Exam III: Respiratory and Ear Surgery, Reconstruction, and Laparoscopy

Question 1

What are the primary components of brachycephalic obstructive airway syndrome?

Answer 1

• Stenotic Nares
• Elongated (+/- thickened) Soft Palate
• Everted Saccules
• Hypoplastic Trachea
• Aberrant Nasal Turbinates
• Laryngeal Collapse
• Redundant Pharyngeal Folds
• Everted Tonsils
• Macroglossia

Primary components that characterize brachycephalic obstructive airway syndrome.

Question 2

What are the secondary components of brachycephalic obstructive airway syndrome?

Answer 2

• GI disease
• Regurgitation
• Sliding Hiatal Hernias
• Gastritis
• Inflammatory GI Disease inflammation

Secondary components that may occur alongside the primary ones.

Question 3

Which components of brachycephalic obstructive airway syndrome are most commonly treated surgically?

Answer 3

• Elongated soft palate
• Stenotic nares

These components are often targeted for surgical intervention.

Question 4

What surgeries are contraindicated for the surgical treatment of brachycephalic obstructive airway syndrome?

Answer 4

• Sacculectomy
• Tonsillectomy

Sacculectomy comes with major complications, while tonsillectomy does not significantly improve breathing quality.

Question 5

What is a reason why dogs with brachycephalic obstructive airway syndrome can present with gastrointestinal signs?

Answer 5

The work it takes to breathe and aspiration pneumonia from a poorly working airway

These factors can lead to gastrointestinal symptoms.

Question 6

What is the ideal time to surgically treat dogs with brachycephalic obstructive airway syndrome?

Answer 6

Early

Early intervention is recommended for better outcomes.

Question 7

What anatomic landmarks are used to determine if the soft palate is an appropriate length?

Answer 7

Soft palate should barely touch epiglottis

This assessment is crucial in determining the need for surgical intervention.

Question 8

How do you prevent laryngeal collapse in dogs with brachycephalic obstructive airway syndrome?

Answer 8

Treat the treatable, elongated soft palate and stenotic nares

Proper treatment of these conditions can prevent laryngeal collapse.

Question 9

What are the most common causes of laryngeal paralysis?

Answer 9

Congenital, Central neurologic lesion, Acquired (Trauma, Compressive masses, Iatrogenic, Polyneuropathy), Idiopathic polyneuropathy is the main cause

Breeds commonly affected include husky, bouvier de flandres, rottweiler, dalmatian.

Question 10

What nerve is primarily affected in laryngeal paralysis?

Answer 10

Recurrent laryngeal nerve

Multiple nerves can be affected, but this nerve specifically impacts the larynx.

Question 11

Name the important anatomic structures involved in laryngeal paralysis.

Answer 11

• Larynx
• Thyroid cartilage
• Arytenoid cartilage
• Cricoid cartilage

Surgery is typically performed caudal to the larynx.

Question 12

What is the common surgical treatment for laryngeal paralysis?

Answer 12

(Unilateral) Arytenoid lateralization, also called ‘tie-back’

This procedure helps to alleviate airway obstruction.

Question 13

What are two clinical presentations for dogs with laryngeal paralysis?

Answer 13

• Inspiratory stridor
• Upper airway sounds
• Cough
• Hyperthermia
• Abnormalities on neuro exam

Signs may include gag reflex, muscle wasting, weakness, CP deficits in pelvic limbs, cranial tibial muscle atrophy.

Question 14

What routine diagnostic workup is recommended for laryngeal paralysis?

Answer 14

• Routine blood work
• Endocrine Function tests
• Thoracic Radiographs
• +/- Esophagram

Routine blood work may show WBC elevation due to pneumonia and tests for hypothyroidism are common.

Question 15

What is the prognosis for laryngeal paralysis?

Answer 15

Good to excellent results unless a permanent tracheostomy is required

Risk factors include aspiration pneumonia, suture failure, and seroma.

Question 16

What complications can arise from cricoarytenoid lateralization?

Answer 16

Over abduction can cause aspiration pneumonia

The risk of aspiration pneumonia exists regardless of procedure.

Question 17

What increases the risk of post-op complications in laryngeal paralysis?

Answer 17

Pre-op pneumonia increases risk by 2.75 times

Other potential complications include pulmonary edema and mediastinal masses.

Question 18

Fill in the blank: The main cause of laryngeal paralysis is _______.

Answer 18

Idiopathic polyneuropathy

Question 19

True or False: Laryngeal collapse is a common differential diagnosis for laryngeal paralysis in all breeds.

Answer 19

False

Laryngeal collapse is unlikely in certain breeds and is lower on the differential list for labs.

Question 20

What is the composition of the external ear canal?

Answer 20

The external ear canal is composed of the pinna

The pinna is the outer part of the ear that helps capture sound.

Question 21

What are common injuries of the pinna?

Answer 21

Common injuries of the pinna include:
* Aural hematoma
* Wounds of the pinna
* Lacerations

Aural hematomas occur due to blood accumulation between the cartilage and skin.

Question 22

What are the conservative treatment options for aural hematomas?

Answer 22

Conservative treatments include:
* Aspiration
* Steroid injection

Advantages include no anesthesia, outpatient treatment, and no ear disfigurement.

Question 23

What are the advantages of surgical treatment for aural hematomas?

Answer 23

Advantages include:
* Easy clot removal
* Low recurrence
* Bandage for 48 hours

Surgical treatment involves incision, drainage, and suture.

Question 24

What are the disadvantages of surgical treatment for aural hematomas?

Answer 24

Disadvantages include:
* Anesthesia required
* Potential scar
* Possible deformity

An erect ear may become floppy after surgery.

Question 25

What is the occurrence rate of malignant tumors in neoplasia of the external ear canal?

Answer 25

88% of tumors are malignant ## Footnote Neoplasia occurs more frequently in unilateral cases than bilateral.

Question 26

What are the indications for surgery in cases of infection in the external ear canal?

Answer 26

Indications for surgery include: * Medical therapy failed * Aural integument irreversibly diseased * Development of cutaneous fistulas * Par-aural abscess * Otitis media or otitis interna ## Footnote Surgery may involve lateral wall resection and possible ventral bulla osteotomy.

Question 27

What is the success rate of total ear canal ablation (TECA-LBO) in dogs?

Answer 27

90-95% success rate in dogs ## Footnote TECA-LBO is indicated for chronic disease and end-stage external ear disease.

Question 28

What are the potential complications associated with total ear canal ablation?

Answer 28

Complications primarily in cats include: * Facial nerve paralysis (56%, 28% permanent) * Horner syndrome (42%, 14-27% permanent) ## Footnote Complications are less common in dogs.

Question 29

What is the main difference between skin flaps and skin grafts?

Answer 29

Skin flaps have a blood supply, while skin grafts are free skin without vascular attachment ## Footnote Skin grafts survive the first 48 hours by absorbing tissue fluid.

Question 30

What are the types of subdermal plexus flaps?

Answer 30

Types include: * Advancement * Rotational * Transposition * Skin fold flaps ## Footnote These flaps have terminal branches of direct cutaneous arteries.

Question 31

What are the general principles of skin flap surgery?

Answer 31

Preserve the blood supply ## Footnote This is essential for the viability of the flap.

Question 32

What are some basic laparoscopic procedures that can be performed in general practice?

Answer 32

Basic laparoscopic procedures include: * Biopsy (Liver, Pancreas) * Ovariectomy * Ovarian Remnant * Cryptorchidectomy ## Footnote Laparoscopy provides minimally invasive options for surgical intervention.

Question 33

What are some advantages of laparoscopy?

Answer 33

Advantages include: * Simple procedure * Well tolerated * Smaller incision * Visualization/magnification ## Footnote These benefits enhance surgical precision and recovery.

Question 34

What are contraindications to laparoscopy?

Answer 34

Contraindications include: * Hemodynamic instability * Respiratory comorbidities * Previous abdominal surgery/adhesions * Diaphragmatic hernia * Large abdominal mass * Septic peritonitis * Intra-abdominal malignancy * Increased intracranial pressure * Pregnancy * Portal hypertension * Coagulopathies ## Footnote These conditions may increase risk during laparoscopic procedures.

Question 35

What are common complications of laparoscopy?

Answer 35

Common complications include: * Hemorrhage * Equipment malfunctions * Organ trauma ## Footnote Hemorrhage is typically manageable, and spleen injuries are rare.

Question 36

What techniques can be used for creating a capnoperitoneum?

Answer 36

Techniques include: * Veress Needle * Hasson Technique * SILS port ## Footnote These techniques facilitate the introduction of carbon dioxide into the abdominal cavity.

Question 37

What are reasons for conversion from a laparoscopic procedure to an open procedure?

Answer 37

Reasons for conversion include: * Time constraints * Realized issues ## Footnote Conversion may be necessary for patient safety.