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What is the blood supply of the lips and cheeks?
branches of facial and infraorbital arteries
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What is the innervation of the lips and cheeks?
branches of facial and trigeminal nerves
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What are the layers you close (close as one line) when closing the lips and cheeks? (3)
- Skin
- muscle and fibroelastic layer
- mucosa
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What is the blood supply to the tongue?
lingual artery
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What is the innervation to the tongue?
hypoglossal, facial, trigeminal, and glossopharyngeal nerves
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The oropharynx is surrounded by...
- soft palate and root of tongue
- palatopharyngeal arches laterally
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What is the blood supply to the soft palate?
minor palatine artery
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What is the innervation to the soft palate?
glossopharyngeal and vagus nerves
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What are the layers of the soft palate?
nasal mucosa--> muscle--> oral mucosa
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What is the blood supply to the tonsils?
tonsillar artery
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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
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What are the major salivary glands? (5)
- zygomatic
- parotid
- mandibular
- sublingual monostomatic and polystomatic
- molar (cats only)
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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
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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
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What are tests to evaluate function of salivary glands?
topical atropine (should stop salivation) or lemon juice
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What are congenital conditions of the lips and cheeks? (3)
- tight lip syndrome
- lower lip redundancy (large jowels)
- lip fold dermatitis
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What are neoplastic conditions of the lips and cheeks? (3 most common)
- malignant melanoma (most common)
- SCC
- soft tissue sarcomas
- many more
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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
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What are examples of benign lesions of the tongue? (3) How are these treated?
- eosinophilic granuloma
- calcinosis circumscripta
- trauma
- Marginal surgical excision usually curative; always biopsy because they are hard to tell from malignant lesions
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What are the most common malignant neoplasias of the tongue?
- SCC most common in dogs and cats
- granular cell myoblastoma
- FSA
- melanoma
- LSA
- MCT
- HAS
- ectopic thyroid
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_________ lesions on dog tongues are more likely to be a tumor; _________ lesions in cats are more associated with tumors.
dorsal; ventral/ frenulum
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Most patients can toleration __________ glossectomy.
- 40-60%
- more than half tongue, put in a feeding tube because it will be a few months before they adapt
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What are common conditions of oropharynx? (4)
- FB penetration (sometimes with draining tract, granuloma, abscess)
- congenital cleft palate
- elongated soft palate
- malignant melanoma
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What are clinical signs of oral and oropharyngeal conditions? (8)
- drooling
- dysphagia
- oral pain
- dyspnea
- bloody oral d/c
- loss of appetite
- swelling
- halitosis
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With acute penetrating injuries, clinically you can see..
pneumothorax/ pneumomediastinum if the pentration went through the trachea also
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How do you approach oropharyngeal wounds?
- oral approach or ventral midline surgical exploration
- esophageal penetration associated with worse prognosis
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What are benign diseases of the tonsils? (4)
- upper resp infection
- brachycephalic airway obstruction
- polyps
- cysts
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What neoplasia occurs in the tonsils? (2)
- SCC- more aggerssive, commonly met to LN or lungs at presentation
- lymphoma
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What are clinical signs of tonsillar disease? (7)
- cough
- gagging
- fever
- depression
- anorexia
- halitosis
- bloody saliva
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Describe cancer of the salivary glands.
- usually malignant
- locally invasive
- high rates of metastasis
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Describe sialadenosis.
- trauma, systemic, or localized infection
- immune mediated
- respond to phenobarb; thought to be limbic epilepsy
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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
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What are differentials for a cervical mucocele?
- abscess
- neoplasia
- enlarged LN
- draining tract
- lipoma
- ---> ASPIRATE THAT SHIT
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What is the most common salivary gland affected by a mucocele?
sublingual salivary gland
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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)
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How do you treat sialadenosis?
- phenobarb
- maybe biopsy just to confirm
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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
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What are potential complications of oral surgery? (6)
- hemorrhage
- dehiscence
- oronasal fistula
- aspiration pneumonia
- dyspnea
- cosmesis
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What are potential complications of salivary gland surgery? (6)
- ln removal instead of salivary gland
- operating on the wrong side
- infection
- recurrence- wrong side, incomplete removal
- seroma formation
- lingual nerve neuropraxia or paralysis
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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
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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
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What type of needle do we use in oral surgery?
reverse cutting, swaged-on needles imperative
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What is the blood supply to the palate?
major and minor palatine arteries
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What is the functions of the muscles of the palate?
swallowing
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What is the blood supply to the mandible?
mandibular alveolar artery
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What part of the mandible is part of the TMJ?
condyloid process
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What is the blood supply of the maxilla? (3)
- infraorbital artery
- major palatine artery
- sphenopalatine artery
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What is the innervation of the maxilla?
infraorbital nerve
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What are factors that contribute to congenital cleft palate? (5)
- nutritional
- hormonal
- mechanical
- toxic
- hereditary (brachycephalic, broad-headed fetuses)
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What are causes of acquire cleft palates? (4)
- [aka. oronasal fistula]
- chronic infection (periodontal dz, osteomyelitis)
- trauma
- neoplasia
- iatrogenic
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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
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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
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What step of palatal fusion is disrupted with primary congenital cleft palate?
failure of fusion of maxillary process
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What are clinical signs of primary cleft palate? (4)
- rhinitis
- sneezing
- nasal d/c
- cosmesis/ asymptomatic
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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
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What step of palatal fusion is disrupted with secondary congenital cleft palate?
failure of fusion of the lateral palatine processes
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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]
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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
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Describe repair of acquired cleft palate.
- [you need to get creative]
- debridement
- 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)
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What are benign odontogenic tumors? (5)
- acanthamatous ameloblastoma
- dentigerous cysts
- odontoma
- feline odontogenic tumor
- ameloblastoma
- [can't tell they're benign without incisional biopsy and rads looking for mets]
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What are benign peripheral odontogenic fibromas? (2)
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Odontogenic tumors arise from the _____________.
periodontal ligament
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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)
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Describe surgery for odontogenic tumors.
- although they are benign, require aggressive resection- mandibulectomy or maxillectomy
- b/c they invade bone and cause bony lysis
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Describe surgery for peripheral odontogenic fibromas.
- slow-growing, non-invasive
- soft tissue resection +/- tooth extraction and alveolar bone exicision
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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)
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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!
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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
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Describe osteosarcoma of the oral cavity. (2)
- medium to large breed, middle to older female dogs
- locally aggressive
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What surgery is indicated for a rostral oral tumor not crossing midline?
rostral hemi-mandibulectomy
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What surgery is indicated for a bilateral rostral mandibular tumor?
rostral mandibulectomy (prefer to resect at PM1)
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What surgery is indicated for a tumor confined to the vertical ramus?
caudal hemi-mandibulectomy
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What surgery is indicated for a unilateral high grade tumor of the mandible?
total hemi-mandibulectomy, cheiloplasty (lip reduction)
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When is a segmental and rim excision of the mandible indicated?
only if the tumor does not invade the medullary cavity of the bone
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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)
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What surgery is indicated for a maxillary tumor on one side of the hard palate?
unilateral rostral maxillectomy
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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
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What surgery is indicated for lateralized mid-maxillary lesions?
hemi-maxillectomy; 2-layer closure for nasal cavity please
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What surgery is indicated for bilateral mid-maxillary/ bilateral palatine lesions?
maxillectomy and major palatine reconstruction; prognosis poor
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