Oral surgical conditions

• General principles of oral surgery

  Use atraumatic technique.

  Control haemorrhage using pressure, ligation or appropriate electrosurgery.

  Prevent tension: make flaps 2 to 4mm larger than the defect.

  Support flaps do not suture over defects.

  Use appositional sutures (e.g. simple interrupted, simple continuous, cruciate - consider locked horizontal mattress or vertical mattress).
• Choice of suture materials for oral surgery

  Many suture materials may be used for oral surgery and there is significant surgeon preference when making a choice.

  Commonly materials:

  • Monofilament, absorbable materials providing wound support for between 14-28 days
  • Multifilament, absorbable materials providing wound support for between 10-21 days.

  Infection in the mouth generally resolves itself and heals quite well, however sutures will breakdown due to tension, sutures need to provide wound support for around 14 days.
• Congenital palatine defects - cleft palate

  Birth defect leading to abnormal opening between the mouth and nose.

  Lip (primary cleft palate, cleft lip, harelip) - uni and bilateral.

  Along the roof of the mouth (secondary cleft palate)

  • Affecting hard palate only
  • Affecting soft palate only.
  • Affecting both hard and soft palate.
• Bilateral primary cleft defect

  Unsightly but is most likely not causing the dogs any problems. Is a potential hole between the mouth and the nose but is cranial so is unlikely to get any large amounts of food going through into the nasal cavity, which is the main problems with most cleft palates as this will cause irritation.

  Most of these cases are put to sleep early on as the breeder does not want to spend the money, they are not easy to operate on.

  
• Palatine hypoplasia

  Failure of the soft palate to fuse correctly on one or both sides. Bilateral looks like it has a uvula (dogs and cats do not have uvulas).
• Clinical signs of palatine hypoplasia

  Stunted growth due to poor weight gain - can’t eat well.

  Breathing difficulties upon exertion.

  Coughing or gagging especially when eating or drinking.

  Nasal discharge that my include food.

  Infection or pneumonia due to food aspiration.

  Abnormal visual appearance with cleft lip defect.
• Management of palatine hypoplasia

  Breeders commonly euthanise affected individuals.

  Otherwise, management usually surgical.

  Usually wait until affected individuals is 3-6 months old if you want a successful surgical repair as the more robust the tissue is that you are suturing.

  Numerous ways on surgical management dependent on type of cleft. Prone to dehiscence and requirement for repeat surgery.
• After and outcome of pallate surgery

  Give antibiotics for individuals wot pneumonia or nasal infection.

  Elizabethan collar for 2-3 weeks to stop self-trauma.

  Soft food for 3-4 weeks. No hard or toys etc. that can be chewed. Use of Oesophagostomy feeding tube appears to make little or no difference to liklihood of dehiscence, dogs will usually eat regardless of the oral surgery, cats are the opposite any sort of oral surgery they will most likely stop eating.

  Do not breed from affected individuals as is congenital.
• Complications of palate surgery

  Partial or complete dehiscence

  Nasal discharge or sneezing

  Continue coughing or gagging due to short soft palate.
• Symphyseal separation

  Common in RTA type injuries. The dental arcade is no longer straight and intact. Simplest way to stabilise is to just put a suture around it. Can also use dental acrylic to stabilise. The aim is to achieve normal occlusion.
• Surgical diseases of the salivary gland

  Salivary gland and duct injury - if you locate the duct you don’t get a mucocoele the gland just atrophies.

  Salivary fistulas.

  Sialoloths - can get crystal formation in the gland.

  Salivary gland neoplasia - most likely carcinoma, usually quite malignant so have a fairly guarded prognosis.

  Mucocoeles - accumulation of the fluid in a cavity (doesn’t have to be a cystic cavity), the fluid is being produced by the salivary gland. Salivary gland mucocoele is the most likely issue to see in practice.