Mouth&Esophagus

Question 1

Main types of Mandibular and maxilla fractures

Answer 1

Incisive/ rostral region
Interdental space
Caudal horizontal ramus
Vertical ramus

Question 2

What causes fractures in the incisive and interdental space?

Answer 2

Thin bones and minimal soft tissue coverage
Direct trauma from other horses or objects

Question 3

Why are fractures of the caudal horizontal ramus (molars/ temporomandibular joint) less common?

Answer 3

Greater bone and muscle mass (masseter muscle)
Higher morbidity

Question 4

Acute clinical signs of mandibular and maxilla fractures

Answer 4

Displacements
Pytalism
Swelling
Prehensile difficulties
Dysphasia
Oral/ cutaneous wounds

Question 5

Chronic clinical signs of mandibular and maxilla fractures

Answer 5

Debilitation
Difficult prehension
Malodorous breath
Loss of normal occlusal alignment of dental structures

Question 6

Diagnosing mandibular and maxilla fractures

Answer 6

Clinical signs
Radiographs
Cross bite (cd. mandible, vertical ramus, temporomandibular joint fractures/ luxations)

Question 7

Treatment for incisive fractures

Answer 7

Orthopedic wires
Interdigitate on reduction
Eat normal diet
Heal within 4-8 weeks

Question 8

Treatments for interdental space fractures

Answer 8

Interdigated: orthopedic wires
Long oblique fractures: cortical screws

Question 9

Treatments for unstable fractures of the interdental space

Answer 9

Acrylic splints
Dynamic compression plates
Kirschner- Ehmer appliances

Question 10

Treatment for unilateral non-displaced ramification fractures

Answer 10

Non surgical
Soft diets
Analgesics (non steroidal anti inflammatory drugs)
4-6 weeks (good prog)

Question 11

Where are caudal angle mandibles fractured?

Answer 11

From the junction of the vertical and horizontal ramus as a free fragment (uncommon)

Question 12

Treatment of caudal angle mandible

Answer 12

Excision of fragments
With molar involvement: internal fixation with plates/ screws

Question 13

Treatment for the temporomandibular area fracture

Answer 13

Rare and difficult to repair
Mandibular condylectomy

Question 14

Treatment for the coronoid process

Answer 14

Excision (preferred if dental abnormalities result) or conservative management

Question 15

Prognosis for mandibular and maxilla fractures

Answer 15

Incisive region/ interdental area: good
Horizontal and vertical rami: guarded to fair
Temporomandibular and coronoid: guarded

Question 16

What are the predisposing causes of esophageal impaction (choke)

Answer 16

Communal feeding
Post exercise (after feeding)
Esophageal lesions
Dental problems

Question 17

What is the most common site of esophageal obstruction?

Answer 17

Second cervical vertebra

Question 18

Causes of esophageal impaction

Answer 18

Feeds, pellets, sugar beet pulp, wood shavings, rough hay

Question 19

Clinical signs of esophageal impaction

Answer 19

Food, mucous, saliva from nostrils
Retching
Nasal cough
Aspiration pneumonia

Question 20

How do you dx esophageal impaction?

Answer 20

CS
Radiographs (radiodense or solid fluid and gas proximal to site of impaction)
Endoscopy (obstruction and esophageal mucosa)

Question 21

When are contrast esophagrams necessary?

Answer 21

Chronic recurrent choke

Question 22

Treatment of esophageal impaction

Answer 22

Nasogastric tube
Tranquilization
Anesthesia and endotracheal intubation (lateral recumbency)

Question 23

How does nasogatric tube for impaction work?

Answer 23

Blow air into esophagus to induce secondary peristalsis then advance obstruction
If fails then sedate with xylazine

Question 24

What is considered a risky tx for impaction?

Answer 24

Esophagostomy
Longitudinal incision —> feed through incision —> 4-6w recovery

Question 25

Aftercare of impaction

Answer 25

Confirm if entire esophageal lumen is patent with nasogastric tube Endoscopic evaluation Scurried diet for a few days (pelleted feeds, bran mashes)

Question 26

Prognosis for esophageal impaction

Answer 26

Acute: good Chronic: guarded to good

Question 27

Eophageal ulceration?

Answer 27

Any trauma , chemical or infectious origin Longitudinal scars expand well, circular scars don’t

Question 28

What causes esophageal ulceration

Answer 28

Protraction esophageal impaction (acute, most common) External trauma to neck (chronic)

Question 29

__________ and __________ are the most common causes of recurrent choke

Answer 29

Ulceration and stricture

Question 30

Conservative tx for mild cases of esophageal ulceration

Answer 30

Slurries diet for a few days then pelleted feed and bran mashes Constriction worse at 30 days then normal function at 60

Question 31

Surgical tx for esophageal ulceration

Answer 31

Esophagostomy/ Esophagplasty Esophagomyotomy Patch grafting Resection and anastomosis

Question 32

Why isn’t resection and anastomosis the best option for tx of esophageal ulceration?

Answer 32

Stricture Doesn’t hold together (lacks serosa) Long

Question 33

Esophageal wounds

Answer 33

Longitudinal slits along the ventral and dorsal esophageal walls Closed and open wounds

Question 34

Why are closed esophageal wounds more dangerous?

Answer 34

Secretions and food material trapped in deep fascial planes

Question 35

What causes esophageal wounds?

Answer 35

Closed: ingested wire, impacted foreign bodies, pre-existing defects Open: blunt trauma (cervical vertebrae)

Question 36

CS of open esophageal wounds

Answer 36

Swollen wound Salivary discharge Food drainage

Question 37

CS of closed esophageal wounds

Answer 37

Cellulitis causing ventral neck swelling Anorexia Febrile and depression Shock from toxic products that accumulate in tissues

Question 38

What causes mediastinitis and pleuritis in closed esophageal wounds?

Answer 38

Cellulitis and necrosis in the neck —> causing infection and gas dissect along fascial planes to mediastinum

Question 39

Dx of esophageal wounds

Answer 39

Acute swelling ventral neck SQ emphysema over neck and shoulders Endoscopy Rads (gas through facial planes and extra luminal food)

Question 40

Conservative tx for esophageal wounds

Answer 40

Good ventral drainage: esophagostomy and excise necrotic tissue Second intention healing Abx and anti- inflammatories Tetanus prophylaxis 3-4 weeks healing

Question 41

What does saliva lost via wounds and fistulas causes?

Answer 41

Hyponatremia, hypochloremia Metabolic acidosis then metabolic alkalosis

Question 42

Sx tx for esophageal wounds

Answer 42

Resection and anastomosis Esophagostomy

Question 43

Sx complications from esophageal wounds

Answer 43

Esophagus has no serosa surface Constant movement Neurological complications

Question 44

What results from esophageal wounds?

Answer 44

Cellulitis Laryngeal hemiplegia (left recurrent laryngeal nerve) Horners syndrome (ptosis, miosis, enophyhalmos) Chronic esophagocutaneous fistula Strictures are rare