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Oral, Pharyngeal and Aural surgery > The Palate > Flashcards

The Palate Flashcards

1
Q

What 3 bones and structure (1) make up the hard palate?

A

palatine, maxillary and incisive bones and the palatal mucoperiosteum.

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2
Q

What is the surface of the hard palate lined with?

A

Stratified squamous epithelium

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3
Q

The incisive papilla opens just rostral to the ? on the midline

A

first transverse ridge

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4
Q

The major palatine foramina are located medial to the ? either side of the hard palate.

A

maxillary fourth premolar teeth

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5
Q

Which artery courses rostral from the foramina to supply the rostral hard palate?

A

The major palatine

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6
Q

Several what are present, one of which runs between the canine and third incisor to anastomose with the infraorbital artery?

A

Rami

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7
Q

Sensory innervation to the oral surface of the hard palate is provided by the ?

A

major palatine branch of the maxillary division of the trigeminal nerve.

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8
Q

The soft palate is continuous with the hard palate, extending where in non-brachycephalic breeds

A

Just caudal to the last maxillary molar teeth

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9
Q

The soft palate consists of what lining?

A

oral stratified squamous epithelium

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10
Q

Blood supply of soft palate?

A

minor palatine arteries

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11
Q

Soft palate drainage?

A

palatine plexus

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12
Q

Where does the palatine plexus lie in relation to the palatine muscles?

A

Lateral

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13
Q

Sensory innvervation of soft palate?

A

minor palatine branch of the maxillary division of the trigeminal nerve.

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14
Q

The muscles of the soft palate include the (3)

A

palatinus and the levator and tensor veli palatini.

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15
Q

Where does the palatinus run?

A

The palatinus runs from the palatine process of the palatine bone to the caudal edge of the soft palate,

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16
Q

When the palatinus contracts; what happens to the soft palate?

A

Shortens

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17
Q

Where does the tensor veli palatini:
A) Arise from?
B) Insert?

A

A) bony process rostral to the tympanic bulla
B) palatine aponeurosis

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18
Q

The tensor veli palatini stretches the palatine muscle between what?

A

pterygoid bones.

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19
Q

The levator veli palatini
A) Origin?
B) Insert?

A

A) bony process rostral to the tympanic bulla
B) caudally on the soft palate.

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20
Q

Role of the levator veli palatini on the soft palate?

A

It elevates the caudal soft palate helping to protect the nasopharynx during swallowing and vomiting.

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21
Q

Which of these muscles stretches the palatine muscle between the pterygoid bones?

Palatinus

Levator veli palatini

Tensor veli palatini

A

Tensor veli palatini

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22
Q

The sensory innervation of both hard and soft palate comes from branches of which division of the trigeminal nerve?

A

Maxillary

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23
Q

Congenital palate defects occur due to?

A

Incomplete fusion of the maxillofacial structures during foetal development

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24
Q

Define primary palate

A

Lips and cheeks

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25
Q

Define secondary palate

A

Soft + hard palate

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26
Q

Are Clefts of the primary palate (lips and cheeks) mor common RHS or LHS?

A

LHS

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27
Q

Clinical signs commonly seen with primary palate?

A

Mild rhinitis

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28
Q

How to surgically repair primary palate?

A

Surgical repair of these defects requires reconstruction of the lip, philtrum, the floor of the nasal vestibule and the rostral hard palate. Flaps are usually harvested from the oral and nasal tissues to achieve this.

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29
Q

When are secondary palates more commonly noticed?

A

Weaning

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30
Q

Signs of a secondary palate?

A

failure to create negative pressure when suckling
drainage of milk form the nares during suckling
rhinitis
coughing
aspiration pneumonia
failure to thrive.

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31
Q

Where do Congenital hard palate defects effect?

A

Midline

32
Q

What are midline congenital hard palate defects commonly combined with?

A

a midline defect of the soft palate.

33
Q

How can soft palate defects be classified?

A

Midline or unilateral

34
Q

Before congenital hard palate surgery; what is recommended and for how long? Why? (2)

A

Tube feeding
until 8 weeks of age (preferably older)
due to the friable nature of these tissues in paediatric patients and the significant risk of failure of the repair.

35
Q

What is the oldest hard palate defects should be repaired? Why?

A

Beyond 4-5 months to avoid widening of the defect as the animal grows.

36
Q

Acquired palate defects occur following? (5)

A

infection,
trauma,
neoplasia,
surgery,
radiation therapy

37
Q

Oral tissues are delicate: handling should be with(2)

A

non-crushing forceps and stay sutures

38
Q

How to control bleeding in the palate?
What NOT to use?

A

digital pressure on any bleeding areas using swabs

  • Electrocautery is avoided in the palate
39
Q

How many layer of closure of palate where poss?

A

2

40
Q

Ideally where should suture lines NOT be compared to defect?

A

Directly over it

41
Q

Post op palate sx:
A) What to feed?
B) What to Avoid?

A

A) Soft 10-14 days
B) Chew toys

42
Q

Main complication of palate surgery?

A

Dehiscence

43
Q

Congenital primary defects should be repaired using (3)

A

oral or nasal tissue, or oral flaps

44
Q

Prior to repair of Congenital primary defects, what will assist flap management?

A

Removal of canine teeth and incisors in the maxilla prior to surgery

45
Q

Overlapping flap technique for hard palate repair is mainly used for what defects?

A

midline clefts of the hard palate.

46
Q

Overlapping flap technique for hard palate repair
Why is an overlapping flap preferred? (4)

A

There is less tension on the suture line;

The suture line is not directly over the defect;

The area of opposing connective tissues is larger;

It provides more reliable results.

47
Q

Overlapping flap technique for hard palate repair;
How to make the overlap flap?

A

A mucoperiosteal incision is made 1-2 mm from the teeth along the dental arcade, from the rostral to caudal margins of the defect.

48
Q

Overlapping flap technique for hard palate repair;
How to make the envelope flap?

A

A mucoperiosteal incision is made along the medial margin of the defect on the opposite side of the palate

49
Q

Overlapping flap technique for hard palate repair;
What is used to undermine flaps?

A

Periosteal elevator

50
Q

Overlapping flap technique for hard palate repair;
CARE not to hit what artery that runs both sides?

A

Major palatine artery

51
Q

Overlapping flap technique for hard palate repair;
The overlap flap is elevated to expose the periosteal aspect and secured into the envelope flap using

A

horizontal mattress sutures.

52
Q

After a Overlapping flap technique for hard palate repair; Granulation and epithelialisation of the exposed bone takes how long?

A

3-4 weeks.

53
Q

Medially positioned flap for hard palate repair
Where is this most commonly used?

A

Traumatic midline clefts in cats.

54
Q

Medially positioned flap for hard palate repair; is less robust. Why (2)

A

The suture line is directly over the defect
There is a smaller area of opposing connective tissue in the defect.

55
Q

Medially positioned flap for hard palate repair
Where are the initial incisions?

A

Paired mucoperiosteal incisions are made adjacent to the dental arcade, 1-2 mm from the teeth and along the edges of the defect.

56
Q

Medially positioned flap for hard palate repair
Whic direction are the flaps moved and how are the sutured?

A

moved medially and sutured together in the midline.

57
Q

Within a few weeks post Medially positioned flap for hard palate repair what will happen?

A

The exposed bone laterally will granulate and epithelialis

58
Q

What are Medially positioned flap technique for soft palate repair used for?

A

midline clefts of the soft palate.

59
Q

Lateral relaxing incisions are often used for Medially positioned flap technique for soft palate repair. Why?

A

The tensor veli palatini and levator veli palatini will place tension on the repair

60
Q

Medially positioned flap technique for soft palate repair
Where is the initial incision?

A

Incisions are made along the medial margins of the defect to the level of the caudal end of the tonsils.

61
Q

Medially positioned flap technique for soft palate repair; how are the flaps made?
How are these closed?

A

Palatal tissues are bluntly dissected to form a dorsal (nasopharyngeal) and ventral (oropharyngeal) flap on each side.

The dorsal and ventral flaps are closed separately with simple interrupted sutures.

62
Q

Best flap for; Traumatic midline clefts in cats?

A

Medially positioned flap for hard palate repair

63
Q

Best flap for; Midline clefts of the hard palate?

A

Overlapping flap technique for hard palate repair

64
Q

Best flap for; Midline clefts of the soft palate?

A

Medially positioned flap technique for soft palate repair

65
Q

Repair of Lateral Clefts of the Soft Palate

Where do the clefts occur?

A

Lateral to palatine muscle; can be bilateral or unilateral

66
Q

With lateral clefts of soft palate; what will pull the caudal edge of the cleft laterally? (3)

A

the tensor and levator veli palatini muscles or palatopharyngeal muscles

67
Q

What type of flap is used to Repair of Lateral Clefts of the Soft Palate?

A

A nasal pharyngeal mucosal flap

68
Q

Repair of Lateral Clefts of the Soft Palate:
A) Where is the flap base?
B) Where does the free edge originate?

A

A) dorsal to the palatine tonsil,
B) from the dorsolateral wall of the nasopharynx.

69
Q

How wide should a flap for Repair of Lateral Clefts of the Soft Palate be?

A

A couple of mm larger than defect

70
Q

Repair of Lateral Clefts of the Soft Palate:
The medial edge of the cleft is incised to form ?

A

2 layers

71
Q

Repair of Lateral Clefts of the Soft Palate:

The free edge of the ? mucosa is enveloped into this and closed in two layers.

A

pharyngeal

72
Q

When is a labial-based mucoperiosteal flap performed?

A

oro-nasal fistulae

73
Q

First step in a labial-based mucoperiosteal flap ?

A

Granulation tissue and epithelial lining at the edge of the fistula is removed.

74
Q

labial-based mucoperiosteal flap
Where are Diverging releasing incisions made?

Where do they extend from and to?

A

Diverging releasing incisions are made from rostral and caudal to the defect, extending from the gingiva into the alveolar and labial mucosa.

75
Q

labial-based mucoperiosteal flap
How is it closed?

A

The alveolar mucosa is sutured to freshly incised hard palate mucosa in a simple interrupted pattern.

76
Q

In cases of dehiscence, where primary repair is no longer feasible, axial pattern flaps, wuch as what can be used?

A

Angularis Oris flap

77
Q

How can prosthetics be used in palate abnormalities? How are they made, fitted and maintained?

A

The patient is anaesthetised to allow an impression to be made of the defect that is then sent to a lab to create an appropriate implant. The patient is re-anaesthetised to allow fitting of the prosthetic device. Following implantation, the prosthesis should be removed every 6-12 months to allow cleaning of the device itself and the edges underneath it.

Oral, Pharyngeal and Aural surgery (10 decks)

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