Head and Neck Surgery

target organs of calcium homeostasis?

intestines

kidney

bone

hypercalcemia ddx?

neoplasia

addisons

parathyroid disease

renal disease

remember GOSH DARNIT

biologically active form of calcium

ionized

PTH ? in response to low calcium, and ? in response to high calcium

increases

decreases

PTH stimulates the kidneys to produce ? which increases the amount of ionized calcium in the body

calcitriol

condition described as a functional mass producing parathyroid hormone

primary hyperparathyroidism

90% of masses that cause primary hyperparathyroidism are

adenomas

Clinical signs of primary hyperparathyroidism?

PU/PD

Decreased appetite

Lethargic

Asymptomatic

Possibly uroliths (CaOx)

primary hyperparathyroidism is generally a disease of ? dogs/cats

older

Expected iCa and PTH with primary hyperparathyroidism?

High iCa

Normal to high PTH

is PTHrP typically positive with primary hyperparathyroidism, neoplasia, or renal disease related hypercalcemia?

neoplasia

most reliable diagnostic tool to assess parathyroid glands for a mass?

cervical ultrasound

cervical ultrasound finding indicative of hyperplastic or neoplastic primary hyperparathyroidism?

hypoechoic structure >4mm

normal parathyroid gland size?

2-3mm

TF the number/location of parathyroid glands can vary between individuals

T

cranially located parathyroid gland that is unassociated with thyroid lobes

external parathyroid gland

caudal pole thyroid lobe embedded in thyroid tissue

internal parathyroid gland

primary hyperparathyroid tx?

Surgery

Heat ablation

Chemical ablation

primary hyperparathyroid tx with the highest cure rate?

surgery

rapid way to improve cure rates during primary hyperparathyroid surgery?

intraoperative PTH concentration assay

complication associated with primary hyperparathyroid tx (surgery, chemical/heat ablation) that results in multiple surgeries, higher morbidity, and increased cost?

persistent hypercalcemia

why can persistent hypercalcemia occur with attempted primary hyperparathyroid treatments?

missed adenoma or hyperplasia

ectopic parathyroid

most common complication associated with all possible treatments of primary hyperparathryoidism?

hypocalcemia

clinical signs of hypocalcemia following primary hyperparathyroid tx?

pawing at face

tremors

muscle fasciculation

mentation change

seizure

death

hypocalocemia may occur within ? of parathyroid surgery

12 hours to 7 days

goal of post-operative management for parathyroidectomy patients?

maintain normocalcemia

emergency treatment of hypocalcemia in post-op parathyroid surgery pts?

calcium gluconate 10% solution 0.5-1.5ml/kg IV slowly

ways to manage non-emergent decreases in iCa with post-op parathyroid surgery patients?

Calcitriol

Calcium carbonate

most common endocrine cancer in dogs

thyroid neoplasia

canine thyroid neoplasia is benign or malignant 90% of the time?

malignant

is canine thyroid neoplasia usually functional or non-functional?

non-functional

clinical signs of canine thyroid neoplasia?

Usually asymptomatic as mostly non-functional

Palpable mass on PE

TF biopsy is a first line diagnostic tool for canine thyroid cancer

F

FNA preferred as highly vascular

thyroid imaging modality of choice to evaluate mobility, invasion, vascularity, and metastasis?

CT

treatment of choice for mobile and non-invasive canine thyroid neoplasia with no distal metastasis?

surgery

recommended treatment for fixed/invasive canine thyroid neoplasia with no distal metastasis?

radiation or I-131 +/- surgery

recommended treatment for canine thyroid neoplasia with distant metastasis?

Palliative care

Radiation

Chemo

I-131

Surgery

if bilateral canine thyroid tumors are surgically removed, there is a risk of post operative ____________

hypoparathyroidism

complications of canine thyroid neoplasia surgical removal?

hemorrhage

laryngeal paralysis

dysphagia

canine thyroid neoplasia treatment modalities other than surgery?

RT

I-131

Chemo

NSAIDs

is feline thyroid neoplasia usually functional or non-functional?

functional

is feline thyroid neoplasia usually benign or malignant?

benign

most feline thyroid tumors are unilateral or bilateral?

bilateral

Pre-operative workup prior to treatment for cats with thyroid tumors?

Screen and treat for HCM

Screen for renal disease

Nuclear scintigraphy

when is surgery indicated for feline thyroid tumors?

Medical managment failed

Suspect carcinoma

what parameters should be monitored following feline thyroid tumor treatment?

Ca

T4

Renal values

Diagnostics for suspect salivary gland disease?

Sedated oral exam

MDB

FNA

CT

salivary gland neoplasia is most commonly seen in what individuals?

Old dogs

Siamese male cats

salivary gland neoplasia biological behavior?

Usually malignant

Locally invasive

High rates of metastasis

clinical signs of salivary gland neoplasia?

Firm swelling

Halitosis

Exophthalmos

Dysphagia

salivary gland neoplasia tx options?

Surgery

RT

limbic epileptic condition of the salivary gland that responds to phenobarbital

sialadenitis/sialadenosis

accumulation of saliva due to a damaged duct within a salivary gland due to trauma, sialolithaisis, foreign body, neoplasia, heartworm disease, or idiopathic causes

salivary mucocele

TF salivary mucoceles are cysts

F

salivary mucocele ddx?

abscess

neoplasia

enlarged lymph node

draining duct

lipoma

what salivary gland is most commonly affected by salivary mucoceles?

sublingual salivary gland

salivary mucocele tx?

sialoadenectomy or marsupializaation

landmarks for incision with a sialoadenectomy?

bifurcation of jugular v. to ramus of mandible

sialoadenectomies require ? dissection

intracapsular

rostral end point in a sialoadenectomy?

lingual nerve

sialoadenectomy steps?

Lateral or dorsal approach

Identify bifurcation of jugular v. and ramus of mandible

Open capsule

Dissect out mucocele down to lingual n.

Drain mucocele

what salivary mucoceles can be treated with sialoadenectomy?

mandibular

sublingual

what salivary mucoceles can be treated with marsupialization?

sublingual

pharyngeal

salivary gland surgery complications?

LN removal

Operate on wrong side

Infection

Recurrence due to wrong side

Recurrence due to incomplete removal

Seroma

Lingual n. damage

indications for esophagostomy tube?

Malnutrition

Hyporexia

Dysphagia

Bypass oral cavity

requirements for esophagostomy tube?

Functional GI tract

Normal esophageal function

Minimal vomiting

No cervical disease

steps for esophagostomy tube placement?

Place pt under GA

Surgically prep left side of the neck

Identify wing of atlas and jugular vein

Place curved hemostats into esophagus via oral cavity and press against the left wall of the esophagus

Make a small incision over the tips of the curved hemostats

Size esophagostomy tube

Grab esophagostomy tube with hemostats and pull back through the mouth

Bend esophagostomy tube on itself and reintroduce it back into the mouth while pulling on opposite end until you feel it flip

Check placement with negative pressure and radiographs

Suture in place with finger trap and cute little collar

where should a correctly placed esophagostomy tube end on radiographs?

before the lower esophageal sphincter

care instructions for esophagostomy tube?

Calculate RER and water needs

Blend food

May medicate via tube

Always flush

Ostomy care with dilute chlorhexidine/saline