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Oral, Pharyngeal and Aural surgery > Mandibulectomy and Maxillectomy > Flashcards

Mandibulectomy and Maxillectomy Flashcards

1
Q

Maxillectomy and mandibulectomy are what type of procedure? (clean etc?)

A

Clean contaminated

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2
Q

Why is surgical infection rate rare? (2)

A

Rich vascular supply
Prescence of saliva

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3
Q

What local analgesia agent?
- onset time?
- Action length?

A

Bupivacaine (0.5 – 1 ml, 0.5%)
- 8-30 mins
- lasts: 4-10hr

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4
Q

Which LA block blocks the following:
- Rostral maxilla?

A

Intraorbital

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5
Q

Which LA block blocks the following:
Body of mandible for more extensive sx?

A

mandibular nerve block near the mandibular foramen

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6
Q

Which LA block blocks the following:
Rostral mandible

A

mental foramen block

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7
Q

Which LA block blocks the following:
Entire maxilla

A

maxillary nerve block

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8
Q

For the maxillary nerve block, the needle is introduced where?

A

Rostral to the ramus and ventral to the zygomatic arch, just caudal to the lateral canthus of the eye.

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9
Q

How to control bleeding? (5)

A

Electrocautery,
Ice cold saline,
gelatin sponges,
bone wax
local application of epinephrine

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10
Q

When performing a mandibulectomy, ligation of what a. is needed?

A

Inferior alveolar a.

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11
Q

When performing a maxillectomy, ligation of what a. is needed? (2)

A

major palatine artery or infraorbital artery

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12
Q

Significant haemorrhage is expected with maxillectomy; why?

A

Nasal cavity is often entered, significant turbinate haemorrhage

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13
Q

Temporary or permanent occlusion of what a. may be required in a caudal maxillectomy?

A

Temporary or permanent carotid artery

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14
Q

How to position for:
Central and caudal maxillectomy

A

Oblique lateral recumbency

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15
Q

How to position for:
Segmental removal of body or ramus of mandible

A

Lateral recumbency

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16
Q

How to position for:
Bilateral rostral mandibulectomy and rostral maxillectomy

A

Dorsal recumbency

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17
Q

What should be placed to improve visualisation?

A

Mouth gag

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18
Q

Where should bone be cut in relation to teeth? and how far from tumours?

A

Between teeth roots.
1cm from tumours.

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19
Q

What teeth are involved with Rostral mandibulectomy?

A

Excision of bone including some or all incisors and one or more canine teeth.

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20
Q

Define Central mandibulectomy

A

Removal of a segment of one mandibular body.

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21
Q

Define Caudal mandibulectomy

A

Removal of all or a portion of ramus.

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22
Q

Define Total hemimandibulectomy

A

Removal form the symphysis including all of one body and the ramus.

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23
Q

Define three quarter mandibulectomy

A

Removal of one hemimandible and the rostral portion of the other hemimandible.

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24
Q

Define Pre-maxillectomy

A

Removal of the bone surrounding the incisors (may include the nasal planum).

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25
Define Rostral hemimaxillectomy
Removal of the bone surrounding the canines and incisors.
26
Define Central hemimaxillectomy
Removal of the bone surrounding the pre-molars.
27
Define Caudal hemimaxillectomy
Removal of the bone surrounding the molars. This may include the zygomatic arch and the bone of the ventral orbit.
28
How to position for rostral mandibulectomy or lateral recumbency for segmental hemimandibulectomy?
Position the patient in dorsal recumbency
29
Rostral and central mandibulectomy; Where is gingiva incised?
The gingiva is incised 0.5 cm beyond the level of planned bone transection and is elevated from the bone using a periosteal elevator, preserving a cuff of gingival tissue for closure.
30
What 3 attachements are transected in Rostral and central mandibulectomy; to give the 1cm margins?
Oral mucosa, labial mucosa and muscular attachments
31
How to control haemorrhage in Rostral and central mandibulectomy
Electrocautery
32
Rostral and central mandibulectomy; A) How to transect bone? (3) B) How to split longitudinally
A) n oscillating saw, air drill or burr B) Osteotome
33
Rostral and central mandibulectomy; What artery is ligated/cauterised?
Inferior alveolar a.
34
Rostral and central mandibulectomy; How to split the symphysis
Osteotome
35
How to close Rostral and central mandibulectomy? Including skin
Closure is achieved by suturing labial mucosa to the gingival and sublingual mucosa. Following rostral mandibulectomy, the skin can be sutured directly to the sublingual mucosa.
36
Caudal mandibulectomy and hemimandibulectomy How to position
Lateral
37
Caudal mandibulectomy and hemimandibulectomy What incision may help improve exposure?
A full-thickness incision in the cheek from the commissure to the level of the caudal border of the ramus may help improve exposure.
38
Caudal mandibulectomy and hemimandibulectomy What removal facilitates visualisation of the dorsal ramus and TMJ and is necessary if it is involved in the pathology.
Zygomatic arch
39
How to replace zygomatic arch in Caudal mandibulectomy and hemimandibulectomy? Is this needed?
Stabilisation with orthopaedic wire Not necc; more for post op cosmesis
40
Caudal mandibulectomy and hemimandibulectomy; Soft tissues are transected at least 1 cm from the edges of the tumour. What muscles (4) and capsule (1) does this include?
masseter, digastricus, temporalis and pterygoid muscles and the TMJ capsule.
41
Caudal mandibulectomy and hemimandibulectomy; What vessel is ligated and where?
The inferior alveolar artery is ligated and transected at the mandibular foramen.
42
Caudal mandibulectomy and hemimandibulectomy; Mucosa closure?
For closure, the labial mucosa is sutured to the gingival and sublingual mucosa.
43
Caudal mandibulectomy and hemimandibulectomy; How to suture to prevent the tongue hanging out the mouth?
The commissure of the lip can be advanced to the level of PM1 or 2
44
When is Mandibular rim excision appropriate?
For tumours that do not invade the ventral cortical bone and that lie next to the pre-molars or molars
45
Rostral and central maxillectomy How to position?
Oblique lateral
46
Rostral and central maxillectomy; What 3 structures need to be incised at the site of transection?
Labial mucosa Gingiva Palate
47
Does the major palate a. and infraorbtal a. need to be ligated in a central or rostral maxillectomy?
Central
48
Rostral and central maxillectomy What is used for bone resection; why this?
Osteotome; bone is thin
49
Rostral and central maxillectomy; its challenging to control bleeding until what is fully removed?
Maxillary segment
50
What osteotomy should be left until the end to minimise bleeding with Rostral and central maxillectomy?
Caudal
51
How to suture mucosa in Rostral and central maxillectomy? What flap might be needed?
Labial mucosa suture to gingival and palatine mucosa Dorsally based labial advancement flap.
52
What can be used to reduce breakdown of dorsally based labial advancement flaps?
Pre-placing drill holes into the hard palate and suturing through these
53
Rostral and central maxillectomy How to prevent drooping of noce?
dorsal cartilage can be sutured via drill holes in the nasal bone
54
Rostral maxillectomy How far from tumour is incision?
1cm
55
Caudal maxillectomy How to position?
Oblique lateral
56
Caudal maxillectomy Where is the cheek incised to increase exposure?
From the commissure to the caudal border of the ramus to increase exposure.
57
What incision will improve exposure of the dorsal osteotomy site, ventral orbit and zygomatic arch with Caudal maxillectomy?
Dorsolateral
58
What 3 structures are incised with Caudal maxillectomy?
Labial, gingival and palatine
59
Caudal maxillectomy; what osteotomy is left util the end to reduce haemorrhage?
caudal osteotomy is left until last to allow ligation of the major palatine a
60
When can food/water be introduced after surgery?
day after soft for 10-14 d
61
What should be avoided chewing after?
Hard food Chew toys
62
Wat tube should be placed in any cat that is undergoing a mandibulectomy or maxillectomy procedure?
Oesophagostomy
63
What may occur following maxillectomy, if the patient is asymptomatic monitoring may be appropriate, otherwise repair is recommended?
Oro nasal fistula
64
What may occur during mandibulectomy or maxillectomy. If tooth death occurs, extraction may be required?
Tooth root damage
65
When may the tongue may fall to one side, potentially increasing the rate of drooling (2)
Following hemimandibulectomy or rostral mandibulectomy
66
Mandibular drift may also follow a?
hemimandibulectomy
67
Mandibular drift usually have no problems; but when is it a problem and what helps?
canine tooth impinges on the hard palate. Extraction or crown reduction of the canine tooth may improve signs associated with this.
68
What may be used to prevent drift?
Orthodontic chains from the canine tooth of the intact mandible running to the ipsilateral fourth pre-molar
69
In dogs, removal of what length of both mandibular bodies may have difficulty with prehension of food in the initial stages, but usually adapt over time.
At least half
70
Removal of both mandibular bodies means what for feeding?
hand feeding for life

Oral, Pharyngeal and Aural surgery (10 decks)

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