Surgery of the Head and Neck in Small Animals
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1 Surgical anatomy Surgery of the Head and Neck in Small Animals T. Németh, DVM, PhD Surgical anatomy Surgical anatomy Surgical anatomy Main Surgical Diseases of the Oral Cavity Mandibular symphyseal separation Palatoschisis / Cleft palate Surgery of the tongue Surgery of tonsils Salivary mucocele
2 Main Surgical Diseases of the Oral Cavity Mandibular symphyseal separation Palatoschisis / Cleft palate Surgery of the tongue Surgery of tonsils Salivary mucocele Mandibular Symphyseal Separation Incidence cat, (dog) high rise syndrome car accident Diagnostics history salivation, eating unability mandibular dislocation X-ray Mandibular Symphyseal Separation Therapy stabilisation short acting narcosis fixation (tension band wire) antibiotics artificial feeding (syringe, gastrostomy) implant-removal after 4 weeks Mandibular Symphyseal Separation Main Surgical Diseases of the Oral Cavity Mandibular symphyseal separation Palatoschisis / Cleft palate Surgery of the tongue Surgery of tonsils Salivary mucocele Incidence Palatoschisis / Cleft palate congenital: brachycephalic dogs Development of palates Soft palate hypoplasia Soft and hard palate hypoplasia
3 Palatoschisis / Cleft palate Palatoschisis / Cleft palate Incidence acquired: cats ( high rise syndrome ) Diagnostics history (congenital or traumatic) oronasal reflux nasal discharge, regurgitation, sneezing, gagging aspiration / pneumonia oral inspection endoscopy radiology (aspiration) Palatoschisis / Cleft palate Palatoschisis / Cleft palate 1. Therapy surgery (?) suturing (monofil absorbable orsteel wire) Therapy surgery (?) suturing (monofil absorbable orsteel wire) rotational flap Palatoschisis / Cleft palate Therapy surgery (?) suturing (monofil absorbable orsteel wire) advancement flap Palatoschisis / Cleft palate Therapy surgery (?) suturing (monofil absorbable orsteel wire) advancement flap antibiotics (anaerobics!) soft diet stitch removal after 4 weeks
4 Main Surgical Diseases of the Oral Cavity Mandibular symphyseal separation Palatoschisis / Cleft palate Surgery of the tongue Surgery of tonsils Salivary mucocele 7% of canine tumours (1. Skin tumours, 2. Mammary tumours, 3. Oral tumours) gingiva dental alveoli labium palate tongue Benign neoplasia Periferial Odontogenetic Fibroma Papilloma Adamantinoma Fibroma ( epulis ) benign fibromatosus proliferation along the gingiva individual susceptibility in case of growing, extension and oral discomfort surgery (electrocautery) supplementory examination: cytology, histopath, X-ray (thorax) Epulis - boxer Epulis - boxer
5 Fibroma ( epulis ) benign fibromatous proliferation along the gingiva individual susceptibility in case of growing, extension and oral discomfort surgery (electrocautery) supplementory examination: cytology, histopath, X-ray (thorax) Papilloma - viral background - in young age ( 1 Year) - immunosuppression (?) - typical clinical manifestation Papilloma - spontaneous healing - elektrocautery - immunostimulation general: e.g. Baypamun Papillomatosis specific: autovaccination Malignant neoplasia Staging - TNM system Gingival Squamous Cell Carcinoma Fibrosarcoma Malignant Melanoma T umour-size N ode (lymphonode) M etastases Owen, WHO, 1980
6 Staging - TNM system I. 2 cm, bone involvement, metastic disease II. 2-4 cm, bone involvement, metastic disease III. 4 cm, bone involvement, metastic disease or any tumour with bone involvement or any tumour with ipsilateral node involvement IV. Any tumour with bilateral node involvement or with distant metastic disease Staging - TNM system Predictable survival rate at 1 Year I. 100 % II. 75 % III. 35 % IV. 0 % Malignant neoplasia Fibrosarcoma I. relatively frequent (dog, cat) in older age (6 years ) fibrosarcoma, melanoma malignum, squamous cell carcinoma X-ray (osteolysis?, lungmetastasis?) cytology, biopsy scintigraphy (electrocauterisation) mandibulectomy maxillectomy radiotherapy (euthanasia) Fibrosarcoma I. Fibrosarcoma I.
7 Bilateral Rostral Body Mandibulectomy Bilateral Rostral Body Mandibulectomy VIDEO Fibrosarcoma II. Fibrosarcoma II. Fibrosarcoma II. Hemimandibulectomy Fibrosarcoma II. Hemimandibulectomy
8 Fibrosarcoma II. Hemimandibulectomy Fibrosarcoma II. Hemimandibulectomy + Cheiloplasty Fibrosarcoma II. Hemimandibulectomy + Cheiloplasty Fibrosarcoma II. Hemimandibulectomy (3 months later) Fibrosarcoma III. Dobermann, 7 Y, male ( Zeus ) Fibrosarcoma III. Hemimaxillectomy
9 Fibrosarcoma III. Hemimaxillectomy Postoperative management Mashy diet Antibiotics Analgesics (NSAID) Check-up physical scintigraphy X-ray Main Surgical Diseases of the Oral Cavity Mandibular symphyseal separation Palatoschisis / Cleft palate Surgery of the tongue Surgery of tonsils Salivary mucocele Surgical Diseases of the Tongue Injuries of the tongue biten, stab, lacerated wounds checking the frenulum and the tone of the tongue general wound management suture: monofilament, absorbable (PDS, Monacryl, Maxon) antibiotics (metronidazol) Injuries of the Tongue Biten wound Injuries of the Tongue Contusion wound
10 Injuries of the Tongue Lacerated wound Surgical Diseases of the Tongue Neoplasia of the tongue rare papilloma, squamos cell carcinoma partial resection (apex linguae) PDS, Monacryl, Maxon antibiotics (metronidazol) Neoplasia of the Tongue Squamous Cell Carcinoma Neoplasia of the Tongue Squamous Cell Carcinoma Neoplasia of the Tongue Squamous Cell Carcinoma Neoplasia of the Tongue Squamous Cell Carcinoma
11 Neoplasia of the tongue Melanoma malignum Neoplasia of the tongue Melanoma malignum Neoplasia of the tongue Melanoma malignum Neoplasia of the tongue Melanoma malignum Neoplasia of the tongue Carcinoma partial amputation Neoplasia of the tongue Carcinoma partial amputation
12 Neoplasia of the tongue Carcinoma partial amputation Neoplasia of the tongue Carcinoma partial amputation Neoplasia of the tongue Carcinoma partial amputation Neoplasia of the tongue Carcinoma partial amputation Main Surgical Diseases of the Oral Cavity Mandibular symphysiolysis Palatoschisis / Cleft palate Gingival tumors Surgical diseases of the tongue Surgery of tonsils Salivary mucocele Indication Tonsilectomy Chronic tonsilitis (poodle, spaniel) Tonsil-tumour carcinoma planocell.: retropharingeal and lung-metastasis lymphosarcoma: usually bilateral as the part of the generalised form
13 Chronic tonsillitis Tonsilectomy Indication Chronic tonsilitis (poodle, spaniel) Tonsil-tumour carcinoma planocell.: retropharingeal and lung-metastasis lymphosarcoma: usually bilateral as the part of the generalised form Tonsil carcinoma Tonsilectomy Tonsilectomy Surgery Precise indication General anesthesia Intratracheal intubation!!! Epinephrine-infiltration topically Simple excision ( electrocautery) Extubation with insufflated cuff antibiotics, mashy diet Main Surgical Diseases of the Oral Cavity Mandibular symphysiolysis Palatoschisis / Cleft palate Gingival tumors Surgical diseases of the tongue Surgery of tonsils Salivary mucocele
14 Cysta salivalis Surgical anatomy gl. parotis, mandibularis, sublingualis, zygomat. Salivary Mucocele Anatomy parotid, mandibular, sublingual, zygomatic, (molar, cat!) gl. maxillary a., v., linguofacial a., v. Salivary Mucocele Anatomy parotid, mandibular, sublingual, zygomatic, (molar, cat!) gl. maxillary a., v. linguofacial a., v. Salivary Mucocele Anatomy parotid, mandibular, sublingual, zygomatic gl. (molar, cat!) gl. Salivary Mucocele Salivary Mucocele Incidence mainly in young dogs (German shepherd, poodle) as a consequence of salivary gland injury or inflammation forms: cervical, pharyngeal, ranula Diagnostics typical localisation fluctuant lump, not painful puncture: consistent, viscous bloody brownish fluid possibility of abscessation Cervical mucocele
15 Salivary Mucocele Salivary Mucocele Diagnostics typical localisation fluctuant lump, not painful puncture: consistent, viscous bloody brownish fluid possibility of abscessation Ranula Diagnostics typical localisation fluctuant lump, not painful puncture: consistent, viscous bloody brownish fluid possibility of abscessation Pharyngeal cyst Diagnostics typical localisation fluctuant lump, not painful puncture: consistent, viscous bloody brownish fluid possibility of abscessation Salivary Mucocele Salivary Mucocele Therapy antibiotics (metronidazol) resection (gland, duct, mucocele) drainage marsupialisation (ranula) (atropine) Salivary mucocele (Resection) Salivary mucocele (Resection)
16 Salivary mucocele (Resection) Salivary mucocele (Resection) Salivary mucocele (Resection) Salivary Mucocele Therapy antibiotics (metronidazol) resection (gland, duct, mucocele) drainage marsupialisation (ranula) (atropine) Salivary Mucocele Surgery Surgery of the Ear in Small Animals T. Németh, DVM, PhD
17 Surgical Diseases of the Pinna Aural haematoma Injuries of the ear Neoplasia of the pinna Aural Haematoma Incidence relatively frequent (dog, cat) primary or secondary History trauma of the pinna contemporary external otitis Aural Haematoma Diagnostics typical enlargement on the internal surface of the pinna (fluctuent) puncture maturation process Aural Haematoma Therapy waiting time! antibiotics surgery: drainage (different techniques) Aural Haematoma Surgery Aural Haematoma Surgery
18 Injuries of the Pinna Incidence frequent, sharp traumas (biten, lacerated wounds) Diagnostics depend on the types of wound continuous bleeding usually the edge is affected penetrating wounds septic consequences, necrosis of cartilage Injuries of the Pinna Therapy primary wound management secondary wound management cover (compression) bandage Elisabethian collar antibiotics Neoplasia of the Pinna Incidence dog (cat) papilloma, mastocytoma, carcinoma Diagnostics depend on the type of neoplasia usually close to the edge of the pinna rapid ulceration Therapy excision partial or total resection of the pinna Surgical Aspects of External Otitis Incidence frequent (mostly in dogs) seasonal feature, breed-disposition recurrence Etiology Predisposing causes Primary causes Perpetuating causes Predisposing causes anatomic congenital acquired functional increased aural discharge
19 Primary causes parasites Otodectes Demodex Sarcoptes foreign bodies grass awn sand dust hair dermatoses atopy seborrhoea autoimmune Perpetuating causes bacteria Staph., Pseudom., Proteus, Bacteroides fungi Malassezia, Candida, Aspergillus Anatomy, Pathogenesis Anatomy, Pathogenesis Diagnostics Otoscopy History Physical examination Supplementory examination instrumental laboratory X-ray CT hematology allergology
20 Otoscopy Otoscopy Otoscopy Otoscopy Otoscopy Otoscopy
21 Therapy Precise causative diagnosis Conservative way topical and systemic treatment ear canal irrigation (warm saline, chlorhexidine, povidone iodine) Surgery (ultimaration) Lateral Wall Resection (Zepp) Total Ear Canal Ablation + Lateral Bulla Osteotomy (TECA + LBO) Lateral Wall Resection (Zepp) Lateral Wall Resection (Zepp) Lateral Wall Resection (Zepp) Lateral Wall Resection (Zepp) Therapy Precise causative diagnosis Conservative way topical and systemic treatment ear canal irrigation (warm saline, chlorhexidine, povidone iodine) Surgery (ultimaration) Lateral Wall Resection (Zepp) Total Ear Canal Ablation + Lateral Bulla Osteotomy (TECA + LBO)
22 TECA + LBO TECA + LBO TECA + LBO TECA + LBO TECA+LBO Surgical Aspects of Otitis Media and Interna Incidence rare primary or secondary mostly unilateral Diagnostics head tilt, restlessness vestibular ataxia, desorientation, nystagmus consistent external otitis otoscopy (tympanic membrane), Rtg, CT
23 X-ray X-ray Anesthesia!!! Precise projection Bulla tympani X-ray CT Anesthesia!!! Bulla tympani!!! negative positive CT CT negative Otitis media
24 CT CT Otitis media Otitis media vs tumour Surgical Aspects of Otitis Media and Interna Therapy Conservative topical: treatment of external otitis, middle ear lavage systemic: antibiotics, corticosteroids, B1, B12 vitamine Surgery Ventral Bulla Osteotomy (cat) TECA + LBO (dog) VBO Atlas der Kleintierchirurgie VBO VBO Atlas der Kleintierchirurgie
25 VBO VBO VBO VBO VBO Thank You Very Much for Your Attention!
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