1887

Surgery of the oral cavity and oropharynx

image of Surgery of the oral cavity and oropharynx
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Abstract

Surgery of the oral cavity and oropharynx is required to treat neoplasia, traumatic and congenital lesions, and diseases affecting the lips and salivary glands. The clinical signs, diagnosis, surgical management, prognosis and postoperative care of these problems are addressed in this chapter. : Partial rostral maxillectomy; Total mandibulectomy; Cleft palate repair; Split palatal U-flap technique; Oronasal fistula repair; Mandibular and sublingual salivary gland resection (lateral approach).

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Figures

Image of 3.1
3.1 Punch biopsy of a fibrosarcoma at the rostral maxilla in a dog. Two previous biopsies had indicated a peripheral odontogenic fibroma. A small mucoperiosteal flap was created to obtain a deeper tissue sample.
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3.2 Peripheral odontogenic fibroma of the mandibular incisor area in a dog.
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3.3 Right maxillary malignant melanoma in a dog. Note the extension of tumour tissue into alveolar and buccal mucosa.
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3.4 Squamous cell carcinoma of the right maxillary area in a dog.
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3.5 Fibrosarcoma of the left mandible in a dog.
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3.6 Lower lip avulsion in a kitten after motor vehicle trauma.
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3.7 (a) Lingual calcinosis circumscripta in a dog. (b) A radiograph of the excised tissue showing a circumscribed lesion containing material with bone density that is arranged in lobules.
Image of 3.8
3.8 Cleft of the primary palate in a Bulldog. There are no rugae on the left side of the hard palate, indicating previous repair of a cleft of the secondary palate.
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3.9 Acute oronasal fistula following extraction of the right maxillary canine tooth.
Image of 3.10
3.10 Cleft of the secondary hard palate in a Bulldog repaired using the overlapping double flap technique. The larger major palatine artery (*) and smaller accessory palatine artery (arrowed) are attached to the overlapped flap.
Image of 3.11
3.11 Traumatic cleft palate in a cat repaired with medially positioned double flaps. An inter-arcade fixation was necessary to reduce bone separation, and bilateral relieving incisions were made to accommodate the flaps.
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3.12 Cervical sialocele (arrowed) in a Poodle.
Image of Maxillectomy with an osteotome and mallet.
Maxillectomy with an osteotome and mallet. Maxillectomy with an osteotome and mallet.
Image of Resection of the premaxilla and/or maxilla exposes the nasal cavity.
Resection of the premaxilla and/or maxilla exposes the nasal cavity. Resection of the premaxilla and/or maxilla exposes the nasal cavity.
Image of A single-layer, buccal mucosal closure is performed.
A single-layer, buccal mucosal closure is performed. A single-layer, buccal mucosal closure is performed.
Image of The dog is positioned in lateral recumbency. Exposure of the caudal mandible can be enhanced by retraction of the labial commissures.
The dog is positioned in lateral recumbency. Exposure of the caudal mandible can be enhanced by retraction of the labial commissures. The dog is positioned in lateral recumbency. Exposure of the caudal mandible can be enhanced by retraction of the labial commissures.
Image of Symphyseal osteotomy must be performed early in the procedure to enhance surgical exposure of the medial mandible and associated structures. A large Backhaus towel clamp or bone-holding forceps will facilitate manipulation of the mandible.
Symphyseal osteotomy must be performed early in the procedure to enhance surgical exposure of the medial mandible and associated structures. A large Backhaus towel clamp or bone-holding forceps will facilitate manipulation of the mandible. Symphyseal osteotomy must be performed early in the procedure to enhance surgical exposure of the medial mandible and associated structures. A large Backhaus towel clamp or bone-holding forceps will facilitate manipulation of the mandible.
Image of The mandible is displaced laterally and the labial incision is continued, the mylohyoid and digastricus muscles divided and the mandibular alveolar artery, vein and nerve identified and divided.
The mandible is displaced laterally and the labial incision is continued, the mylohyoid and digastricus muscles divided and the mandibular alveolar artery, vein and nerve identified and divided. The mandible is displaced laterally and the labial incision is continued, the mylohyoid and digastricus muscles divided and the mandibular alveolar artery, vein and nerve identified and divided.
Image of The masseter temporalis and medial pterygoid muscles are removed from the lateral mandible and coronoid process to expose the temporomandibular joint.
The masseter temporalis and medial pterygoid muscles are removed from the lateral mandible and coronoid process to expose the temporomandibular joint. The masseter temporalis and medial pterygoid muscles are removed from the lateral mandible and coronoid process to expose the temporomandibular joint.
Image of Disarticulate the temporomandibular joint and remove the final attachments of the temporalis muscle to the dorsal mandibular coronoid process to complete the mandibulectomy.
Disarticulate the temporomandibular joint and remove the final attachments of the temporalis muscle to the dorsal mandibular coronoid process to complete the mandibulectomy. Disarticulate the temporomandibular joint and remove the final attachments of the temporalis muscle to the dorsal mandibular coronoid process to complete the mandibulectomy.
Image of Commissuroplasty can minimize lateral tongue displacement as a complication of this procedure and is essential for brachycephalic dogs.
Commissuroplasty can minimize lateral tongue displacement as a complication of this procedure and is essential for brachycephalic dogs. Commissuroplasty can minimize lateral tongue displacement as a complication of this procedure and is essential for brachycephalic dogs.
Image of Oral mucosa is closed with synthetic absorbable suture material and the skin with non-absorbable suture material.
Oral mucosa is closed with synthetic absorbable suture material and the skin with non-absorbable suture material. Oral mucosa is closed with synthetic absorbable suture material and the skin with non-absorbable suture material.
Image of Hard palate defect.
Hard palate defect. Hard palate defect.
Image of Incisions are made in the mucoperiosteum of the hard palate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made in the mucoperiosteum of the hard palate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Incisions are made in the mucoperiosteum of the hard palate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Elevating flap B.
Elevating flap B. Elevating flap B.
Image of Elevating flap A. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Elevating flap A. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Elevating flap A. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Elevating flap A. Note the major palatine artery (arrowed) attached to the flap. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Elevating flap A. Note the major palatine artery (arrowed) attached to the flap. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Elevating flap A. Note the major palatine artery (arrowed) attached to the flap. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Flap A is turned on itself and sutured under flap B so that connective tissue surfaces are in contact. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Flap A is turned on itself and sutured under flap B so that connective tissue surfaces are in contact. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Flap A is turned on itself and sutured under flap B so that connective tissue surfaces are in contact. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Incisions are made at the margins of the soft palate defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made at the margins of the soft palate defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Incisions are made at the margins of the soft palate defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Dorsal and ventral flaps are sutured separately. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Dorsal and ventral flaps are sutured separately. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Dorsal and ventral flaps are sutured separately. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Both defects closed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Both defects closed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Both defects closed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Appearance at end of operation.
Appearance at end of operation. Appearance at end of operation.
Image of Incisions are made at the medial edges of the hard palate defect. Relieving incisions 2 mm away from the gingiva are often necessary for accommodation of the flaps. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made at the medial edges of the hard palate defect. Relieving incisions 2 mm away from the gingiva are often necessary for accommodation of the flaps. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Incisions are made at the medial edges of the hard palate defect. Relieving incisions 2 mm away from the gingiva are often necessary for accommodation of the flaps. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Undermining the mucoperiosteum. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Undermining the mucoperiosteum. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Undermining the mucoperiosteum. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of The margins of the defect are debrided, and two flaps of unequal length are created rostral to the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The margins of the defect are debrided, and two flaps of unequal length are created rostral to the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The margins of the defect are debrided, and two flaps of unequal length are created rostral to the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of The mucoperiosteal flaps are raised with a periosteal elevator. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The mucoperiosteal flaps are raised with a periosteal elevator. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The mucoperiosteal flaps are raised with a periosteal elevator. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of The shorter flap (B) is rotated through 90 degrees and sutured over the defect. The longer flap (A) is rotated through 90 degrees and sutured to the edge of flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The shorter flap (B) is rotated through 90 degrees and sutured over the defect. The longer flap (A) is rotated through 90 degrees and sutured to the edge of flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The shorter flap (B) is rotated through 90 degrees and sutured over the defect. The longer flap (A) is rotated through 90 degrees and sutured to the edge of flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Chronic oronasal fistula in the area of a missing right maxillary canine tooth in a dog.
Chronic oronasal fistula in the area of a missing right maxillary canine tooth in a dog. Chronic oronasal fistula in the area of a missing right maxillary canine tooth in a dog.
Image of Appearance of the oronasal fistula once the debris and hair have been removed.
Appearance of the oronasal fistula once the debris and hair have been removed. Appearance of the oronasal fistula once the debris and hair have been removed.
Image of A labial mucosal flap has been sutured to the hard palate mucosa.
A labial mucosal flap has been sutured to the hard palate mucosa. A labial mucosal flap has been sutured to the hard palate mucosa.
Image of Position of curvilinear incision (white dotted line) from the bifurcation of the external jugular vein (shown in blue) to the caudoventral aspect of the mandibular body.
Position of curvilinear incision (white dotted line) from the bifurcation of the external jugular vein (shown in blue) to the caudoventral aspect of the mandibular body. Position of curvilinear incision (white dotted line) from the bifurcation of the external jugular vein (shown in blue) to the caudoventral aspect of the mandibular body.
Image of The mandibular salivary gland and the contiguous sublingual gland complex course between the masseter and digastricus muscles. Dissection is performed carefully rostral to the digastricus muscle in order to visualize the lingual nerve. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The mandibular salivary gland and the contiguous sublingual gland complex course between the masseter and digastricus muscles. Dissection is performed carefully rostral to the digastricus muscle in order to visualize the lingual nerve. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The mandibular salivary gland and the contiguous sublingual gland complex course between the masseter and digastricus muscles. Dissection is performed carefully rostral to the digastricus muscle in order to visualize the lingual nerve. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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