Surgery of the Oral Cavity and Salivary Glands

What are some large blood vessels in the maxilla?

Infraorbital

What is a large blood vessel on the palate?

Palatine

What vessel runs in the mandible?

Mandibular artery

What are some disorders of the oral cavity

Congenital malformations

Trauma

Neoplasia

Salivary gland disorders

What are some surgical considerations for oral surgery?

Sedation/anesthesia may be needed for good oral exam

Tumors or swelling can complicate intubation

Cuffed endotracheal tube

Pack pharynx with sponges

Analgesia

What is the primary palate?

Upper lip and premaxilla (rostral to the incisive foramen)

What is the secondary palate?

Hard and soft palate

What is a cleft palate?

Communication between oral and nasal cavity, can be primary or secondary palate

What causes cleft palate?

Inherited due to intrauterine trauma or stress day 25-28 of gestation

What species have a higher risk for cleft palate?

Brachycephalics

What is a primary cleft palate?

Only affects primary palate (lips and premaxilla)

What is a secondary cleft palate?

Only affects secondary palate (hard and soft)

What are the C/S of a primary cleft palate?

Cosmetic

What are the C/S of secondary cleft palate?

Failure to nurse well, milk from nares, nasal discharge, aspiration pneumonia, poor weight gain, sneezing, gagging

How do you manage a cleft palate?

Surgery after 4 months of age

Before a patient is old enough to get a cleft palate fixed what do you need to do?

Supportive care

What surgery is the most successful to fix the cleft palate?

The first one

What are the goals of cleft palate surgery?

Tension free closure

Maintain blood supply to flaps

Two layer closure

Avoid suture lines over a void

Educated owners that multiple procedures can be necessary

What do you do for post op care for a cleft palate surgery?

Soft food for 2 weeks or feeding tubes

Dehiscence 5 days

Delay re-suturing if it dehisces

What is dehiscence?

Reopening of a wound

What can cause an oronasal fistula?

Periodontal disease

Post tooth extraction/dehiscence

Electrical cord burns

Neoplasia

How common are oral tumors?

6% of canine tumors

T/F you should go through the check to get samples if the mass is on the mandible or maxila?

False

What can you do to diagnose an oral tumor?

FNA

Incisional biopsy

What is the most common malignant oral tumor in the dog?

Malignant melanoma and squamous cell carcinoma

What oral tumor is a dog will never metastasize?

Acanthomatous ameloblastoma

What are the common malignant oral tumors in a dog?

Malignant melanoma

Squamous cell carcinoma

Fibrosarcoma

Osteosarcoma

Acanthomatous ameloblastoma

How should you treat oral tumors in a dog?

Maxillectomy/mandibulectomy with CT scan planning

Where does melanoma usually metastasize to?

LN or lungs

How do you treat melanoma?

Wide excision (take 2cm of healthy tissue) and consider adjuvant treatments

Draining lymph node extirpation

Describe squamous cell carcinomas

Locally invasive with regional metastasis common

What species has a poor prognosis with squamous cell carcinoma?

Cats

Describe fibrosarcomas?

Located in the maxillary gingiva and hard palate

Local infiltration is common

Wide surgical excision

Describe osteosarcomas

Locally aggressive and high metastatic rate

Where does acanthomatous ameloblastoma arise from?

Odontogenic tissue invading underlying bone

How do you treat acanthomatous ameloblastoma?

Maxillectomy/mandibulectomy

What are epulides?

Peripheral odontogenic fibromas

What can peripheral odontogenic fibromas be made of?

Fibromatous

Ossifying

How can you treat peripheral odontogenic fibromas?

Local removal with rim of alveolar bone acceptable

What limits where you can choose a maxillectomy?

Ability to lose oronasal defect

What can you have to combine mandibulectomies with?

Cheiloplasty

T/F patients can do well after a mandibulectomy?

True

What are the indications for a glossectomy?

Neoplasia (SCC), traumatic lacerations

How much can you remove of the tongue before it is poorly tolerated?

40-60%

What are the margins for a glossectomy?

1cm margins

What suture pattern for a glossectomy?

Horizontal mattress due to heavy bleeding and to appose mucosa

What is a mucocele?

Collection of saliva leaking into tissue

What is a common sign of a salivary mucocele?

Ventral cervical fluctuant swelling

Respiratory distress

What is a ranula?

Salivary mucocele under the tongue

What salivary glands can get mucoceles?

Parotid, mandibular, zygomatic, sublingual

How do you treat salivary mucoceles?

Surgical treatment, a drain will not solve the problem

How do you diagnose a salivary mucocele?

FNA w/ nondegenerate neutrophils, mucin, and foamy macropahges

T/F you can aspirate salivary mucoceles repeatedly?

False

What is the most common source of a salivary mucocele?

Sublingual gland/duct

Why do mandibular and sublingual glands have to be removed together?

Due to intimate anatomic association

What is a sialadenectomy?

Removal of a salivary gland

What is the approach for a sialadenectomy?

Lateral or ventral

What muscle do you work under with a ventral sialadenectomy?

Digastricus

Why would you choose the ventral over lateral approach to a sialadenectomy?

There is a higher recurrence rate with a lateral approach