upper airway Flashcards
(165 cards)
1
Q
most common clinical signs associated with nasal conditions?
A
nasal discharge (unilateral vs. bilateral) sneezing reverse sneezing stertor epistaxis facial deformation ocular discharge
2
Q
What diagnostics should be considered when working up a condition of the nasal cavity?
A
CBC/chem +/- UA- MDB thoracic rads sedated oral exam imaging- skull or dental, CT(better than rads at detecting neoplastic changes), MRI- improved visibility because of cross sectional imaging, increasd ability to detect subtle lesions rhinoscopy cytology Bx (imaging preceedes biopsy) culture- fungal/bacterial
3
Q
Define brachycephalic airway syndrome. What are the congenital and secondary
abnormalities of this syndrome? How do the congenital abnormalities
cause the secondary abnormalities(i.e what is the pathophysiology)?
A
local chondrodysplasia
stenotic nares, elongated soft palate, everted laryngeal saccules +/- hypoplastic trachea
congenital (primary)- stenotic nares, elongated soft palate, hypoplastic trachea
secondary- elongated soft palate, everted laryngeal saccules (stage 1 laryngeal collapse), hypoplastic trachea
Pathophysiology: higher negative pressure to overcome obstruction–> secondary tissue changes (edema, hypoplasia, collapse)–> decreased airflow with increased obstruction
4
Q
What are other conditions that can contribute to airway occlusion in these animals?
What clinical signs are seen with brachycephalic airway syndrome?
A
cardiovascular changes- chronic decreased PaO2 secondary to airway obstruction–> pulmonary vasoconstriction–> V/Q mismatch–> subsequent vasoconstriction/hypertension–> R sided CHF
delayed gastric emptying
clinical presentation:
Asymptomatic- very young, less severely affected animals
mild/moderate- exercise intolerance, increased noise, snoring, snuffing, reverse sneezing, +/- GI signs, secondary mild signs
severe-emergent acute respiratory distress, severe upper airway swelling, hyperthermia, cyanosis, +/- heat stroke, +/- GI signs, +/- lower airway disease (noncardiogenic pulmonary edem, aspiration pneumonia), numerous significant secondary changes
5
Q
Which components of the syndrome are diagnosed by laryngeal exam?
A
tonsils, soft palate, arytnoid cartilages (symmetry, evidence of collapse, everted saccules), laryngeal function, mucosal lesions, excess mucus/saliva, masses
6
Q
In what patients should surgery be recommended? Why is early surgical intervention
recommended?
A
sx is recommended for any animals presenting signs of BAS/ any brachycephalic dog at time of spay/neuter
early surgical intervention is recommended to prevent secondary changes
7
Q
When diagnosing an elongated soft palate, what is the landmark used to determine
excessive length? What landmarks are used In surgery to know how much palate to
trim? What are the risks associated with trimming too much palate?
A
we use the larynx as a landmark to determine excessive length and the tonsils as a landmark to know how much to trim.
Risks: rhinitis/sinusitis
8
Q
Describe the 3 different stages of laryngeal collapse.
A
Stage 1- everted laryngeal saccules (they get edematous and evert into the airway)
Stage 2- collapse of cuneiform cartilage
Stage 3- collapse of corniculate cartilage
9
Q
What other body systems can be affected by the airway obstruction seen in
brachycephalic airway syndrome? What is the pathophysiology in these other systems?
A
GI delayed emptying, hiatial hernia, esophageal deviation
R sided heart failure from pulmonary vasoconstriction, V/Q mismatch and subsequent hypertention
10
Q
Why is medical treatment an important component in the management of
Brachycephalic airway disease?
A
because it reduces the occurence of secondary effects and aspiration pneumonia
11
Q
What are the most common complications associated with surgical treatment of
brachycephalic airway syndrome?
A
severe- pharyngeal swelling (acute distress, emergency tracheostomy), vomiting, regurgitation, aspiration pneumonia
Minor- dishiscence of nares (recurrence of stenosis), bleeding, persistent stridor/ sterdor, Rhinitis/sinusitis, voice change
12
Q
What complications are associated with ventriculocordectomy? What can be done to
minimize this risk?
A
webbing- leave 1-2 mm ventral cord intact to decrease the risk
13
Q
Differentials of nasal disease
A
dental disease and nasopharyngeal polyp
14
Q
most common indication for nasal planum resection
A
neoplasia (SCC)
15
Q
risks and complications of nasal sx
A
hemorrhage (dorsal, lateral and major palatine arteries)
flap necrosis
oronasal fistula
dishiscence
stenosis of airways
incomplete resection/local recurrence (neoplasia)
16
Q
What are the disease components of BAS?
A
nasopharyngeal turbinates
stage 2-3 laryngeal collapse, tonsilar eversion, tracheal collapse, secondary edema, macroglossia
17
Q
what are the clinical signs associated with elongated soft palate (most common cause of BAS?
A
inspiratory and expiratory dyspnea (stertor)
extension into the rima glottis–> severe obstruction, loss of protective laryngeal function–> higher risk of aspiration pneumonia
18
Q
which drugs affect laryngeal function?
Which drugs should be used?
A
Ketamine, diazepam and large doses of mu agonists
propofol +/- butorphanol or buprenorphine, doxapram improves strength of respiration
19
Q
Which mode of diagnosis is considered gold standard?
A
endoscopy/tracheoscopy
20
Q
Which procedures are used for BAS?
A
Wedge resection- stenotic nares
soft palate resection- elongated soft palate
excision of everted laryngeal saccules
21
Q
Which drugs are used pre- op?
A
Gi protectants and promotility drugs- decreases risk of aspiration pneumonia, treat for 10-14 days prior to sx if symptomatic
anti inflammatories- for soft palate resection and everted saccule excision- Dexamethasone
antiemetics at time of pre op
preoxygenation prior to induction
22
Q
When would it be appropriate to perform tonsilectomy, unilateral arytnoid lateralization and temporary or permanent tracheostomy?
A
tonsilectomy- never recommended for BAS unless neoplastic or abscessed
unilateral arytnoid lateralization- only in cases of laryngeal paralysis
temporary or permanent tracheostomy- if no clinical improvement or decompensation
23
Q
what is epiglottic reversion and how is it diagnosed and treated?
A
upper airway obstruction caused by laxity of the hyoepiglitticus m. in face of extreme inspiratory effort
tx: surgical pexy of the ventral aspect of the epiglottis and the dorsal base of tongue
24
Q
Which muscle is responsible for laryngeal abduction? What nerves innervate it?
A
cricoarytenoideus dorsalis (it contracts during inhalation)
vagus–> recurrent laryngeal n–> caudal laryngeal n.
25
what are the 3 functions of the larynx?
swallowing
abduction during inhalation and adduction during exhalation (passive)
voice production
26
clinical signs of laryngeal dz
```
depends on disease process
respiratory stridor
exercise intolerance
gagging/dysphagia
voice change
dypnea that doesnt improve with open mouth breathing
```
27
which side is best approach to arytnoid lateralization?
L so esophagus is out of the way
28
Define laryngeal paralysis. What is known about the etiology of this condition?
What are the 2 common age groups for laryngeal paralysis?
dysfunction/damage to the vagus n and its branches affecting function of the cricoartynoideus dorsalis m.
congenital- progressive degeneration of neurons with onset before 1 yr
idiopathic- large breed older, part of generalized neuropathy commonly as secondary to a disease process
29
Describe the typical history, presenting complaints and clinical signs associated
with laryngeal paralysis.
same as most laryngeal diseases, mild resp stertor to servere respiratory distress and cyanosis
30
How is a definitive diagnosis made? What method is commonly used? What other
diagnostic tests or evaluations should also be done?
laryngeal exam is definitive dx
US, tracheoscopy, 3 view rads, CHC/chem, UA, TSH, T4, acetylcholine receptor antibody titer
31
What movements do the corniculate,
cuneiform and arytenoid cartilages have during normal inspiration? What is
different in the dog with laryngeal paralysis? How is this different from the dog
with laryngeal collapse?
arytnoid should abduct during inhalation
in laryngeal paralysis it will close during inhaation
32
What is the purpose of arytenoid lateralization for treatment of laryngeal
paralysis? Describe the main anatomical change that results from this surgical
procedure.
decreases airway resistance during inhalation by widening the rima glottis
33
What are the complications of arytenoid lateralization? What medical management
strategies should be recommended in any patient with laryngeal collapse?
medical management- (for mild clinical signs) weight loss, stress reduction, exercise restriction, environmental changes
excessive tension--> aspiration pneumonia
recurrent or persistent signs, seroma intramural hematoma, coughing, gagging, dysphagia, post op megaesophagus
34
What is the anatomical cause of tracheal collapse? What factors are associated
with the etiopathogenesis of this condition? Explain how small airway diseases
such as chronic bronchitis can affect the trachea.
anatomical cause- laxity of the trachealis muscle--> weakness of tracheal rings
hypocellular tracheal cartilage
decreased water retention secondary to loss of GP and GAG
progressive cough--> squamous metaplasia, reduction of ciliated cells, increased viscosity of secretions
chronic bronchitis can affect the trachea via cough
35
What is the most common signalment for this condition? What are the clinical signs of
tracheal collapse?
small/toy breeds, middle aged
progressive goose honk cough, waxing and waning dyspnea, exercise intolerance, cyanosis, syncope
36
How would you definitively diagnosis tracheal collapse? What is the gold standard for
diagnosis and why?
tracheoscopy is the gold standard because we can directly visualize collapse and grade its severity and can obtain samples
37
What are the differences between medical management for cases that present acutely
versus for the chronic management of tracheal collapse?
see sam notes
38
External tracheal prosthetic rings are designed to prevent flattening of the tracheal rings
on inhalation and exhalation. Explain how these splints work. What are important
considerations in application of external splints?
external prosthetic tracheal rings- cervical use only, must start and end in area of normal trachea
39
List advantages and disadvantages of internal tracheal stents
adv- minimally invasive, shortened anesthesia time, cervical or thoracic, immediate improvement
disadv- fluroscopy or endoscopy, $$, shorter lifespan than tracheal rings, moderate to high complication rate
40
What are the indications for permanent tracheostomy in the dog? What tissues
are sutured in this “ostomy”? How is tension on this suture line reduced?
What is the prognosis after permanent tracheostomy in dogs? What about cats?
indications- untreatable upper airway obstruction
tissues sutured: mucosa and skin
prognosis
dogs- good for indoor dogs
cats- guarded to poor because mucus plugs and soft tracheal cartilage predisposes to tracheal collapse
41
What are the two primary surgical approaches to the thoracic cavity? Know the
advantages and disadvantages of each. How does the surgeon decide which approach
is most appropriate?
median sternotomy- for bilateral thoracic exploration, cranial mediastinal masses and cranial thoracic trachea, more painful and prolonged recovery because cutting through bone
lateral/intercostal thoracotomy- directed approach to a specific structure, less traumatic since going through muscle layer
42
Why is complete lobectomy more difficult from a median sternotomy approach?
In what situations would this approach nevertheless be indicated?
What are the advantages /disadvantages of minimally invasive approaches?
total lobectomy is more difficult from a median sternotomy approach because we need access to the hilus
adv- access to the thorax during celiotomy
disadv- cant feel tissue texture
43
What techniques can be used to perform a complete lobectomy? When is partial
lobectomy preferred over total lobectomy? What methods can be used to perform a
partial lobectomy?
lateral thoracotomy or thoracoscopy
total vs partial- depends on dz process and where lesion is within lobe. Total- diffuse and through multiple lung lobes (neoplasia, abscess, truma)
partial lobectomy can be performed by thoracoabdominal stapler, guillotine suture, 2 rows of continuous suture pattern
44
Describe etiology, signalment, history and presenting signs, and physical
examination and radiographic findings for lung lobe torsion. Which lobe is most
commonly affected? What is the prognosis, following lobectomy?
large deep chested dogs (right middle or left cranial) and pugs (left cranial)
CS- acute onset, dyspnea, tachycardia, cough, exercise intolerance, hemoptysis
PE findings- pyrexia, pale MM, decreased lung sounds ventrally
Radiographic findings- consolidation, air bronchogram and fluid line
prognosis- good for pugs, guarded for other breeds
45
List or chart the different types of pneumothorax vs. etiology, signalment, source
of air, and integrity of chest wall. Which is the most common type? Which type
is not traumatic in origin? Which type has the best prognosis?
neoplasia- good prognosis if no LN involvement
trauma (HBC)- most dont require surgical intervention
penetrating chest wounds
46
How do both pulmonary contusion and pneumothorax result in ventilation/perfusion
mismatch? Why do these patients develop respiratory acidosis,
despite tachypnea?
there is less space for exchange and therefore more CO2 remains in circulation--> resp acidosis
47
What specific treatment is required for the patient with
severe closed pneumothorax, before oxygen supplementation is of greatest
possible benefit?
thoracocentesis
48
Why do animals with fractured ribs become hypoxic? What can you do to
alleviate this condition? Much of the dyspnea seen in patients with fractured ribs
and flail chests is a result of another traumatic condition. What is that condition?
What is the recommended treatment for a simple flail chest?
hypoxemia is due to hypoventilation secondary to pain and V/Q mismatch because of contusion
treat conservatively with splint to improve comfort unless severely displaced
49
What is chylothorax and what are the possible causes? How do we diagnose this
condition?
secondary to impaired or disrupted lymphatic drainage, idiopathic is most common
diagnosis- cytologic evaluation of pleural effusion- triglycerides of fluid>blood, cholesterol of fluid
50
What are the surgical procedures performed for the treatment of chylothorax? Which of
these procedures helps with the mechanical drainage of chyle from the thoracic cavity?
What is the overall success rate of surgery in dogs? What about cats?
thoracic duct ligation, cysterna chyli ablation, subtotal pericardectomy, +/- omentalization, +/- pleuralport placement (chronic drainage catheter into the abdominal cavity)
dogs have improved outcome compared to cats
51
What is the long term complication associated with chronic untreated chylothorax?
fibrosing pleuritis
52
Know the anatomy of the diaphragm
aortic hiatus closer to the spine, esophageal hiatus in the center and caval foramen closer towards sternum
53
Peritoneopericardial diaphragmatic hernias are always congenital in dogs and
cats. Are these hernias inherited? What concomitant abnormalities may be found?
defect in embryogenesis- unknown cause
may be found with polycystic kidneys (cats), ventricular septal defects and sternal deformaties
54
What are typical presenting signs and physical examination findings of patients with
peritoneopericardial diaphragmatic hernia?
signs referrable to respiratory, GI, cardiac and neurologic systems
PE- muffled heart sounds, ascites, murmur, +/- concurrent ventral abdominal wall defect
55
What is the prognosis for the patient with peritoneopericardial diaphragmatic
hernia? Is this a pleural space condition?
excellent prognosis for animals surviving surgery post 24 hrs
not a pleural space condition
56
How does diaphragmatic hernia result from blunt trauma to the abdominal wall?
Is diaphragmatic hernia a pleural space disease? Why is vomiting a common sign in patients
with chronic diaphragmatic hernia?
the muscle layer of the diaphragm is susceptible to tears which can happen to increased pressure in the abdomen cause by blunt trauma
this is a pleural space disease
vomiting is a common sign in patients with chronic diaphragmatic hernia because irritation of the vagal nerve
57
What are typical findings on thoracic auscultation in dogs and cats with
diaphragmatic hernia?
PE- muffled lung sounds, Borborygmi auscultated on thoracic auscultation, tachycardia, tachypnea, empty abdomen on palpation
58
You are presented with a dog that has been hit-by-car 30 minutes ago and has a
diaphragmatic hernia. When would you choose to repair this hernia? What condition might
make you go to surgery sooner?
surgery as soon as patient is stable, go sooner (before stabilized) if stomach is herniated because it can rapidly expand and become herniated
59
You are presented with a cat that has a chronic diaphragmatic hernia, secondary
to trauma 2 years ago. Describe your course of action with this patient?
US guided thoracocentesis first to look for pleural effusion, ventral midline approach, look for adhesions
60
What are the intra-operative and postoperative complications of diaphragmatic
hernia repair?
perioperative death, re-expansion pulmonary edema (common in chronic, keep IPPV
61
Know and understand the various roles of surgery in providing oncologic treatment
most important component of tx of small animals with solid tumors, best chance of curative is the first attempt
62
Know the indications for incisional versus excisional biopsies as well as the pros and cons of each
procedure
incisional- when sampling large superficial lesions, careful surgical planning necessary due to percieved difficulty with curative sx (size and location of lesion), less invasive sampling have not yielded a dx, can cause seeding of neoplasia in normal tissues. Deep narrow wedge facilitates closure
excisional- removes tumor along with surrounding normal tissue, allows removal of smaller, non-invasive masses in single procedure, should only be considered when treatment would not be altered by tumor types and re-excision possible without great morbidity.
63
Know the various approaches to removal of a mass and when each is indicated (marginal vs
radical, etc)
Sarcoma- 3cm, carcinoma- 2cm, vaccine associated fibrosarcoma- 5-7cm
intracapsular- rarely if ever
marginal- lipomas and benign masses, malignant- goal is microscopic disease. (mast cell tumors, sarcomas)
wide- removal of 2-3 cm normal issue 3D or 2-3 cm laterally and 1 fascial plane deep (3-4 cm of fat counts as a fascial plane), based on histopath report on grade, mitotic index and degree of differentiation
radical- removal of entire compartment (amputation, hemipelvectomy)
64
Be able to list and discuss the various important principles of oncologic surgery. What intraoperative
techniques are important?
best chance of cure is at first sx
ability to close wound should not influence aggressiveness if intent is to cure, minimize handling of tumor (dont penetrate tumor capsule, protect normal tissues), ligate blood supply as early as possible (increase in circulating tumor cells perioperatively), excise biopsy tract, excise LN if indicated, lavage tissues, change gloves and instruments and lavage again before closing, AVOID USE OF DRAINS!
identify margins using sutures, dye
65
Why is it important to understand the flow of lymphatics when working up a patient with a
malignancy?
local draining LN should be aspirated prior to sx and excision is prognostic for multiple tumor types (mammary carcinoma, mast cell tumors, aprocrine gland adenocarcinoma of the anal sac. Sentinel LN mapping uses radioactive material an NS or radiopaque contrast and radiography or CT to tract LN's that drain mass
66
Know what type of tumors can be most readily diagnosed from a cytologic sample
those that are very differentiated
67
What information is important to receive on a histopathology report to help guide further
treatment and to provide a prognosis to an owner?
margins- clean, close or dirty. measurement in mm is more useful. if dirty wait and see depending on the remainder of report, re-excision based on surgical scar, adjunctive tx (radiation, chemo)
immunohistochemistry- determines the cell of origin as tumor becomes less differentiated, poorly differentiated tumors may not express these markers making IMHC less useful
tumor or other, benign vs malignant, histologic type, grade, margins
68
Understand the concept of body mapping
size and location of masses, mobility, consistency
69
What is the difference between palliative and curative surgery?
palliative- no curative intent, will improve quality of life but not extend life
70
Understand normal dental anatomy and development
in utero- deciduous buds form and give rise to permanent buds
Dentin is formed by odontoblasts throughout the life of the tooth
enamel is formed by ameloblasts on the crown of the tooth prior to eruption and then self destruct
cementum- formed by remnants of the dental sac on the outer dentinal surface of the root when the tooth is almost mature. Produced throughout life by cementoblasts
development:
pulp consists of blood vessels, lymphatics, nerves and connective tissue and causes root growth, closure of the apex and continuously narrows as the animal ages. as the root lengthens the deciduous tooth erupts and after they are fully erupted the root begins to resorb meanwhile the permanent tooth bud develops and erupts as the deciduous tooth is shed (molars dont have deciduous)
71
Be familiar with and be able to use proper dental terminology including anatomical and directional terms
mesial- toward the midline of the dental arch- central incisor (rostral)
distal- away from midline (caudal)
proximal- (contact) surface of adjoining teeth
interproximal- between proximal surface of adjoining teeth
```
diastemia- wider space between teeth
rostral/caudal- structures on head (not teeth)
lingual/palatal- side facing tongue
vestibular- labial/buccal
occlusal- chewing surface of molars
```
apical- toward the root
coronal- towards crown
normal anatomy
enamel- produced once
dentin
cementoenamel junction
cementum-attaches to alveolar ligament
crown
pulp chamber
cervical buldge- where gingiva meets tooth
neck
root
root canal
apical delta- where pulp enters tooth
dental tubules- communicate with pulp and dentum where it gets nutrients (cant treat an infection here with abx. must do root canal or extraction)
furcation- area between roots where alveolar bone rises
cingulum- shelf on the inside (palatal) surface of the maxillary incisors where the mandibular incisors occlude/rest
72
recognize abnormal pathology, including malocclusions, periodontal dz, tooth fractures, endodontic dz (including pulpits and caries, impacted teeth, etc. be able to recommend treatment options for above conditions
polyodontia (supernumerary teeth)- extraction after rads
fusion- (one crown, 2 roots, less numbers of teeth)
gemination- incomplete splitting of 2 teeth (2 crowns one root)
ano/oligo/hypo-dontia (missing teeth)- if deciduous tooth is congenitally absent, adult tooth will be missing. rads determine if it is missing or retained (can be in nasal cavity and cause discharge)
malocclusions- interceptive orthodontics (preemptively extract teeth to avoid or correct problem), appliances, incline planes (also used for base narrow canine- when canine goes into the gingiva) to slowly push teeth to the correct location, causes mucositis
Impacted teeth- uncommon, rads to dx, can lead to abscess or cyst formation and should be extracted. Vital impacted teeth may erupt into normal position if the overlying gingiva and alveolar bone is removed
enamel hypoplasia/hypecalcification- focal= restore defect with composite; several= cap to prevent wear;
tetracycline staining- no treatment needed, can bleach or resin bond
attrition- orthodontic correction for malocclusion, crown reduction, extraction
abrasion- abnormal contact with crown surface by foreign object- remove offending object, monitor for pulp exposure and crown fractures
endodontic exposure- probe with explorer and if it enters chamber extract or do root canal. reparative dentin is brown and hard
caries (soft, brown, leathery)- pulp capping, root canal, extraction
periapical infection (caused by endodontic (apical ascess) +/- periodontal lesions)--> nasal or retrobulbar dz (roots of molars 1 and 2 in the zygomatic arch) (swelling/discharge; draining tract associated with teeth= parulis).
gingival hyperplasia caused by periodontal dz (focal) or generalized- remove excess tissue to return sulcus depth to normal with scalloped contour, .2% chlorohex rinse BID for 2 weeks.
pulpitis (pulp bleeds)-monitor, root canal, extraction
endodontic dz (decreased wall size, luscency around apex, apical resorption)
complicated root fracture- vital pulpotomy, root canal, crown restoration or extract
enamel fx/uncomplicated fractures- crown restoration +/- indirect pulp capping
tooth lux/avulsion- if not salvageable extract, if it is re-seat in alveolus, splint and root canal
canine resorptive lesions- extract or monitor for progression
periodontal dz- thorough deep cleaning, extraction, at home care
73
be able to describe the stages of periodontal dz and the steps and intsrumentation used when performing a dental cleaning
stage 1- erythema, gums bleed when probed, normal sulcus depth, reversible with proper tx and home care, no furcation involvement or probe can enter 1mm
stage 3- gingival hyperplasia and/or recession, moderate to deep pocket formation, 25-50% bone loss, slight to moderate mobility, probe passes through and through
stage 4- gingival recession, deep pockets, furcation exposure, >50% bone loss, advanced mobility, horizontal and vertical bone loss, periapical luscency
instruments used when cleaning: scalers (2 cutting surfaces, work away from sulcus, never use below gingival margin), curettes (sub gingival calculus removal and root cleaning), periodontal probe (measure sulcus depth), dental explorer, mirror, 3 way syringe, chlorohex rinse, sealants, dental x ray unit
74
be able to describe how loss of attachment is determined and know its importance in assessing treatment of periodontal dz
loss of attachment is determined with the periodontal probe and the sulcus depth which gives a better overall picture of state of periodontal dz
75
recognize and treat specific dz's such as tooth resorption lesions and feline gingivostomatitis complex, canine ulcerative paradental stomatitis
Tooth resorption- type 1 extract whole tooth; type 2 amputate crown and superficial root structure, leave ankylosed root
gingivostomatitis- inflammation of the gums surrounding the teeth because allergic to plaque- teeth extraction, prevent by brushing teeth
76
know the indications and methods for performing dental radiography.
essential in a complete dental cleaning
77
know the indications and theory behind endodontic therapy. be able to differentiate between vital pulpotomy and complete root canal
endontics (treatment of dental pulp)
indications- fractured teeth, pulpitis, tooth luxation/avulsion, crown reduction, certain types of caries
adv- less invasive than extraction, preserves tooth function and integrity of jaw
disadv- longer anesthetic time, special instuments and training
vital pulpotomy- maintain a viable tooth that will continue to mature (maintain a viable pulp), immature tooth (young animals 24months old (closed apex), maintains tooth function but tooth is dead, complete removal of pulp contents and seal apex to prevent bacteria from escaping the tooth
78
what constitutes a dental emergency?
a recent crown fracture exposing the pulp, tooth avulsion/luxation if you want the tooth to be saved
eosinophilic granuloma with severe episodes of bleeding (palatine a.)
79
what 4 parts make up the periodontium and which part is visible
gingiva- only visible part in a normal mouth (gingival sulcus- the potential space between tooth and gingiva. dogs 1-3mm, cats
80
what are the functions of the peridontal ligament
attaches tooth to the alveolus (isolates tooth from osteoclasts that remodel the surrounding bone. if ossified osteoclasts remodel tooth to brittle bone causing the root to disappear and the crown to break off when it chews something solid), absorbs shock from the impact of occlusal forces and transmits them to the alveolar bone, supplies nutrients to alveolar bone and cementum via arterioles and drainage via venules and lymphatics, tactile and proprioceptive information essential in coordinating the neuromuscular activity of mastication
81
which tooth accumulates tartar more quickly and why
premolar 4 (PM^4/208) because the parotid salivary gland papilla is located right above this tooth and it secretes mineral rich saliva
82
be familiar with the anatomical and triadan system of numbering teeth. Be able to ID all teeth using both systems
Dog:
deciduous: I3/3, C1/1, P3/3 x2=28
adult: i 3/3, C1/1, P4/4 M2/3 x2= 42
cat:
deciduous: I3/3, C1/1, P3/2 x2=26
adult: i 3/3, C1/1, P3/2 M1/1 x2= 30 (maxillary premolars are 2,3,4; mandibular premolars are 3,4)
anatomical system: I, C, P, M, deciduous are small case. number goes on the corresponding side of the letter and maxillary teeth go on top and mandibular teeth on the bottom. start numbering from midline
Triadan system: first number is quardrant and 2nd and 3rd number is the tooth
start on R maxilla as 1 (upper right and go clockwise as if looking at the teeth). deciduous teeth are 5, 6, 7, 8 in the same order
cats- canines are 4, maxillary premolars start at 6 and mandibular premolars start at 7
83
what is the rule of 4 and 9?
in the Triadan system tooth 4 is the canine and tooth 9 is the 1st molar
84
If retained which ways do the permanent canine get pushed?
maxillary get pushed forward (mesial)
mandibular get pushed lingually (as do the rest)
85
what is scissor bite?
normal
maxillary incisors rostral to mandibular incisors, mandibular incisors in the cingulum, mandibular canine between last incisor and maxillary canine
86
What are the classes of malocclusion
Class 1- malpositioned teeth, normal jaw length. Anterior cross bite- one or more maxillary incisors are displaces towards the palate (trauma or inherited)
posterior cross bite- maxillary premolars are lingual to the mandibular premolars or molars
Class 2- mandibular bradygnathism (parrot mouth, overbite)
Class 3- mandibular prognathism (underbite)
Level bite- incisor crowns meet because bottom jaw is slightly longer than normal--> attrition
87
What is wry mouth?
unequal arch development, off midline
88
what are the different classifications of tooth fractures
enamel infraction- cracks in enamel, no loss in structure
enamel fracture- loss of enamel only
uncomplicated crown fracture- pulp chamber not exposed
complicated- pulp exposed
uncomplicated crown/root fx- pulp not exposed
complicated crown/root fx- pulp exposed
89
what are the different types of tooth resorption lesions, what species is it common to and how is it treated?
type 1- periodontal ligament remains intact- extract entire tooth
type 2- disappearance of the periodontal ligament with varying degrees of root resorption- amputate crown and superficial root structure and leave ankylosed part of the root since it is being resorbed anyway
type 3- type 1 and 2 in same tooth especially multirooted
common in cats
90
what is CUPS, how is it treated and what is special about its lesions?
canine equivalent of gingivostomatitis, treated by extraction, kissing lesions with mucosa that touches the teeth
91
periodontal disease is implicated in the formation of what other conditions
chronic nephritis, hepatopathies, endocarditis
92
which is reversible, gingivitis or periodontitis?
gingivitis
93
Know the common indications for tooth extraction
retained deciduous teeth, interceptive orthodontics (interferes with normal eruption of adult tooth), severe periodontal dz, non vital teeth or fractured crown with root exposure, teeth undergoing resorption, malocclusion (interference), supernumerary teeth, impacted teeth (predisposed to dentigerous cyst formation)
94
what are the principles of tooth extraction? Know how to extract single and multiple-rooted teeth
single rooted- severe epithelial attachment with blade an enter the periodontal space, use appropriate size root elevator/luxator to enter the periodontal space (rotate to stretch/tear periodontal lig, remove and work around entire tooth, keep working deeper until tooth becomes mobile, continue elevating until tooth luxates, use extraction forceps with care, assess tooth for complete removal, debride alveous with excavator if necessary (periodontal dz, periapical abscess, flush alveolus thoroughly, compress sides with finges to collapse alveoulus, +/- suture gingiva
multiple rooted- same as single root but section the tooth at the furcation of roots and elevate and remove each root segment individually
95
know the indications for surgical and nonsurgical tooth extraction
surgical extraction: teeth with healthy root structure where simple elevation is difficult and time consuming (canine, upper 3 and 4th PM. upper and lower 1st molar)
96
know the common causes of oronasal fistulas in dog
dental dz and extractions, pressure necrosis from FB, complications of sx, radiation tx, hyperthermia tx, trauma (electrical cord burns, bite wounds and gunshot wounds, blunt trauma to head)
97
know the pathophysiology of electrical cord (electric shock) injuries
causes burns, pulmonary edema (esp in cats), extent of injury difficult to asses initially (delay definitive repair until known)
98
know the keys for successful suturing in the oral cavity
use absorbable 3-0 to 5-0, reverse cutting needles work well, must be very accurate in placing sutures in attached gingiva, tie firmly but do not crush tissue, secure corners of flap first, place q 2-4mm, TENSION=FAILURE
99
know when to use one layer and two layer closure in managing maxillary defects and the advantages and disadvantages of each
single flap for acute (nonhealed) fistulas, defects that are too large to allow 2 layer closure. (removal of a small amount of tissue around the fistula places the suture line over supported tissue and reduces movement with respiration and facilitates air tight closer
double flap for congenital defects and chronic fistulas where the oral mucoperitoneum has healed to nasal mucosa. Hinge flap recieved its blood supply from the nasal mucosa so elevation of this flap toward the fistula must be done carefully to avoid damaging the blood supply
100
know the management options for traumatic cleft palate. this problem is associated with what syndrome in small animals? What other injuries are commonly seen with this syndrome?
conservative management- suture, acrylic splint, pin and figure 8 wire + suture only if others dont work
associated with blunt traua (HBC, kicks, high rise syndrome)
High rise syndrome- oronasal, forelimb and thoracic trauma
101
know the salvage techniques for animals with uncorrectable palate defects
intraoral appliances (can lead to mucositis)- acrylic appliances, nasal septal button
102
What is dilaceration and hypercementation
dilaceration-curved root tip
hypercementation- expansion or apical portion of root
103
How do you handle a retained root tip?
use root tip elevator but be careful not to push the root tip into alveolar canal, high speed bur to remove channel of bone around the tooth root and then elevate the remainder of the root, anatomization (not recommended but for anykylosed roots, dental bur used to drill out remaining root tip)
104
surgical extraction technique
create a buccal mucoperiosteal flap (envelop flap or single pedicle flap) , elevate flap apically past juga , incise junctional epithelium, elevate attached gingiva past the mucogingival line, remove some of the lateral crestal bone to expose furcation with high speed cutting bur, pass elevator through furcation, section tooth and separate each root separately. After tooth is extracted smooth any sharp alveolar or lateral bone, debride empty socket, flush with .12% chlorohex, check length of flap and remove any infected/friable ends. close with simple interrupted/cruciate absorbable suture, tied snug
105
T/F: when excising the canine tooth you want to start with an incision on top of tooth
FALSE- you want to start the incision in the diastema
106
what is the landmark for the apex of the canine tooth?
straight line up from PM1
107
what are the clinical signs of oronasal fistula?
inciting cause, nasal discharge, sneezing, aspiration pneumonia
108
Be able to differentiate the common oral tumors of dogs by biological activity, site predilection, if any, treatment options and prognosis
malignant- melamona (most malignant, locally invasive and mets early to regional LN and lungs. Gingiva>labial and buccal mucosa>palate>tongue. amelanotic is more aggressive. Tx: local control by surgical extraction radiation adjunct to sx or palliative if nonresctable. Prognosis: poor for achieving cure)
SCC (second most common malignant. Behavior: tonsilar vs nontonsilar- the further caudal in the mouth the worse prognosis because they are larger and harder to get good margins. gingiva and tongue, locally invasive, ulcerated and friable, slower to met. Tx: surgical resection (1-2cm), radiation adjunct to sx or primary tx, chemo: piroxicam. Prognosis: good to guarded with early detection and aggressive tx, late mets after 1 or more years). tonsillar SCC can look like lymphoma, highly malignant and early mets
fibrosarcoma- large breeds, gingiva>palate>labial or buccal mucosa>tongue, maxilla caudal to canine tooth, locally invasive, distant mets later in course, older dogs- slow growing, less frequently ulcerated. young (3-5 years)- very aggressive. Histologically low grade, biologically high grade variant often on maxilla. Tx: wide sx resection, radiation pre and post sx
Malignant but low grade- osteosarcoma (aggressive in other locations)
multilobularosteochondrosarcoma (MLO)
undifferentiated malignant oral tumor- young dogs (6-24months), very aggressive (rapid growth, early mets), maxilla caudal to canine tooth, external swelling with loose teeth, pain, responds poorly to any tx (palliative), survival often = 1 month
benign- peripheral odontogenic fibroma, acanthomatous ameloblastoma, odontogenicodontoma/central ameloblastoma, papilloma
109
know the common oral tumors of cats
SCC- most common, under tongue, extensive bone involvement common, often advanced before dx is made. Guarded to poor prognosis (not as good as in dogs, radiation can cause sig side effects, chemo: piroxicam
fibrosarc, osteosarc, fibroameloblastoma, differentiate from eosinophilic granuoma
110
know the tumors of dental tissue origin. What do the terms inductive and noninductive mean relative to tumors
odontogenic-
central ameloblastoma- arises from dental laminar epithelium (retained from embryo), noninductive (mesenchyme not stimulated to produce dental hard tissues aka doesnt have a tooth structure), can be cystic or multiloculated with considerable bone destruction
odontoma- inductive (mesenchyme induced to produce dental hard tissues), compound (contain tooth structures in various stages of development) or complex (dental tissues not differentiated enough to resemble teeth),
treat with surgical resection (maxillectomy) and radiation
111
know the two primary nomenclature schemes used for the "epulides". How does the biological activity of the different types differ
old: epulis- fibromatous, ossifying (both now considered peripheral odontogenic fibroma- benign, proliferation of fibrous connective tissue containing displaced cells of dental supporting structures, local excision= curative), acanthomatous (acanthomatous ameloblastoma- invade bone and push teeth out the way, arise from remnants of epithelial cells that produce periodontal ligament, contain islands or sheets of squamous epithelium in fibrous connective tissue stroma, benign but locally invasive into bone, surgical excision is treatment of choice + radiation),
112
know the typical signalment of dogs with undifferentiated Malignant Oral tumors. Know the biological activity of this tumor
undifferentiated malignant oral tumor- young dogs (6-24months), very aggressive (rapid growth, early mets), maxilla caudal to canine tooth, external swelling with loose teeth, pain, responds poorly to any tx (palliative), survival often = 1 month
113
Know the types of mandibulectomy and maxillectomy procedures and likely effects of these procedures on post op appearance and function. Know the common post op complications
mandibulectomy:
unilateral rostral
bilateral rostral- can go as far back as 4PM
central
total mandibulectomy- removal of L or R mandible. total (hemimandibulectomy), subtotal (vertical ramus left)
caudal
3/4 mandubulectomy
close the commissure to the level of the 2nd premolar to improve ability to prehend food and drink water and prevents tongue lol on that side
Maxillectomy- more hemorrhage especially if nasal turbinantes are affected
caudal- nasolacrimal gland and parotid duct are in these areas
partial
mandibulectomy complications- pseudoranulas under tongue, wound dishiscence (more common with rostral mandibulectomies), mandibular drifting (clicking sounds when jaw is closed, resolves over time), bilateral rostral mandibulectomies caudal to 4PM and 3/4 mandibulectomy will significantly affect ability to prehend food
maxillectomy complications- wound dishiscence with oronasal fistula (delay repair until inflammation subsides), bilateral rostral maxillectomy caudal to canines will allow nose to droop and affect prehension of food
114
which LN drain the oral cavity?
mandibular, parotid and retropharyngeal
115
know the typical etiologies of lip avulsion
shearing trauma, avulses along mucogincival line leaving very little soft tissue for reattachment
116
know how to surgically manage lip avulsion
suture reconstruction effective for maxillary lesions but on lower lip it falls because of the weight
for lower lip place interdental stent sutures to support weight of lip first, suture mucogingival junction
117
what is tight lip? what breed is most commonly affected?
lower lip very tight where it may cover incisors
shar pei most commonly affected
118
know the surgical options for lip reconstruction. what are the keys to a successful functional and cosmetic result
cheiloplasty- incise along the mucogingival line creates minor lip avulsion allowed to heal by second intention
119
know the major salivary glands of the dog and cat. know their anatomic locations, regional anatomy and the locations of the duct openings
```
dog:
parotid
mandibular
sublingual- most affected by mucocele
zygomatic- presents with retrobulbar signs
```
Cat: (additional major salivary gland) molar salivary gland
duct exits at the sublingual caruncle
120
know how to manages nasal folds
deep nasal folds are predisposed to dermatitis.
Tx:
conservative- initially treat to control inflammation
surgery- resect nasal folds
121
know the pathophysiology of salivary mucocele. Which salivary gland (s) is/are most commonly affected?
sublingual is most commonly affected
subcutaneous (submucosal) accumulation of saliva within a nonepithelial, nonsecretory lining
122
know the clinical presentations of salivary mucocele
all comes form the same gland usually, soft, nonpainful (painful if in acute inflammatory stage or if secondarily infected)
cervical mucocele is the most common
pharyngeal mucoceles can cause respiratory distress (least common presentation
123
know the treatment options for salivary mucocele. what does the term marsupialization mean?
surgical removal- definitive tx for all mucoceles
percutaneous aspiration of accumulated saliva in conjunction with definitive tx, conservative tx in high risk patients
Marsupilaization (of ranula)- salvage procedure creating a permanent communication with the oral cavity. used in high risk patients and may recur because it isnt treating the cause
lancing of pharyngeal mucocele- to relieve respiratory distress prior to definitive sx
124
know the anatomic landmarks, regional anatomy and surgical technique for excision of the mandibular/sublingual salivary gland complex. What is the importance of identifying the lingual nerve?
excision parallel to jaw line. duct goes between digastrigus and masseter muscles. look for lingual nerve
excise the mandibular and sublingual salivary glands because they are too closely associated to allow excision of just the sublingual gland
the gland/duct can be passes under the digastricus muscle if the rostral extent of the sublingual gland cannot be clearly determined
place drain if mucocele cant be adequately drained during sx
the actual mucocele itself doesnt need to be removed. it is a granulation tissue lined sac filled with saliva and inflammatory exudate. drain contents and will resolve if affected gland is removed
125
what are the common reasons for mucocele recurrence after sx?
inadequate excision of polystomatic sublingual gland, operation on the wrong side, removal of wrong structure
126
what are the surgical considerations for lip reconstruction
breed/species differences- dogs have more lips than cats
lesion size and location- proximity to mucocutaneous junction
suture at lip margin to avoid step deformity, avoid mucosal inversion, figure 8 suture apposes lip margin well
options: direct apposition, labial advancement flap, labial rotation flap
127
what is a parotid fistula and how is it treated
caused by trauma to the parotid duct
tx- ligation of the parotid duct proximal to the defect that is causing the fistula results in atrophy of the gland
128
What are predisposing causes of aural hematoma, and what is the origin of the bleeding?
aural hematoma- collection of blood within the cartilage plate of the ear caused by shaking/scratching, otitis externa and capillary fragility (cushings)
129
What are the treatment goals of aural hematoma, what are the non-surgical options and
surgical options and when would you choose one over another for treatment?
Goals- remove blood or clot, prevent recurrence, retain ear appearance
nonsurgical options (needle drainage) for recent and fluctuant hematomas, smaller hematomas, recurrence likely, repeated needle aspirations
+ IV Dex- 88% effective
+local dex infusion- 93% effective
+ localmethylpred- 90-98% effective (if small)
surgical- for chronic hematomas, harder to remove clot through aspiration, usually larger, place drain tube (penrose, larson teat cannula [creates dead space], butterfly catheter, incisional drainage (straight or S shaped [leave gap for drainage, cut on concave surface, remove clot, irrigate and multiple mattress sutures in correct orientation, full or partial thickness], dermal punch, laser), practivet system, and bandage
130
How do you treat lacerations of the pinna in dogs and cats?
one skin surface- pinna maintains normal position, 2nd intention or suture
two skin surfaces/cartilage- primary closure, vertical mattress, far bite aligns cartilage, near bite aligns skin
laceration at ear tip- suture edge and stitch superficially
131
How do you manage SCC of the pinna in a cat and what is the prognosis?
pinnectomy +/- vertical ear canal ablation
curative procedure
132
What are some of the causes and predispositions for otitis externa and when should surgical
intervention occur?
pendulous ears, narrow canals, excessive hair , excessive cerumen, chronic ear moisture, inappropriate antibiotics, polyps or tumors
surgical intervention should occur when medical treatment has failed
133
When is a lateral or vertical ear canal resection indicated and when is it contraindicated?
Lateral-
indications- when skin changes are reversible, tumor involving tragus or lateral wall of vertical canal, improves ventilation, decreases moisture
vertical
indications- hyperplastic otitis involving vertical canal only, neoplasia involving vertical canal only
134
What are the indications for a TECA and why do you perform a bulla osteotomy in conjunction
with it?
cockers most commonly
indications: ceruminous gland adenocarcinoma, extensive benign otitis, failed lateral ear canal resection, middle ear dz
bulla osteotomy
135
. What structures do you need to avoid during a TECA and where are they located?
avoid retroglenoid vein, carotid artery, maxillary artery, facial nerve
136
Should you use bandages and drains after TECA surgery?
no
137
What complications can occur with TECA and bulla osteotomy surgery, what is the incidence,
and what is the prognosis for resolution?
Horners syndrome- cats mostly affected, post ganglionic sympathetic fibers run superficial in ventral medial canal
facial nerve paralysis- usually resolves over time, droopy lip, no blink reflex, dropped ear
hearing- fibrous tissue fills the bulla further diminishing sound transmission
hemorrhage
dishiscence- common, poor technique
infection/draining tract due to incomplete removal of affected epithelium
138
What are the surgical diseases of the middle ear and how do you diagnose middle ear disease?
otitis media- extension of otitis externa
middle ear polyps- common in cats
cholesteatoma- keratinization secondary to otitis media
neoplasia- extremely rare
diagnostics- other dermatological diseases, palpate LN (parotid and retropharyngeal), temporomandibular joint palpation will be painful, neuro exam (facial paralysis and horners syndrome), rads (loss of air density, thickening of wall), CT (evaluates surrounding bony structures), MRI (most sensitive, detects early dz), otoscopy
139
What is the initial management of middle ear disease and when should you choose surgery?
medical management: clean ear, myringotomy, irrigate with saline, topical and systemic non ototoxic abx for 4-6 weeks
sx is severe canal stenosis, tympanic bone infection, failure o medical management, significant neuro signs
140
What are inflammatory polys, what patients do they affect, where are they located, what signs
do they exhibit, what causes them, and how do you manage them?
non neoplastic polyps developed from inflammatory and epithelial cells (viral)
young cats are affected
signs: vestibular or horners, dysphagia, dyspnea
sites of origin- tympanic bulla ( most common), auditory tube, nasopharynx
management:
traction extraction- must be seen through tympanic membrane and regrowth in 50%
ventral bulla osteotomy- most commonly done in cats for polyps, dorsal recumbency, palpate ventral bulla
141
What is surgical preparation different in ophthalmic surgery?
no rough scrubbing because delicate thin skinned eyelids, cornea and conjunctiva are damaged by alcohol and detergents, bacterial flora present on ocular surfaces, deep conjunctiva and 3rd eyelid harbors hairs and pathogens
142
What type of surgical prep solutions are acceptable for ophthalmic
surgery
place lube gel in eye before clipping (prevents hairs from entering conjuctival sac), clip periorbital hair and trim cilia, clip eyelids gently if eyelid sx, gentle scrub of periocular area (1:50/ .2% iodine/saline solution, alternate with sterile saline, avoid scrub because it irritates the cornea) ,
143
What are other important components for surgery of the eyes?
clean conjunctiva and nictitating membrane with cotton swab, irrigate cornea with same solution, routine draping, surgeon seated with armrests and magnification
144
What are the names and usages for ophthalmic instruments discussed
in class?
Barraquer eyelid speculum- hold eye open for conjunctival/ 3rd eyelid sx
Jaeger eyelid plate
bishop-Harmon forceps
derf needle holder
stevens tenotomy scissors
145
What are methods of hemostasis in ophthalmic surgery?
pressure with a cotton tipped applicator- sheds fibers and irritates cornea
wedge-shaped cellulose sponges
4x4 sponge
handheld cautery
phenylephrine, 1:10,000 epinephrine (vasoconstriction)
146
How many layers do you close the eyelid lacerations?
2 layers
deep layer- muscle and fibrous tissue, bites perpendicular to eyelid, avoid conjunctiva, simple continuous with knot as superficial as possible
skin- figure 8 and then simple interrupted to ensure apposition and place know away from cornea. start 4mm from eyelid margin and exit 1mm from margin
147
What are the skin sutures of eyelids? Suture type?
5-0 or 6-0 vicryl (soft suture even though it is braided)
148
What % of eyelid tumors in dogs are benign?
73%
149
what is a really common benign mass of the eyelid?
meibomian gland adenoma
150
What is the most amount of eyelid you can remove and have a primary
closure?
= 1/3 of eyelid margin- treat like laceration
V shaped incision or H shaped resection (when >1/3, preserves eyelid margin)
151
What are the signs, types and treatments for entropion and when do
you treat?
Clinical signs- asymptomatic, ocular discomfort, epiphora, self trauma, corneal erosion, ulceration and visual deficits
congenital- usually bilateral, most common, seen before 6 months but best to correct >8 months because of mature facial features
acquired
152
What is acquired entropion associated with?
lid spasm (spastic)- corneal ulcers, KCS, foreign body
153
What are the surgeries of entropion?
eyelid tacking- severe entropion in a not matured patient, multiple interrupted Lembert patterns, leave for 4 weeks or until age of sx
Hotz Celsus- hemostat technique (hemostats on skin to be removed, leave for 30 sec, remove hemostats and skin with scissor, suture defect), incision method (jaeger lid plate, crescent shaped incision 2mm from lid margin, suture in same fashion)
Modified Hotz celsus- for medial canthal entropion (isolate lacrima puncta, create triangle with ventral apex and suture, may decrease epiphora in some)
arrowhead resection- concurrent upper and lower lateral entropion (make arrow head incision, lateral canthal ligament transection required)
154
What surgery is used for medial canthal entropion?
Modified Hotz celsus
155
How and when do you treat ectropion?
wedge resection if causing KCS
156
What are the most common diseases of the nasolacrimal system and
signs associated with them?
punctal aplasia (membrane over duct are)- epiphora and tear staining
micropunctum- epiphora and tear staining
trauma and scaring
KCS (medical management
157
How do you diagnose diseases/trauma of the nasolacrimal system?
bubble test- inject air into puncta and look for bubbles. determines site of trauma/laceration
158
How do you treat diseases/trauma of the nasolacrimal system?
attempt to cannulate both sides of laceration and leave for 3 weeks to heal by second intention
159
What is the function of the nictitating membrane?
tear production, protect globe and removes debris from cornea
160
What is the most common disorder of the 3rd eyelid?
Prolapsed nictitating membrane (cherry eye)
161
What are the procedures for prolapsed nictitating membrane?
excision- not recommended because it can lead to KCS
Orbital rim anchoring technique
pocket technique
162
When and how do you enuculate an eye?
(removal of globe and all secretory tissue)
when the eye is painful and not visual or neoplasia and non responsive infections
subconjunctival approach
transpalpebral approach- (used for neoplasias)
163
What is exenteration?
removal of the contents of the eye socket including the globe, fat, muscles and other adjacent structures
164
What is proptosis, and how do you manage it?
increase in IOP and eyelid entraps posterior to globe
if intact, manually reduce for cosmetic purposes, can perform lateral canthotomy or eyelid sutures to facilitate, then temporary tarsorrhaphy left in for 2-3 weeks. only 20% regain vision
enucleate if 2 or more rectus muscles are avulsed or if globe is ruptured
165
What and when do you perform a temporary tarsorrhaphy?
allows tissue to heal by minimizing movement or tension
indications: lid reconstruction, entropion/ectropion correction, lacerations, mass removals, proptosis
