Ch 100 Palate Flashcards

Question

What % or airway resistance is due to the nose in normal dogs?

Answer 1

- primary components: hyperplastic soft palate with mucosal hyperplasia, stenotic nares, hypoplastic trachea, aberrant nasal turbinates, and macroglossia - eversion of the mucosa of the lateral ventricles occurs secondary to chronic subatmospheric pressure in the airway that is generated to overcome resistance to airflow. - The turbulent airflow over the mucosa causes edema and swelling. - Over time, the laryngeal cartilage frame can weaken and the larynx can progressively collapse

Answer 2

Q = π(pressure difference)(r^4)/8nl Q - rate of flow r - radius n - viscosity of the gas l - length of airway Flow is proportional to radius to the fourth power

Answer 3

- Stenotic nares and abnormal intranasal turbinate > stertorous breathing due to increased resistance to nasal airflow. - overlong soft palate projects into the larynx and causes stridor - causes a fixed-type upper airway obstruction in the majority of brachycephalic dog studies - increased resistance to airflow is caused largely by a decrease in airway radius as illustrated by Poiseuille's law - inspiratory muscles contract for a longer time during each breath cycle in response to increasing upper airway resistance, thus prolonging inspiration - decreases (PaO2) and increases (PaCO2), stimulates increased respiratory effort when compensation by other mechanisms is inadequate - Inspiratory and expiratory muscle work generates substantial heat. The work of breathing, combined with hot weather and exercise, often precipitates decompensation in brachycephalic dogs - funtional dz may contribute > Fibrosis of pharyngeal dilator muscles or Pharyngeal collapse - are at risk of developing noncardiogenic pulmonary edema - Presumably, subatmospheric intrapleural pressure required to overcome chronic partial upper airway obstruction in affected dogs predisposed them to hiatal hernia, gastroesophageal reflux, and subsequent esophagitis.

Answer 4

A stretch reflex mediated by vagal fibres that control the rate and depth of respiration. Causes a longer contraction of the inspiratory muscles during each breath cycle in response to increased upper airway resistance

Answer 5

Fibrosis of the pharyngeal dilator muscles Pharyngeal collapse

Answer 6

20% of thoracic inlet

Answer 7

Anticholinergic to minimise risk of severe bradycardia from vagal discharge during pharyngoscopy - glycopyrrolate over atropine when needed. Monitor airway function closely, as thickened secretions and tachycardia can worsen respiratory issues.

Answer 8

- Animals in severe respiratory distress need to be evaluated quickly and intubated if respiratory arrest is imminent - cold intravenous fluids, sedation with acetylpromazine (0.01 mg/kg IV), oxygen supplementation, and dexamethasone (0.05 to 0.1 mg/kg IV) - Concurrent cardiac disease has been reported in dogs with overlong soft palates,28 and Bulldogs are particularly prone to congenital pulmonic stenosis. - radiographs of the neck and thorax to evaluate possible concurrent cardiac disease, aspiration pneumonia, pulmonary edema, and tracheal diameter.

Answer 9

- proposed level of palate resection, the caudal border of the palatine tonsils - excessive rostral retraction of the soft palate can make judging the appropriate level of palate resection difficult. - Clinical experience is therefore often used to determine the appropriate palate length. - resection is performed with scissors,a carbon dioxide laser, or bipolar sealing device - caudal pharynx and area surrounding the endotracheal tube must be covered by saline-soaked gauze sponges for protection form laser

Answer 10

- by reducing the soft palate's length and thickness - removed together with underlying connective tissue and parts of the palatinus and levator veli palatini muscles. - suture knots will be located more rostral and farther from the pharynx post op - Corticosteroids (dexamethasone, 0.05 to 0.1 mg/kg IV - respiratory rate and effort and arterial hemoglobin oxygen saturation are monitored frequently. - Food and water are withheld for 12 - postoperative GI signs are aggressively treated with a proton pump inhibitor (omeprazole [0.7 mg/kg PO q24h]), or metoclopramide constant rate infusion [1 to 2 mg/kg/d IV]) | dupre and finji

Answer 11

5-6W Continuous mode

Answer 12

Good to excellent in 90% Persistent or recurrent signs should prompt a skull CT and retroflexed nasopharyngeal endoscopy to assess for nasopharyngeal turbinates or progression of laryngeal collapse

Answer 13

- death, most often associated with aspiration pneumonia, failure to recover from anesthesia, or postoperative swelling - dyspnea and cyanosis - requiring temporary tracheostomy - wound breakdown - failure to improve - progressive dz

Answer 14

major comp 7% resp compl 15-23.4 mortality 2.4 - 4% (0-10%) temporary tracheostomy 5- 8% (0-11%) risk factors: older, coallapse, emregent presentation, worse BOAS, post-op trach, post-op pneumonia, pre-op regurge > post op regurge, Factors for temporary tracheostomy postoperatively age postoperative aspiration pneumonia, concurrent airway pathology, emergent presentation prior to surgery increased surgical duration

Answer 15

Retrospective. Risk factors staphylectomy or folded flap palatoplasty: 76 risk factors for complicated recovery: - surgery type (staphalectomy more than FFP > consider effect size, small difference) - age - laryngeal collapse grade >2 - length of general anaesthesia Postoperative complications (39%), (53%) major (need TT or death) and (47%) minor Dexmedetomidine CRI due to anxiety (26%) postoperatively, (16%) regurgitated after surgery A temporary tracheostomy (8%) mortality (4%)

Answer 16

Retrospective Comparison staphylectomy using incisional, carbon dioxide laser, or bipolar vessel sealing device. 606. mortality 24/606 (4.0%). 13 cases > using bipolar use of BVSD and grade of laryngeal collapse were associated with a higher risk of perioperative mortality. No difference between cutting and CO2 laser. histopathology CO2 laser> higher damage day 0, no differences at days 3, 7, and 14. prospective needed | prospective needed

Answer 17

Study design: Prospective, randomized, double-blinded controlled study. Sample population: A total of 32 client owned This study demonstrated that the use of adrenaline in a bilateral maxillary nerve block results in significantly lower intraoperative hemorrhage during cut and sew sharp staphylectomy and appeared safe to use.

Answer 18

Retrospective study. Sample population: Client-owned dogs (n = 124). FFP dogs without concurrent non-airway procedures were associated with longer duration of surgery (p = .02; n = 63; S, median = 51 min [34–85]; FFP, median = 75 min [56.25–94.5]) and anesthesia (p = .02; n = 63; S, median = 80 min [66–125]; FFP, median = 111 min [91–140.8]). Neither soft palate surgery was associated with the occurrence of anesthetic complications (p = .30; 99/120; S, 49; FFP, 50), postoperative regurgitation (p = .18; 27/124; S, 17; FFP, 10), or with hospitalization duration Although FFP took longer, no other clinically significant differences were appreciated between S and FFP procedure The results of this study indicated that S and FFP surgeries had similar anesthetic, minor, and major complications, as well as similar hospitalization duration the FFP has been reported to involve more tissue manipulation and longer surgical times

Answer 19

Four postoperative respiratory complications were observed: hypoxaemia (n=10/199; 5%), dyspnoea requiring tracheal re-intubation (n=13/199, 7%), dyspnoea requiring tracheostomy (n=10/199, 5%) and aspiration pneumonia (n=12/199, 6%). Risk factors for tracheostomy were preoperative and postoperative aspiration pneumonia and increasing brachycephalic obstructive airway syndrome grade

Answer 20

Retrospective. Nebulised adrenaline 90 cases Agitation uncommon, (96%) dogs remaining calm, temporary tracheostomy (14.4%) results in minimal increases in respiratory rate and heart rate Adrenaline’s > α-adrenergic receptors > decreased vasodilation> reducing mucosal oedema dont comment on efficacy (complications rates were the same

Answer 21

Prospective 25 dogs Wound healing folded flap palatoplasty - monopolar 8/13 (61.5%) vs scissors 1/11 (9.1%) Wound healing > nine dogs (36%). 8 major wound complications, 4 > no clinical signs. Two patterns: incisional dehiscence with caudal retraction + full-thickness defect in the centre Clinical improvements in respiratory function after FFP has been established both by subjective and whole-body barometric plethysmography. FFP > generation of a random, single pedicle mucosal advancement flap on the perfusion of the remaining tissues is unknown. direct injury, subepithelial plexus > cause FTD incision lateral and rostral tissues of the soft palate > vascular supply to then reliant on anastomoses to the dorsal soft palate, inadequate perfusion > ID.

Answer 22

post-operative respiratory complications in 248 dogs (23.4%) had complications 5/ 22 dogs requiring re-intubation deteriorated 12 or more hours after Sx > importance of close monitoring for a minimum of 24 h Successful recovery following temporary tracheostomy tube placement was made in 19/21 cases

Answer 23

The study sample included 42 Beagle dogs This study revealed that change in nasopharyngeal lumen over 50% can be identified in Beagle dogswithout cardiopulmonary diseases and may be over-diagnosed as partial pharyngeal collapse. Further studies for comparing change in nasopharyngeal lumen between clinically normal dogs and dogs with respiratory signs are warranted.

Answer 24

Sixty-three dogs met the inclusion criteria for the study. Forty-two dogs underwent owner-assisted recovery and 21 dogs standard recovery. No statistical difference was found between groups in age, breed, gender, severity of respiratory or gastrointestinal clinical signs and surgical techniques employed. The incidence of postoperative complications was higher in dogs that received standard recovery (28%) compared to dogs recovered with the owners (2%). None of the dogs recovered with the owners and discharged the same day required veterinary assistance after discharge from the hospital. that the percentage of dogs with severe laryngeal collapse was higher in dogs that underwent standard recovery. However, the stage of laryngeal collapse as a prognostic indicator in BOAS surgery is controversial

Answer 25

Prospective clinical trial. Animals: Sixteen client-owned dogs Owners of dogs treated with CMS perceived an improvement in clinical signs of SHH and GER that was not confirmed by VFSS studies. Clinical significance: Conventional multilevel surgery in dogs with BOAS does not appear to consistently resolve SHH and GER, although clinical signs may improve. study by Poncet,11 a very similar percentage of dogs (approximately 80%) showed an improvement in their gastrointestinal clinical signs and in 10 dogs in that study that underwent endoscopic reevaluation, the response was variable and approximately 25%-30% appear to be “nonresponders.” The inferiority of VFSS compared to 24 h ambulatory pH monitoring or high-resolution manometry has been reported in human medicine

Answer 26

Prospective Outcomes and prognostic factors of surgical treatments plethysmography (WBBP) used median BOAS indices decreased (from 76% to 63%, although dogs with indices in this range would still be considered clinically affected) age, collapse and surgery associated with prognosis suggests modified multilevel surgery (MMS) may have a better outcome than traditional multilevel surgery (TMS) severely affected French bulldogs had a poorer response to traditional respiratory functions remained compromised in 60% of dogs MMS - modified rhinoplasty technique combining a Trader’s and nasal vestibuloplasty (dorso-medial and caudal portion of the alar fold) - FFP - bilateral ventriculectomy - partial cuneiformectomy for dogs with Grade II or III laryngeal collapse - partial tonsillectomy in dogs with extruded tonsils

Answer 27

Dogs were evaluated with fluoroscopy awake and standing corrective upper airway surgery (alaplasty, staphylectomy, sacculectomy, tonsillectomy) was performed. A cohort (n = 11) of the surgically treated brachycephalic dogs had fluoroscopy repeated a minimum of 6 weeks after surgery. Surgery did not improve the reduction in dorsoventral diameter of the nasopharynx during respiration in brachycephalic dogs (n = 11) postoperatively (p = .0505). The lack of significant postoperative improvement may represent a type II error, a failure to adequately address anatomical abnormalities that increase resistance to airflow, or inadequate upper airway dilator muscle function in some brachycephalic dogs.

Answer 28

The harmonic shears resulted in the shortest surgical times (HSS 46 s, DLS 300 s, SIS 360 s; P < 0.001). There was a difference in the intraoperative haemorrhage among the three techniques; intraoperative haemorrhage did not occur in HSS and DLS groups. HSS was associated with more frequent damage involving the connective tissue (P = 0.001), muscle (P = 0.038), salivary gland tissue (P < 0.001), but less oedema was observed (P < 0.001). HSS was the fastest of the techniques evaluated for caudal elongated soft palate resection, resulting in less tissue oedema, and no intra-operative haemorrhage. These characteristics might result in reduced postoperative swelling and airway obstruction compared to other techniques.

Answer 29

prospective pilot study, seven client-owned brachycephalic dogs Six out of seven dogs were successfully extubated less than 2 hours post palatopexy and survived to discharge. One dog failed extubation secondary to worsening lower airway disease and laryngeal collapse. one to three vertical mattress sutures placed using 2-0 or 3-0 poliglecaprone 25 (Monocryl: Ethicon), tacking the caudal free edge of the soft palate rostrally to the junction of the hard and soft palate procedure may be less successful in addressing a BOAS crisis if other abnormalities or lower airway disease are significant contributors. This was demonstrated in the one dog in this pilot study who required emergent re-intubation, likely due to a combination of pneumonia and laryngeal collapse Palatopexy may also be useful as a temporary measure to bridge the time between crisis and definitive BOAS surgery. This could allow time for any inflammation and oedema to subside without having to keep patients in severe respiratory distress intubated or tracheostomized, as

Answer 30

Prospective Nebulization of epinephrine to reduce the severity. 31 Whole body barometric plethysmography (BOAS index; 0%–100%) 0.05 mg/kg epinephrine diluted in 0.9% saline preoperatively Five > not tolerate nebulization, Nebulized epinephrine reduced the BOAS index of dogs in this study. This effect was clinically significant in preoperative dogs with a BOAS index >70% and in dogs recovering from surgery.

Answer 31

The odds of having complications during the postanesthetic period following subsequent anesthetic events were decreased by 79% in dogs having previous surgical intervention to correct clinical signs of brachycephalic airway syndrome. Previous corrective upper airway surgery decreased odds of postanesthetic complications in brachycephalic dogs that underwent subsequent anesthetic events.

Answer 32

implementation of a standardized perianesthetic protocol. 84. preop metoclopramide and famotidine, restricted opioids, and recovery in intensive care unit > before (group A) and after (group B) implementation postoperative regurgitation [9%]) was significantly lower than non-protocol group [35%]). postoperative pneumonia and respiratory distress did not differ A history of regurgitation > postoperative regurgitation.

Answer 33

Sixteen brachycephalic dogs and 12 mesaticephalic dogs. A relative macroglossia was detected in brachycephalic dogs along with reduced air volume in the upper airway. Tongues of brachycephalic dogs were denser than those of mesaticephalic dogs. Clinical significance: The relative macroglossia in brachycephalic breeds may contribute to upper airway obstruction.

Answer 34

Corrective surgery for BOAS was associated with a marked incidence of postoperative regurgitation. Younger dogs and those with a history of regurgitation were predisposed to postoperative regurgitation.

Answer 35

hard palate defect was closed with medially positioned flaps (Von Langenbeck technique) or pedicle flaps (2-flap palatoplasty) and a membrane composed of autologous auricular cartilage from the pinna or allogenous fascia lata underlying the mucoperiosteal flaps. Resolution of clinical signs occurred in all cases. Complete success (ie, complete closure of the palate defect and absence of clinical signs) was achieved in 5 dogs The size of the soft tissue defect of the hard palate was classified as mild if it was < 25% of the width of the palate at the same location, moderate if the relative width was between 25% and 50%, or severe if it was > 50%. The chance of successful closure of an ONF decreases with the number of failed surgeries performed in people and dogs, and a small ONF may persist despite multiple surgical attempts at closure. Common areas of failure after CFP repair are rostrally near the incisive papilla and caudally at the transition between the hard and soft palate.3,6

Answer 36

Successful closure of the cleft (hard and soft) palate defects was achieved in all 12 dogs in a single surgical procedure. A small residual opening was noted at the level of the incisive papilla in each dog; this was of no clinical consequence in this report Successful execution requires the complete elevation of each flap, which facilitates their tension-free advancement over the palatal cleft. Vertical mattress sutures evert the flap margins, allowing for direct collagen surface contact for proper healing. Placement of sutures in the rugal folds increases the tissue purchase to reduce the risk of suture cut-out. Fine interrupted sutures, placed between the vertical mattress sutures, maintains the proper alignment of the incisional margins. The author waits a minimum of 5 months before closing cleft palate defects, Computed tomographic findings in dogs has demonstrated variable abnormalities in individual dogs, including the following: abnormal development of the incisive and maxillary bones, absent or poorly developed nasal septum, hypoplastic nasal turbinates, vomer abnormalities, incomplete cribiform plate, abnormal tympanic bullae, anomalous frontal sinuses, otitis media, anomalous frontal sinuses, and displaced ventricles or ventriculomegaly CT may not essential to cleft palate repair in many cases, it may be useful nonetheless in planning a problematic closure and detecting other anomalies It has been suggested that waiting until 5 months of age runs the risk of the defect enlarging.29 This, however, is contrary to the author’s clinical experience. The cleft either remains proportional to the lateral palatal donor areas or proportionately decreases in width when compared to the initial assessment of the defect at birth. Another study38 suggested that oronasal fistula formation may be greater in dogs over 8 months of age. This was not recognized in this current case study.

Answer 37

Surgical treatment has good to excellent outcomes when the procedure is carefully planned and appropriately executed despite the high rates of postoperative oronasal fistula reported bilateral overlapping flaps covered by labial/ buccal advancement flaps The rate of ONF may reach 50% to 100% after the initial CP repair. Risk factors for developing ONF in dogs are previous surgical attempts and CP repair after 8 months of age An ONF immediately caudal to the incisive papilla may not show as many clinical signs a Angularis oris axial pattern flaps, large buccalbased advancement flaps, and use of auricular cartilage grafts and fascia lata membrane 1 study, 33% of dogs had more than 1 surgery performed to repair the ONF

Answer 38

we did not detect an association between clinical GER and dexmedetomidine administered as an anesthetic premedication or as a postoperative bolus injection

Answer 39

Anatomical cadaver study and short case series. Animals: One cadaver and three dogs with neoplasia of caudal hard palate Anatomical studies provide evidence that the HAOF can be used to reconstruct caudal and central hard palate defects extending to the maxillary canine teeth. Its clinical use led to successful closure of such defects in three dogs. In conclusion, the HAOF may be an alternative to the buccal mucosal or hard palate flaps that have been previously reported.

Answer 40

Whole-body barometric plethysmography was used as a comparative, objective measure of disease severity The sensitivity of clinical examination for BOAS diagnosis was 56.7% pre-ET, 70% after a 5-minute walk test, and 93.3% after a 3-minute trot test. The sensitivity of laryngeal stridor as a predictor of laryngeal collapse was improved after exercise (70%) compared with before exercise (60%). Specificity of laryngeal stridor for laryngeal collapse was 100% (pre-exercise and postexercise). simple and inexpensive diagnostic test correlates well with objective plethysmography data, and widespread application of the functional grading scheme described could help to standardize the way BOAS dogs are assessed and improve the accuracy and transferability of clinical records.

Ch 100 Palate Flashcards

(69 cards)