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Oral, Pharyngeal and Aural surgery > The Mandible and Maxilla > Flashcards

The Mandible and Maxilla Flashcards

1
Q

Cat vs dog - who tolerates mandibulectomy/maxillectomy more?

A

Dog

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2
Q

What are the 4 components of the mandible?

A

Right and left half – hemi-mandible

Horizontal component – body

Vertical component – ramus.

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3
Q

What joins the two halves of the madible at the rostral aspect?

A

Fibrous symphysis

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4
Q

The vascular supply to the mandible comes from? A branch of what?

A

inferior alveolar artery, a branch of maxillary artery.

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5
Q

Where dos the inferior alveolar a. enter the mandible? Travel and exit?

A

This enters through the mandibular foramen on the medial aspect of angle of the mandible, travels rostrally within the marrow cavity of the mandible and exits laterally through the mental foramen just caudal to the canine tooth

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6
Q

Which artery must be cauterised or ligated and transected during mandibulectomy?

A

mandibular artery

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7
Q

What provides sensory innervation to the mandible and lower teeth?

A

mandibular nerve (a branch of trigeminal)

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8
Q

How does the mandibular nerve (a branch of trigeminal) course? and change?

A

entering at the mandibular foramen, coursing rostrally as the inferior alveolar nerve through the marrow cavity and exiting at the mental foramen as the mental nerve.

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9
Q

The ducts of the mandibular and sublingual salivary glands run where in relation to the body of the mandible

A

medial

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10
Q

The ducts of the mandibular and sublingual salivary glands open where?

A

Sublingual papilla

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11
Q

What happens if you transect The ducts of the mandibular and sublingual salivary glands during mandibulectomy?

A

Not a concern

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12
Q

3 bones of the maxilla?

A

Maxillary
Incisive (premaxilla)
Nasal

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13
Q

What teeth are containe in the:
A) Maxillary bone?
B) Incisive bone?

A

A) Canines, premolars, molars
B) Incisors

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14
Q

The vascular supply of the maxilla comes from branches of?

A

Maxilary artery

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15
Q

Where does the major palatine a. run ?

A

Through the caudal nasal cavity and caudal portion of the hard palate before running rostrally, ventral to hard palate, midway between the midline and the maxillary teeth.

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16
Q

Where does the infraorbital a. run, pass and exit?

A

Runs through the caudal nasal cavity dorsal to the major palatine artery, passing through the maxillary foramen and infraorbital canal of the maxilla, exiting at the infraorbital foramen just rostral to the carnassial tooth.

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17
Q

Which vessels may be ligated/transected in a maxxilectomy?

A

Both the major palatine artery and the infraorbital artery

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18
Q

The nerve supply to the maxilla is from the ? that supplies the teeth?

A

infraorbital nerve (a branch of the maxillary nerve)

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19
Q

Where will the infraorbital a. be transected in a maxillectomy?

A

within the infraorbital foramen

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20
Q

The parotid salivary gland duct terminates where?

A

At a papilla just lateral to the fourth upper pre-molar tooth and the zygomatic salivary ducts terminate just caudal to this

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21
Q

T or F
These ducts can be transected without concern during maxillectomy.

A

true

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22
Q

Where does Digastricus run from and to?

A

Runs from the occipital region of skull to the ventral border of the body of the mandible

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23
Q

Where does the Masseter run from and to?

A

Runs from the zygomatic arch to the lateral surface of the caudal body and ramus of the mandible

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24
Q

Where does the Pterygoideus (A lateral and medial muscle ) run from and to?

A

run from the pterygoid, sphenoid and palatine bones to the angular process of the ramus

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25
Q

Where does the Temporalis run from and to?

A

Extends from the temporal region to the dorsal ramus

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26
Q

What is the function of the digastricus?

A

Open the jaw

27
Q

What is the function of the Masseter and Temporalis?

A

Close the jaw

28
Q

What is the function of the Pterygoideus?

A

Close the jaw and pull to the side for chewing

29
Q

he most frequently occurring oral tumours in dogs are? (6 in order)..

A
  1. malignant melanomas,
  2. non-tonsillar squamous cell carcinomas,
  3. fibrosarcomas,
  4. osteosarcomas,
  5. canine acanthomatous ameloblastomas
  6. fibrous/ossifying epulides
30
Q

Malignant melanoma:
A) Age?
B) Breed size?
C) Colour of growth?
D) Met rate?
E) Met location?

A

A) Older
B) Small breed
C) Often dark, 33% amelanotic
D) 80%
E) LN; not just ipsilateral side!

31
Q

Squamous cell carcinoma (non-tonsillar):
A) Age?
B) Breed size?
C) Appearance?
D) Met rate?
E) Met location?

A

A) Older
B) Large
C) Flat, ulcerated, minimally external
D) 20%
E) Local

32
Q

Fibrosarcoma:
A) Age?
B) Breed size?
C) Breed? (2)
D) Arise from?
E) Met rate?
F) Met location?
G) What anatomy is commonly involved?

A

A) Middle age- Older
B) Large
C) Labrador + golden retriever
D) Gingiva near maxillary carnassial
E) 35%
F) Local
G) Hard palate

33
Q

Osteosarcoma:
A) Breed size?
B) (Origin? (2)
C) Met location?

A

A) Medium + Large
B) Maxillary and mandibular
C) Lung

34
Q

Do axial osteosarcomas vs appendicular osteosarcoma have a better prognosis post-operatively?

A

axial osteosarcomas

35
Q

Canine acanthomatous ameloblastoma (CAA):
A) Breed size?
B) Arise from what epithelium?
C) Met?
D) Invade?
E) Oten arise from the rostral mandible or maxilla, what happens 2ry to this?
F) Tx of choice?

A

A) Medium - large
B) Odontogenic
C) No!
D) Locally
E) Displace incisors
F) mandibulectomy/maxillectomy.

36
Q

Fibromatous epulides arise from?

A

Peridontal ligament

37
Q

Epulis arise from?

A

Gingiva

38
Q

Fibrous/ossifying epulides are often located where?

A

Pre-maxillary

39
Q

Fibrous/ossifying epulides; Local excision without bone removal often provides excellent local control but likelihood of cure is improved if?

A

if the tooth and a small margin of the alveolar bone is removed with an air drill.

40
Q

Which of these are more commonly seen in older, small-breed dogs?

Osteosarcoma

Fibrosarcoma

Malignant melanoma

A

Malignant melanoma

41
Q

What is involved in pre op staging of oral tumours?

A

Thorax image - radiograph vs cT
Pre op biopsy (deep into lesion)
LN asessment; ideally mandibular, parotid, retropharyngeal nodes bilaterally

42
Q

What is the issue of using x rays to visualise oral tumours?

A

Often under-estimate the degree of bony involvement due to the delay in lysis appearing radiographically

43
Q

T or F
Pre-operative biopsy is useful to determine the degree of resection required.

A

True

44
Q

T or F
Compared to MRI, CT is superior to assess tumour bone margins.

A

True

45
Q

T or F
Optimal staging of oral tumour would include removal of mandibular and parotid nodes unilaterally.

A

Optimal staging would include removal of all three nodes (mandibular, parotid, and retropharyngeal) bilaterally.

46
Q

Follow-up intra-oral examinations should be performed every ? following surgery

A

3-4 months

47
Q

One year survival rates of 70-90% have been reported following aggressive surgical management of oral tumours, with reported recurrence rates ?

A

50%

48
Q

Do you know why caudally based tumours have a poorer prognosis in general? (2)

A

longer to notice them,
more advanced at presentation

49
Q

Which tumours generally have the highest survival rates following surgical excision? (2)

A

Oral (non-tonsillar) SCC and acanthomatous ameloblastoma

50
Q

Why do fibrosarcoms have a higher recurrence rate? (2)

A

invasive
Often located in the central or caudal maxilla

51
Q

Mean survival times for malignant melanoma?

A

1 year

52
Q

When is Radiation therapy (RT) is indicated indicated? (3)

A

high potential for local recurrence,
- incomplete histologic margins,
- large tumours
- tumours located in the caudal oral cavity.

53
Q

How to access the nasopharynx and achieve biopsy samples or remove benign tumours?

How to reduce risk of dehiscence and aid reconstruction?

A

Soft palate split through midline

Leave distal aspect in tact

54
Q

Radiation therapy works better against microscopic disease so should be used pre or post op?

A

Post op

55
Q

Platinum-based chemotherapy (e.g., carboplatin) has been used to treat ? with a significant reduction in tumour volume reported.

A

malignant melanoma

56
Q

Most common feline oral tumour?

A

SCC

57
Q

SCC in cats usually arise from what mucosa? (2)

A

Gingiva
Sublingual

58
Q

SCC in cats:
A) How invasive?
B) 20% met to?
C) How common is distant met?

A

A) Highly
B) LN
C) Rare

59
Q

Most SCC in cats occur where?

A

Caudal to canines

60
Q

Maxillary SCC masses in cats invade where?

A

Periocular

61
Q

Tongue SCC masses in cats invade where?

A

Sublingually

62
Q

Advanced imaging is particularly recommended in cats SCC. Why?

A

Highly invasive; often extend within the medulla of the mandibular bone far beyond their gross limits

63
Q

After what % of mandible is excised, long-term inappetence is a concern in cats?

A

50%

64
Q

Feeding tubes should be placed following mandibulectomy in cats; why?

A

Often do now eat!

Oral, Pharyngeal and Aural surgery (10 decks)

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