What is the blood supply of the lips and cheeks?
branches of facial and infraorbital arteries
What is the innervation of the lips and cheeks?
branches of facial and trigeminal nerves
What are the layers you close (close as one line) when closing the lips and cheeks? (3)
- muscle and fibroelastic layer
What is the blood supply to the tongue?
What is the innervation to the tongue?
hypoglossal, facial, trigeminal, and glossopharyngeal nerves
The oropharynx is surrounded by...
- soft palate and root of tongue
- palatopharyngeal arches laterally
What is the blood supply to the soft palate?
minor palatine artery
What is the innervation to the soft palate?
glossopharyngeal and vagus nerves
What are the layers of the soft palate?
nasal mucosa--> muscle--> oral mucosa
What is the blood supply to the tonsils?
What is the function of the tonsils and their anatomical location?
- tonsillar fossa and within pharyngeal mucosa
- lymph tissue to modulate immune response from oral and nasal cavity
What are the major salivary glands? (5)
- sublingual monostomatic and polystomatic
- molar (cats only)
What are the minor salivary glands? (4) How are they different from the major salivary glands?
- labial, lingual, buccal, palatine
- minor salivary glands do not have a duct and live right where they're secreting salivary fluid
What diagnostic test is unreliable in the mouth?
- FNA is NOT reliable in the mouth; it will always read inflammation and distorted cells
- biopsy is always recommended
What are tests to evaluate function of salivary glands?
topical atropine (should stop salivation) or lemon juice
What are congenital conditions of the lips and cheeks? (3)
- tight lip syndrome
- lower lip redundancy (large jowels)
- lip fold dermatitis
What are neoplastic conditions of the lips and cheeks? (3 most common)
- malignant melanoma (most common)
- soft tissue sarcomas
- many more
What are manifestations of tight lip syndrome? (3)
- trauma to the lip- puppies biting lip b/c it's too tight
- inhibition of mandibular growth, leading to overbite
- disruption of normal tooth eruption
What are examples of benign lesions of the tongue? (3) How are these treated?
- eosinophilic granuloma
- calcinosis circumscripta
- Marginal surgical excision usually curative; always biopsy because they are hard to tell from malignant lesions
What are the most common malignant neoplasias of the tongue?
- SCC most common in dogs and cats
- granular cell myoblastoma
- ectopic thyroid
_________ lesions on dog tongues are more likely to be a tumor; _________ lesions in cats are more associated with tumors.
dorsal; ventral/ frenulum
Most patients can toleration __________ glossectomy.
- more than half tongue, put in a feeding tube because it will be a few months before they adapt
What are common conditions of oropharynx? (4)
- FB penetration (sometimes with draining tract, granuloma, abscess)
- congenital cleft palate
- elongated soft palate
- malignant melanoma
What are clinical signs of oral and oropharyngeal conditions? (8)
- oral pain
- bloody oral d/c
- loss of appetite
With acute penetrating injuries, clinically you can see..
pneumothorax/ pneumomediastinum if the pentration went through the trachea also
How do you approach oropharyngeal wounds?
- oral approach or ventral midline surgical exploration
- esophageal penetration associated with worse prognosis
What are benign diseases of the tonsils? (4)
- upper resp infection
- brachycephalic airway obstruction
What neoplasia occurs in the tonsils? (2)
- SCC- more aggerssive, commonly met to LN or lungs at presentation
What are clinical signs of tonsillar disease? (7)
- bloody saliva
Describe cancer of the salivary glands.
- usually malignant
- locally invasive
- high rates of metastasis
- trauma, systemic, or localized infection
- immune mediated
- respond to phenobarb; thought to be limbic epilepsy
Describe salivary mucoceles. (5)
- usually unknown cause!NON-PAINFUL
- classified based on location- cervical, pharyngeal, sublingual (ranula), zygomatic
- lined by granulation tissue
- NOT A CYST, fluid coming from the salivary gland and pooling
What are differentials for a cervical mucocele?
- enlarged LN
- draining tract
- ---> ASPIRATE THAT SHIT
What is the most common salivary gland affected by a mucocele?
sublingual salivary gland
How do you treat salivary mucocele?
remove sublingual AND mandibular salivary gland- closely associated in same capsule (at the bifurcation of jugular vein; end point is lingual nerve)
How do you treat sialadenosis?
- maybe biopsy just to confirm
What is one of the most important aspects of oral surgery?
- CLIENT EDUCATION- proper post-op care
- canned food for at least 2 weeks
- no chew toys
- monitor oral cavity for smells, d/c, pain
What are potential complications of oral surgery? (6)
- oronasal fistula
- aspiration pneumonia
What are potential complications of salivary gland surgery? (6)
- ln removal instead of salivary gland
- operating on the wrong side
- recurrence- wrong side, incomplete removal
- seroma formation
- lingual nerve neuropraxia or paralysis
What are principals of oral surgery on the bony tissues? (6)
- good debridement
- scalpels, not scissors
- avoid cautery
- gentle tissue handling
- tension free, airtight, well-supported closure
- 2 layer closure in larger resections
What type of suture do you use to close bony tissues of the oral cavity? What patterns?
- absorbable monofilament suture (maybe vicryl)
- simple interrupted or mattress sutures
What type of needle do we use in oral surgery?
reverse cutting, swaged-on needles imperative
What is the blood supply to the palate?
major and minor palatine arteries
What is the functions of the muscles of the palate?
What is the blood supply to the mandible?
mandibular alveolar artery
What part of the mandible is part of the TMJ?
What is the blood supply of the maxilla? (3)
- infraorbital artery
- major palatine artery
- sphenopalatine artery
What is the innervation of the maxilla?
What are factors that contribute to congenital cleft palate? (5)
- hereditary (brachycephalic, broad-headed fetuses)
What are causes of acquire cleft palates? (4)
- [aka. oronasal fistula]
- chronic infection (periodontal dz, osteomyelitis)
How are congenital cleft palates classified?
- primary: ("harelip") lips, incisive alveolar ridge, premaxilla cranial to foramen
- secondary: involves hard and soft palate (you won't see this kind fo cleft palate from the outside)
- combinations of these do occur commonly
Describe the embryology of congenital cleft palate.
- opposing palatal shelves come together in four steps: migration--> contact of processes--> epithelial regression--> complete fusion
- with cleft palate, one of these steps does not occur
What step of palatal fusion is disrupted with primary congenital cleft palate?
failure of fusion of maxillary process
What are clinical signs of primary cleft palate? (4)
- nasal d/c
- cosmesis/ asymptomatic
Describe repair of primary cleft palate.
- surgery at 2-4 months of age
- Goals include:
- closure of nasal floor
- closure of lip
- extraction of teeth
What step of palatal fusion is disrupted with secondary congenital cleft palate?
failure of fusion of the lateral palatine processes
What are clinical signs of secondary congenital cleft palate? (7)
nasal signs, failure to nurse, coughing, gagging, milk coming out of nose, aspiration pneumonia, poor weight gain [much more severe than primary cleft palate]
Describe repairs of secondary congenital cleft palate. (when you do it and 2 techniques)
- surgery at 3-4 months of age (tube feeding until ready for repair)
- flush nasal cavity thoroughly
- 2 techniques:
- make overlapping flaps- make incision on one side and rostrally and caudally, elevate flap, and flip it over (oral mucosa in nasal cavity), tuck flap under contralateral side; more supported by bone than other technique
- split mucoperiosteal sliding flap- make bilateral incisions along where the teeth are, elevate flap, slide flap and suture them together
Describe repair of acquired cleft palate.
- [you need to get creative]
- buccal-based mucoperiosteal flaps +/- overlapping flaps, double flap repair
- may need distant tissue transfer
- +/- septal button (piece of plastic fitting into nasal cavity and oral cavity; usually temporary)
What are benign odontogenic tumors? (5)
- acanthamatous ameloblastoma
- dentigerous cysts
- feline odontogenic tumor
- [can't tell they're benign without incisional biopsy and rads looking for mets]
What are benign peripheral odontogenic fibromas? (2)
Odontogenic tumors arise from the _____________.
What are the 4 general categories of benign oral tumors?
- odontogenic tumors
- peripheral odontogenic fibromas
- giant cell epulis
- oral papillomatosis (spontaneous regress in 4-8wks)
Describe surgery for odontogenic tumors.
- although they are benign, require aggressive resection- mandibulectomy or maxillectomy
- b/c they invade bone and cause bony lysis
Describe surgery for peripheral odontogenic fibromas.
- slow-growing, non-invasive
- soft tissue resection +/- tooth extraction and alveolar bone exicision
Describe malignant SCC of the oral cavity. (4)
- most common tumor in cats; common in older large breed dogs
- usually very advanced by the time we see it, very aggressive and usually extensive
- usually arises from gingiva and invades bones
- aggressive soft tissue and bone resection (1-2cm margins)
Describe malignant melanomas of the oral cavity. (3)
- most common oral tumor in dogs common in older small breed males
- poor prognosis because very malignant
- surgery is only meant to control local disease- stage first!
Describe fibrosarcoma of the oral cavity. (4)
- large, male, older dogs
- locally invasive, 20% metastatic rate
- in Goldens, even if histo shows low-grade, still very aggressive
- surgery is aggressive, + radiation
Describe osteosarcoma of the oral cavity. (2)
- medium to large breed, middle to older female dogs
- locally aggressive
What surgery is indicated for a rostral oral tumor not crossing midline?
What surgery is indicated for a bilateral rostral mandibular tumor?
rostral mandibulectomy (prefer to resect at PM1)
What surgery is indicated for a tumor confined to the vertical ramus?
What surgery is indicated for a unilateral high grade tumor of the mandible?
total hemi-mandibulectomy, cheiloplasty (lip reduction)
When is a segmental and rim excision of the mandible indicated?
only if the tumor does not invade the medullary cavity of the bone
What surgery is indicated for a maxillary tumor that does not enter the nasal cavity?
invisivectomy (+/- removal of 1 canine tooth depending on size of tumor)
What surgery is indicated for a maxillary tumor on one side of the hard palate?
unilateral rostral maxillectomy
What surgery is indicated for a rostral maxillary tumor on both sides of the hard palate?
rostral maxillectomy, required intact buccal mucosa for closure; remove both canine teeth
What surgery is indicated for lateralized mid-maxillary lesions?
hemi-maxillectomy; 2-layer closure for nasal cavity please
What surgery is indicated for bilateral mid-maxillary/ bilateral palatine lesions?
maxillectomy and major palatine reconstruction; prognosis poor