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Small Animal Soft Tissue Surgery Q&A 01 (view source)

Revision as of 09:47, 30 August 2011

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'''This dog was presented with an acute inability to close the mouth but no lateral deviation of the mandible.'''
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'''A surgical procedure underway in the 2 oral cavity of a four-month-old, male Bulldog is shown. The owner’s complaint is that the dog has a chronic mucopurulent nasal discharge, coughs when eating or drinking, and has not been gaining weight at a rate equal to that of his litter mates. He also has a foul odor from the oral cavity.'''
    
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<FlashCard questions="3">
 
<FlashCard questions="3">
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|q1=What is your tentative clinical diagnosis?
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|q1=What is the diagnosis?
 
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Bilateral traumatic luxation of the temporomandibular joint.
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Congenital cleft of the hard and soft palates (secondary palatal defect).
 
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|q2=How can this diagnosis be confirmed?
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|q2=What secondary complication may be associated with this defect?
 
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The diagnosis is confirmed by radiography. Two views are currently in use: the dorsoventral closed-mouth skull radiograph and the closed-mouth lateral oblique view (15–20°, nose tilted up).
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Aspiration pneumonia is often a complication of secondary palate defects. The animal should be evaluated with thoracic radiographs and treated appropriately prior to surgical correction of the palate defect.
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Unilateral or bilateral luxation is radiologically evidenced by the fact that the condyloid process is not located within the mandibular fossa.
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Capsular osteophyte formation is evidence of a long-standing or recurrent luxation. Usually, the condyloid process displaces rostrodorsally.
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If unilateral, the animal is presented with a typical lateral deviation to the side opposite the luxated joint.
   
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|q3=Presuming that the tentative diagnosis is confirmed, what is the treatment?
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|q3=What are three principles to be followed during surgical repair of this problem?
 
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Reduction is accomplished under general anesthesia by forcing the condyle ventrally. This can be done by inserting a fulcrum (e.g. pencil, syringe, dowel – depending on patient size) in between the molar teeth and gently forcing the mouth closed; this in turn
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Repair flaps should be larger than the primary defect to reduce tension on suture lines.  
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levers the condyloid process in a ventrocaudal direction back into the condyloid fossa.
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Aftercare may include the use of a tape muzzle.  
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Connective tissue and vascular supply is preserved by limited meticulous dissection (avoid the palatine artery) and gentle tissue handling.  
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Recurrent and chronic luxations can be treated by condylectomy.
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Tissue flaps are apposed to cleanly incised epithelium to ensure healing.  
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Temporary feeding via a pharyngostomy or gastrostomy tube should be considered to bypass the oral cavity during wound healing.
 
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</FlashCard>
 
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HelenD
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