Sx of oral and maxillofacial surgery in dogs

Question 1

Context of jaw /face fractures?

Answer 1

Trauma - pathologic fractures: small or toy breeds + soft food + Poor prophylaxis

Question 2

Physical exam of oral fractures?

Answer 2

Excessive drooling
Blood-tinged saliva
Pain
Crepitus
Reluctant to eat

Question 3

What diagnostics for fractures?

Answer 3

• X- Rays: At least 4 views.
• CT scan: gold standard

Question 4

List some treatment options for jaw fracts?

Answer 4

• Muzzle therapy
• Cerclage wire
  Epoxy resin+/- ESF pins

Question 5

What are different open surgery approaches ?

Answer 5

1. Symphysis and body (rostral / incisive)
2. body
3. Ramus
4. Temporomandibular joint
5. Intraosseous wirte fixation of incisive, nasal and maxillary
6. Mini Paltes

Question 6

What complications can occur?

Answer 6

• Delayed union and nonunion
• Malunion
• Wound infection
• Osteomyelitis
• Maloclussion

Question 7

Describe Lip Avulsion?

Answer 7

Associated to trauma (as already seen).
Median age: 22 months
Median weight (dog) 8.3kg
Debridement + Lavage

Question 8

Suture choice for lip avulsion?

Answer 8

Poliglecaprone 25

Question 9

Repair of lip avulsion?

Answer 9

a) Chin mattress
b) Interrupted horizontal mattress
c) Holes + interrupted
d) Wires

drain?

Question 10

what different repair options for facial soft tissue injuries ?

Answer 10

Question 11

Describe maxillofacial tumours ?

Answer 11

• 6% of all canine tumours. Less frequent in cats.
• Generally unnoticed.
• General exam: Size, location, ulceration, necrosis, teeth mobility. Lymph nodes (LN).
• Staging: e.g. TNM-system (T= Extent of the primary tumour; N = LN involvement; M = Metastasis.

Question 12

Diagnostics for maxillofacial tumours?

Answer 12

Question 13

What 5 types of maxillofacial tumours ?

Answer 13

A. Malignant melanoma
B. SCC
C. Fibrosarcoma
D. Osteosarcoma
E. Papillomatosis

Question 14

Malignant melanoma?

Answer 14

Most common (or 2nd most common)
malignant oral tumour.
Can also
appear around the lips/cheecks
74% regional LN metastasis rate
65% pulmonary metastasis rate

Male>Female 3:1-6:1
Spaniels or dogs with dark mucosas.#
Cats: rare

Question 15

SCC?

Answer 15

41.5% of oropharyngeal tumours in dogs
No sex or breed predilection (Lingual: females, poodles, labradors)
Tonsils or gingiva
Locally invasive but lower metastatic rate

Question 16

Fibrosarcoma ?

Answer 16

• Gingiva
• 72 % bone lysis
• 10% Distant metastasis (lungs)
• Golden retreivers (52%)

Question 17

Osteosarcoma ?

Answer 17

• Appendicular > Axial skeleton -> skull
• Medium - large breeds
• Middle-old age

Question 18

Papillomatosis

Answer 18

16% of all oral tumours in dogs.
4-8 weeks incubation + rapid growth +
regression (4-8 weeks)

Question 19

what surgical principles to consider with maxilofacial tumours?

Answer 19

Anaesthesia and analgesia
Surgical margins
Positioning → visibility
Blood supply
Tension Free
Beware of the complications: bleeding, infection, dehiscence

Question 20

What different techniques for maxillofacial tumours?

Answer 20

• Intracapsular excision
• Marginal excision
• Wide excision
• Radical excision

Question 21

What different types of mandibulectomies can you do?

Answer 21

Question 22

What types of maxillectomies can you do?

Answer 22

Question 23

Complications from maxilofacial tumour surgery ?

Answer 23

• Facial swelling
• Sublingual swellings
• skin over maxillectomy may rise/ fall with respiration
• Dehisence common -> 2nd intention healing
• oronasal fistula
• Damage to tooth root -> excision
• Tongue fall out of mouth/ drooling
• Mandibular drift lower canine traumatise palate )> can extract but rarely needed
• IF remove both bodies of mandible will require lifelong hand feeding

Question 24

What about tongue options?

Answer 24

Question 25

Tonsils?

Answer 25

Dogs: SCC, lymphosarcoma - highly metastatic local LN and distant lungs - MSt 1 months - tonsilitis often self limiting

Question 26

When do we do a cheiloplasty?

Answer 26

Lip fold oedema -> Ulceration +/_ halitosis. +/- pruritus

Question 27

Who gets lip fold yo?

Answer 27

St bernard, schnauzers, brachys, spaniels and setter

Question 28

What to do before surgery for cheiloplasty?

Answer 28

Acetic + Boric Acid + Consider ABS

Question 29

Does a congenital cleft palate tend to affect primary or secondary palate?

Answer 29

Secondary (hard and soft)

Question 30

What does this cause?

Answer 30

→ Failure to create -ve pressure during sucking → unnoticed initially → Milk draining from nares, coughing, aspiration pneumonia, failure to thrive

Question 31

Management of cleft palate?

Answer 31

Check for aspiration pneumonia (rads) Tube feed until 8 weeks (tissue friable) Do not leave older than 4-5 months as palate may widen Often euthanised

Question 32

describe Acquired oronasal fistula?

Answer 32

a) Trauma, surgery, infection b) Traumatic cleft palate in cats with malalignment of midline maxillary dental arch c) Following dental surgery d) Foreign body

Question 33

General considerations of palate surgery?

Answer 33

- delicate tissue handling - Avoid electrocautery - NO TENSION - Suture lien not directly over defect - Soft food 14 days -> may need O tube - No chew toys, rough play, may need muzzle/ BC - Dehisence major complications - >may need multiple surgeries - Broad spec AB appropriate - Analgesia

Question 35

Hx and Signs of Oropharyngeal Trauma

Answer 35

Hx: trauma, vocalization. * Signs: ptyalism, depression, pain with cervical flexion or opening the mouth, bloody saliva, and collapse.

Question 36

Damage depending on angle of the stick?

Answer 36

Frontal→ damages soft palate and dorsal pharynx and can lacerate the oesophagus Acute angle → penetrates the pharynx at the tonsil or just behind the last molar. Temporal, masseter or retrobulbar damage. Oblique → parapharyngeal & cervical tissues, intermandibular area or cranial thorax

Question 37

Tx for stick injuries (acute vs chronic)

Answer 37

A) Acute: Examination of the oral cavity and pharynx + identify the site of injury and to retrieve any foreign material B) Chronic: Difficult to treat. meticulous exploration of tracts and debridement of all diseased tissue remove all the diseased tissue and hopefully the foreign material with it.