Surgery of the Oral Cavity and Oropharynx

VSUR 152

• drooling

• dysphagia

• anorexia

• bleeding

• foul smelling mouth

Clinical signs of unhealthy oral cavity/ oropharynx

• pre operative assessment

• endotracheal tube placement

• proper patient positioning

• preparation of specialized instrument

• local anesthesia

• disinfection with hexetidine rinse

General pre and peri operative and considerations

Rabies

CS: excessive salivation, biting indiscriminately, to look at the eyes of the dog for precautionary measures

halitosis

“bad breath”
gingivitis
foreign material stuck between cheek and teeth

Carnassial tooth Abscess

Clinical sign:
- halitosis
- +/- dysphagia
- abscess

Carnassial tooth Abscess

TX
- radiography to see extent of the damage
- address inflammation and infection (ATB/NSAID) before extraction
- toot extraction

Carnassial tooth Abscess

Extraction:
- section the tooth, elevate periosteum, extract the cadual and rostral section of the tooth
- check if complete extraction
- flush with antiseptic (chlorhexidine)
- suture with SISP/ horizontal mattress
- close/crush socket before suturing if needed
- continue antibiotics

ELEVATE —> EXTRACT —> FLUSH —> SUTURE

Flow of sectioning of the tooth

Glossectomy

amputation/ excision of the tongue
- done when dog cannot eat or swallow properly anymore

Glossectomy

CS:
- ptyalism
- halitosis
- dysphagia
- dyspnea (sometimes)

Glossectomy

Due to:
-Trauma (most common)
- blood
- chemical
- lung lesion
- dog fights
- neoplasia (Squamous cell carcinoma)

1. Partial

2. sub-total

3. near total

4. Total

Types of glossectomy

Partial

free tongue (not attached to the frenulum) will be removed

Sub-total

entire free tongue and part of genioglossus and genio-hyoid muscles

Near total

remove 75% of the tongue

Total

100 % Amputation of the tongue

Doven clamp/ A mattress suture

Technique that uses lateral recumbency
- minimum of 2 cm of normal tissue + lesion
- non crushing clamp at base of tongue
- control of hemorrhage by ligation/ pressure cautery
closure
- HMS
- SCSP

50-60%

____ % tolerated by dogs; may make eating and drinking difficult —> feed by tossing food or animal can suck food

bilateral sialoadenectomy

solution of hypertyalism that is seen in subtotal to total glossectomy

major glossectomy

may put in feeding tube

Salivary duct mucocele/ Ranula

• acute and abrupt

• mucocele found under the tongue

• involves the duct and not the gland

Salivary duct mucocele/ Ranula

CS:
- tongue is always out
- ptyalism

Salivary duct mucocele/ Ranula

TX:

• marsupialization

Marsupialization

• incise mucocele

• suture edge to mucosa

• interior of mucocele suppurates

• close by granulation

• draining

• creates surgical window on wall of cyst

• maintain continuity between cyst and oral cavity/ maxillary sinus

• can also used on other cyst of the body

Salivary duct mucocele/ Ranula

Post op:

• histologic exam (to rule out neoplasia)

• change bandage daily if penrose drain used (removed 24-72 hrs post op) when drainage is minimized

• 2nd intention healing for drainage site

• apply warm compress

• soft food (3-5 days)

Salivary duct mucocele/ Ranula

Complications

• droopy face

• dysphagia

• seroma

• infection

• mucocele recurrence (drainage was done, inadequate gland excision, LN mistaken for gland)

Epulis

• most common benign oral neoplasm (accounts for 30%)

• rare in cats

• firm tumors, gingival mass

• arise from periodontal ligament

• Fibromatous

• Ossifying

• Acanthomatous

Types of epulis

Fibromatous Epulis

• pink, smooth, firm gingival mass arising from periodontal ligament

• non-invasive

• originates from gingival sulcus

• may be single/multiple, pedunculated/sessile

• primary cell type: periodontal ligament stroma

Ossifying

• large amount of osteoid matrix in stroma

• firm and difficult to cut

• may transform into malignant tumor —> osteosarcoma

Acanthomatous

• benign, aggressive, most common type

• can infiltrate bone —> lysis

• occur at rostral/mandibular canine teeth

Epulis

Tx:

• excision (2mm from edge of neoplasm —> wide surgical excision to prevent recurrence, remove also the healthy parts

• neoplasia

• laceration

• abscess drainage

• glossitis

• severe trauma

• congenital ankyloglossia (tongue is connected on the floor of the mouth)

• limited movement movement of tongue

• difficulty in prehension and food acquisition

Indication for tongue surgeries