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A disfiguring injury of the lips/cheeks/tongue should be repaired how?
repair under suture- tension sutures
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Should cuts to the tongue be repaired?
yes- repair tongue
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What side of the tongue holds sutures better?
dorsal surface holds sutures better
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Do we need to surgically repair cuts to teh frenulum of the tongue?
no- heal spontaneously
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What is the clinical sign of a foal with a cleft palate?
milk running out of nose when foal nurses
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How do we diagnose a cleft palate in a foal?
speculum, endoscope thru nostril
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Is the hard or soft palate commonly involved in a foal with cleft palate?
soft palate
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What must we also evaluate in a foal with cleft palate?
respiratory tract- aspiration pneumonia common
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Is repair of cleft palate easy? with good outcomes?
- not an easy procedure (difficulty increases with age)
- alot of post-op care
- very few are successful
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In cleft palate surgery how is anesthesia managed?
need tracheotomy for ET tube
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Does a cleft palate always have clinical signs?
no- sometimes we find them incidentally in adults that had no symptoms earlier
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What is the general technique for cleft palate repair?
- mandibular symphysiotomy
- lower teeth are moved lateral so the upper palate is exposed
- palate incised and then apposed in 3 layer closure
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What is the most common complication of cleft palate surgery?
fistula, then have to repeat surgery all over again
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What is the prognosis for cleft palate surgery?
guarded
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When the esophagus begins where is it located?
- median plane dorsal to the cricoid cartilage
- stays dorsal to trachea until 4th Cervical vertebrae
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When the esophagus enters the thoracic cavity where is it located in relation to trachea?
ventral to trachea
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In the thorax is the esophagus dorsal or ventral to the trachea?
Dorsal to trachea
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In the mid-cervical region what is the esophagus dangerously close to?
carotid artery and vagosympathetic trunk
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At the thoracic inlet the esophagus is located dangerously close to what?
jugular vein
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How many layers are there in the esophagus? what are they?
- 4 layers
- fibrous, muscular, submucosa, mucosa
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What is the holding layer of the esophagus?
- submucosa and mucosa
- (hard to stitch just one, so include both)
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Describe the vascular supply to the esophagus? what is the relevance?
- segmental with minimal collateral circulation
- therefore dont pick esophagus up and out of incision b/c you risk damaging BVs that cant be compensated for!
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What are complications of esophageal surgery?
- strictures
- incision breakdown
- laryngela hemiplasia
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Where is the skin incision usually made for esophageal surgery? why?
- ventral midline incision
- because drainage is key
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What are some causes of esophageal obstructions?
- 1. greedy eaters- lush pasture, lots of grain
- 2. poor teeth
- 3. esoophagela stricture- from a previous choke
- 4. diverticulum
- 5. anthelmintic bolus (not used now)
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Where is the most common location for esophageal obstructions?
just cranial to thoracic inlet
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Shortly after the horse obstructs will it keep trying to eat? will it have food coming out the nose?
- yes keeps trying to eat (see food on mouth area)
- no food out the nose- this doesnt ever happen in horses
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What do we use to diagnose esophageal obstructions? what else can we do?
- cant pass ET tube
- can use endoscope or radiology if chronic choke is a problem
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What drug can we use that will sometimes help resolve a choke?
Oxytocin- contracts smooth mm
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What is the problem with waiting for a choke/obstruction to resolve?
when bolus sits there it causes tissue damage in esophagus and can get secondary strictures
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If the bolus/obstruction is lush grass what works best to resolve it?
water lavage
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Why is xylazine used to sedate choke/obstruction horses?
- good sedation and makes them lower head!
- (lower head = less chance of aspiration pneumonia)
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Why doesnt the esophagus heal well?
missing serosa layer
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if you must incise the esophagus to cure a choke/obstruction where should you make the cut?
- cranial or caudal to the obstruction
- thru HEALTHY esophagus
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When suturing the esophagus closed where should the knots be? what suture pattern?
- in the lumen
- interrupted or dontinuous patterns
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You just finished esophageal surgery on an obstructed horse and the mucosa didnt look good- how should we feed post op?
- parenteral nutrition or
- cervical esophagostomy w/ feeding tube
- (we want to bypass that bad segment)
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How can we prevent recurrance of esophageal obstructions?
make horse eat slower- stones in feed bunk, spread out feed over large bunk, hay nets, dont turn out on lush pasture ect
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Are esophageal strictures caused by internal or external trauma?
- can be either/or
- just irritation to the wall resulting in scar tissue
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What is the difference between human choke and horse choke?
- human choke- cant breathe bc blockage in pharynx
- horse choke- in esophagus so animal can still breathe
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How long should i wait to perform surgery to fix an esophageal stricture? why?
- wait about 60 days
- strictures commonly relax and stretch by this time
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What are 3 surgical procedures to fix esophageal strictures?
- esophagomyotomy
- partial resection
- complete resection
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When the stricture is mural (muscular layer involved) what surgical procedure should we use?
esophagomyotomy
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What is the general procedure in an esophagomyotomy?
- but NG tube in
- incise muscularis 1cm no either side of stricture
- dont suture muscularis closed
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If a stricture involves only mucosa/submucosa what surgical correction do we use?
partial resection
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For what surgical procedures on esophageal strictures do we need drains and a cervical esophagostomy distal to the surgical site?
partial and complete resections
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What is the general procedure for a complete esophageal resection?
- circumfrential incision thru all layers
- ring of esophagus removed
- mucosa & submucoas closed
- muscularies closed with horizontal mattress
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What is the max amount of esophagus I can remove in a complete resection surgery?
3 cm
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I have a horse with an esophageal fistula secondary to a previous esophageal surgery, do i need to close this surgically right away?
no- wait several months, many will decrease in size or heal totally by then
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T or F: clinical signs of an esophageal diverticulum are the same as esophageal obstruction?
true- same clinical signs as chronic choke
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What is the surgical correction technique for a pulsion diverticulum?
- mucosal inversion
- (diverticulum is inverted into the lumen and muscle layer sutured closed, so the diverticulum atrophies over time)
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What is the general procedure for placing a cervical esophagostomy tube?
- pass NG tube
- midline incision
- dissect down to mucosa, incise
- insert small NG tube here, and purse string in place
- suture to skin
- partially close incision
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When is it too early to remove a cervical esophagostomy tube?
when the tissue planes havent closed yet
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