The Oral Cavity, Lips and Cheeks Flashcards
Oral cavity functions? (5)
Prehension of water and food
Sensation of taste
Mastication
Digestion
Swallowing
What is the soft tissue attaching the tongue to the mandible?
Frenulum
Clinical signs that can be associated with oral disease include? (7)
Ptyalism
Dysphagia
Inappetence and weight loss
Pain
Halitosis
Oral haemorrhage
Failure to thrive – especially in young animals with congenital disorders.
With oral surgery, other than biochem/haem. What other bloods are warranted? (3)
Clotting profile
Platelet count
BMBT
In some conditions, biopsy or sampling may be performed under sedation as long as?
Adequate analgesia
Other than poor sedation, when should an ET tube be placed for sampling oral lesion? (2)
- Invasive procedure
- Bleeding/aspiration likely
In some patients with neoplasia or severe inflammation, intubation may be challenging and in others, placement of an ET tube may reduce surgical access
What be need to be considered?
pharyngotomy
tracheotomy incision
How to minimise aspiration when examinign oropharynx? (3)
Cuffed ET tube
Suction
Pharyngeal swab
In patients presenting with dyspnoea due to large oral cavity masses, consider what?
Tracheostomy
. Blocks of the infraorbital, maxillary, mandibular and mental nerves may be performed depending on where the lesion is.
What agent? and how much?
Bupivacaine (0.5%) can be used at a dose of between 0.25-1 ml per site to achieve improved levels of comfort both during and after surgery.
How to clean oral cavity before surgery?
Dilute povidone-iodine or 0.2% chlorhexidine and the skin is prepped as normal.
The oral cavity has an innate resistance to infection. Why? (2)
Rich vascular supply
Antibacterial properties of saliva
T or F
Perioperative antibiotics should be given for oral surgery?
False; not always needed.
A single dose of a prophylactic, broad-spectrum agent active against Gram-positive aerobes and anaerobes may be given if necessary (e.g. ampicillin or clindamycin)
When is a therapeutic course of ABx indicated for oral surgery? (2)
Debilitated
Severe peridontal dx.
What should be considered with oral surgery, especially in cats?
oesophagostomy or gastrostomy tube placement
What tube is recommended following significant jaw reconstruction procedures to assist with feeding in the recovery period
Placement of oesophagostomy
What food can be used to stimulate appetite after surgery?
Strong smelling
Post op oral cavity surgery care? (3)
Analgesia
Nutrition
Clean face/neck - especially around the nasal region to improve air flow and help with taste and smell
How to control oral cavity haemorrhage? (2)
Pressure
Vessel ligation
Why avoid electrocautery in the oral cavity?
Avoid swelling
If electro-cautery is needed. What should be used too?
Cooled saline
What suture materail for oral cavity?
Monofilament absorbable suture material (e.g. poliglecaprone-25) of 1.5 M (4-0) size
If prolonged healing times are expected in the oral cavity; what suture materail?
polydioxanone
Why might a braided suture be considered but is often not a concerned?
Softer ends
Risks if tension free closure is not achieved in the oral cavity? (2)
Dehiscence
Oro nasal fistula
What effects may theatre lights have on oral cavity?
Dry out
How many layers to lips and cheeks?
3
What are the layers of the lips and cheeks ?
an outer integument,
a middle muscular/fibroelastic layer
an inner mucosal layer.
Motoer innervation of lips and cheeks?
Facial n
Sensory innervation of lips and cheeks?
trigeminal n
What artery supplies branches to the lower lip and cheek ?
Facial a
What artery supplies branches to the upper lip and cheek ?
Infraorbital a
Congenital abnormalities of lips cheeks (2)
Primary cleft palate
Abnormal lip fold conformation
Traumatic injuries to lips/cheeks?
Lip avulsion
Lip/cheek in dog 1st and 2nd most common neoplasia
- Melanoma
- SCC
What neoplasia have been reported in cats lips/cheek? (although rare) (3)
SCC
MCT
Fibrosarcoma
Properties which make lips/cheeks a good surgical area? (3)
Vascular - healing
- Vascular - resistance to infect
- Elasticity - stretch/manipulation
In what breeds may excessive mandibular lip tissue may be present? (5)
Spaniels,
Saint Bernards,
Newfoundlands,
Retrievers
Irish Setters
1ry cleft palate:
Flaps are created from the oral and nasal tissues and these are defects of the lip and most rostral part of the hard palate leading to harelip are classed as ?
1ry palate defect
Which side do Primary Cleft Palate effect?
Left
Harelip with Primary Cleft Palate; how often is surgery needed?
Rare - often cosmetic
What is used to make flap for 1ry cleft palate?
oral and nasal tissues and these are used to reconstruct the defects in the rostral palate and the floor of the nasal vestibule
What are often needing to be remvoed for successful raising of flaps with primary cleft palate? (2)
Ipsilateral incisors and canine tooth
What surgical procedure is used for lip fold confirmatio issue?
cheiloplasty
How to perform a cheiloplasty?
The patient is placed in dorsal recumbency to allow access to both lips. An elliptical incision is made around the affected area of skin, the muscle is preserved as the skin is elevated and excised. The skin is closed with intradermal sutures.
Larger breed dogs with redundancy and eversion of the lower lip may also present with large amounts of saliva falling out of the oral cavity. This is not a health issue for these dogs but can become a management issue for owners.
What surgery may be considered?
Anti-drool cheiloplasty where the lower lip is suspended from the upper cheek is reported to help with saliva retention. Ligation of the submandibular salivary gland duct in association with cheiloplasty may also be performed.
Lip avulsion; initial step?
The wound should be lavaged and gently debrided to remove any debris
Lip avulsion; how to suture if can 1ry repair?
simple interrupted suture pattern may be achieved
Lip avulsion; if primary repair is not possible; then what?
sutures are placed around the incisor teeth or through pre-drilled holes in the mandibular bone to anchor them securely. The submucosa is sutured through these bone tunnels whilst the gingival tissue is apposed to the mucosa in a continuous pattern.
