CS =
• Painless fluctuant swelling
• Dysphagia, ptyalism, blood in saliva with sublingual mucocoeles
• Inspiratory stridor, coughing or respiratory distress with pharyngeal mucocoeles
• Differential diagnoses =
• Other causes of salivary gland enlargement
• Other causes of cervical/oropharyngeal swelling

Question 7

What is the significance of nasopharyngeal polyps in cats?
Dx? Tx?

Answer 7

• Benign inflammatory polyps of pharynx / middle ear / auditory tube
• Cause URT obstruction (dysphagia / dysphonia), Otitis Externa +/- Horner’s syndrome
• Diagnose by observation or radiographs
• Treat by traction removal +/- VBO or corticosteroids
• May recur if not completely removed or underlying cause uncontrolled

Question 8

How can you diagnose a salivary mucocoele?
Tx?

Answer 8

• Fine needle aspirate
• Stain with periodic acid-schiff (PAS)
• Contrast X-ray to diagnose what gland it’s in
• Tx = remove the gland that’s producing the mucocoele

Question 9

What is seen with pharyngeal stick injuries?
How is it diagnosed?
What should be done?

Answer 9

• CS = Acute onset of gagging, Headshaking, oral/jaw pain, hypersalivation, swelling
• Dx = examination, radiographs, US, FNA
• Tx = remove FB / fragments, debride, arrest haemorrhage, leave open to heal
• medical Tx w analgesia / antibacterials

Question 10

Why would you perform tonsillectomy? What are the 2 techniques?

Answer 10

• Tonsillitis
• Neoplasia
• Two techniques =
• Sharp excision with individual ligation of vessels
• Bulk ligation of pedicle then sharp excision

Question 11

What animals do oesophageal foreign bodies tend to affect? What are the objects?

Answer 11

• Usually <3y/o
• Bones in dogs
• Fishhooks, needles, thread/string in cats

Question 12

What are the 3 places for oesophageal foreign bodies?

Answer 12

• Thoracic inlet
• Heart base
• In front of cardia

Question 13

What should be done after removal of oesophageal FB? What are complications?

Answer 13

• Check oesophageal lining
• surgery if =
  -Perforations/fistulae
  -Can’t remove endoscopically
• Complications =
  -Oesophagitis
  -Dehiscence & infection, fistula
  -Stricture
  -Vascular injury

Question 14

What are vascular ring abnormalities?
CS?
How is it treated?

Answer 14

• Aortic arches encircle + constrict oesophagus + trachea
• Persistent right aortic arch
• CS = Present at weaning with regurgitation of solid food + cranial megaoesophagus
• Tx = ligation / division of least important vessel forming ring