Sx of oral and maxillofacial surgery in dogs Flashcards
Context of jaw /face fractures?
Trauma - pathologic fractures: small or toy breeds + soft food + Poor prophylaxis
Physical exam of oral fractures?
Excessive drooling
Blood-tinged saliva
Pain
Crepitus
Reluctant to eat
What diagnostics for fractures?
- X- Rays: At least 4 views.
- CT scan: gold standard
List some treatment options for jaw fracts?
- Muzzle therapy
- Cerclage wire
Epoxy resin+/- ESF pins
What are different open surgery approaches ?
- Symphysis and body (rostral / incisive)
- body
- Ramus
- Temporomandibular joint
- Intraosseous wirte fixation of incisive, nasal and maxillary
- Mini Paltes
What complications can occur?
- Delayed union and nonunion
- Malunion
- Wound infection
- Osteomyelitis
- Maloclussion
Describe Lip Avulsion?
Associated to trauma (as already seen).
Median age: 22 months
Median weight (dog) 8.3kg
Debridement + Lavage
Suture choice for lip avulsion?
Poliglecaprone 25
Repair of lip avulsion?
a) Chin mattress
b) Interrupted horizontal mattress
c) Holes + interrupted
d) Wires
drain?
what different repair options for facial soft tissue injuries ?
Describe maxillofacial tumours ?
- 6% of all canine tumours. Less frequent in cats.
- Generally unnoticed.
- General exam: Size, location, ulceration, necrosis, teeth mobility. Lymph nodes (LN).
- Staging: e.g. TNM-system (T= Extent of the primary tumour; N = LN involvement; M = Metastasis.
Diagnostics for maxillofacial tumours?
What 5 types of maxillofacial tumours ?
A. Malignant melanoma
B. SCC
C. Fibrosarcoma
D. Osteosarcoma
E. Papillomatosis
Malignant melanoma?
Most common (or 2nd most common)
malignant oral tumour.
Can also
appear around the lips/cheecks
74% regional LN metastasis rate
65% pulmonary metastasis rate
Male>Female 3:1-6:1
Spaniels or dogs with dark mucosas.#
Cats: rare
SCC?
41.5% of oropharyngeal tumours in dogs
No sex or breed predilection (Lingual: females, poodles, labradors)
Tonsils or gingiva
Locally invasive but lower metastatic rate
Fibrosarcoma ?
- Gingiva
- 72 % bone lysis
- 10% Distant metastasis (lungs)
- Golden retreivers (52%)
Osteosarcoma ?
- Appendicular > Axial skeleton -> skull
- Medium - large breeds
- Middle-old age
Papillomatosis
16% of all oral tumours in dogs.
4-8 weeks incubation + rapid growth +
regression (4-8 weeks)
what surgical principles to consider with maxilofacial tumours?
Anaesthesia and analgesia
Surgical margins
Positioning → visibility
Blood supply
Tension Free
Beware of the complications: bleeding, infection, dehiscence
What different techniques for maxillofacial tumours?
- Intracapsular excision
- Marginal excision
- Wide excision
- Radical excision
What different types of mandibulectomies can you do?
What types of maxillectomies can you do?
Complications from maxilofacial tumour surgery ?
- Facial swelling
- Sublingual swellings
- skin over maxillectomy may rise/ fall with respiration
- Dehisence common -> 2nd intention healing
- oronasal fistula
- Damage to tooth root -> excision
- Tongue fall out of mouth/ drooling
- Mandibular drift lower canine traumatise palate )> can extract but rarely needed
- IF remove both bodies of mandible will require lifelong hand feeding
What about tongue options?
Tonsils?
Dogs: SCC, lymphosarcoma
- highly metastatic local LN and distant lungs
- MSt 1 months
- tonsilitis often self limiting
When do we do a cheiloplasty?
Lip fold oedema -> Ulceration +/_ halitosis. +/- pruritus
Who gets lip fold yo?
St bernard, schnauzers, brachys, spaniels and setter
What to do before surgery for cheiloplasty?
Acetic + Boric Acid + Consider ABS
Does a congenital cleft palate tend to affect primary or secondary palate?
Secondary (hard and soft)
What does this cause?
→ Failure to create -ve pressure during sucking → unnoticed initially
→ Milk draining from nares, coughing, aspiration pneumonia, failure to thrive
Management of cleft palate?
Check for aspiration pneumonia (rads)
Tube feed until 8 weeks (tissue friable)
Do not leave older than 4-5 months as palate may widen
Often euthanised
describe Acquired oronasal fistula?
a) Trauma, surgery, infection
b) Traumatic cleft palate in cats with malalignment of midline maxillary dental
arch
c) Following dental surgery
d) Foreign body
General considerations of palate surgery?
- delicate tissue handling
- Avoid electrocautery
- NO TENSION
- Suture lien not directly over defect
- Soft food 14 days -> may need O tube
- No chew toys, rough play, may need muzzle/ BC
- Dehisence major complications - >may need multiple surgeries
- Broad spec AB appropriate
- Analgesia
Hx and Signs of Oropharyngeal Trauma
Hx: trauma, vocalization.
* Signs: ptyalism, depression, pain with cervical flexion or opening the mouth, bloody saliva, and
collapse.
Damage depending on angle of the stick?
Frontal→ damages soft palate and dorsal pharynx and can lacerate the oesophagus
Acute angle → penetrates the pharynx at the tonsil or just behind the last molar.
Temporal, masseter or retrobulbar damage.
Oblique → parapharyngeal & cervical tissues, intermandibular area or cranial thorax
Tx for stick injuries (acute vs chronic)
A) Acute: Examination of the oral cavity and pharynx + identify the site of injury and to
retrieve any foreign material
B) Chronic: Difficult to treat. meticulous exploration of tracts and debridement of all
diseased tissue remove all the diseased tissue and hopefully the foreign material with it.
