General Surgery Of Airway And Oral Cavity

Front 1

What are the two most common causes of upper airway obstruction in the DOG?

Back 1

Brachycephalic Syndrome

Layngeal Paralysis

Front 2

Lesions rostral to the thoracic inlet cause a ______________ noise.

Back 2

Inspiratory

Expiratory noises or 'can't tell which one' noises are caudal to the thoracic inlet

Front 3

What is a potentially fatal consequence of upper airway obstruction?

Back 3

Non-cardiogenic Pulmonary Edema

Front 4

In a Brachycephalic dog, where does the soft palate lie?

Back 4

In the lumen of the trachea

In normal dogs its over the epiglottis

Front 5

What is the most commonly affected breed in Brachy. Synd.?

Back 5

English Bulldog

Front 6

Name the four compnents of Brachycephalic Syndrome.

Back 6

Stenotic nares
Elongated soft palate
Everted laryngeal sacccules
Hypoplastic trachea

Front 7

What are some clinical signs you see in brachycephalic dogs with upper airway problems?

Back 7

Dyspnea
Cyanosis
Stridor
Exercise Intolerance
Hyperthermia
Death

Front 8

Which of the following is NOT a secondary change as a result of brachycephalic syndrome?
a. prolapse of the tonsils
b. thickening of the soft palate
c. laryngeal inflammation
d. narrow tracheal lumen

Back 8

d. is a primary cause not a secondary change

Front 9

All of the following can result from respiratory problems associated with BS EXCEPT:
a. pulmonary edema
b. Left Heart Failure
c. cor pulmonale
d. hypoxia
e. pulmonary hypertension

Back 9

b. You see RIGHT sided heart failure with BS

Front 10

True of False
When you sedate and intubate a BS dog to examine its larynx you should be prepared to surgically fix what you find right away.

Back 10

TRUE

Front 11

What are the two easiest things we can do surgically for a BS dog?

Back 11

Trim the soft palate

Open up the nares

Front 12

What are the main complications associated with temporary tracheostomy?

Back 12

gagging,retchhing
vomiting or plugging
displacement of tube
** this is why oxygen administration is so important before and after surgery

Front 13

What percent of brachycephalic dogs have stenotic nares?

Back 13

50%

Front 14

Describe the ventral wedge technique to a client.

Back 14

Purpose: to widen the nostrils
Steps: #11 blade to remove two wedges on either side of the nostril and then sew the space together.

Front 15

True of False
When installing a temporary tracheostomy you want to place a few sutures arounf the tube to create an airtight seal.

Back 15

FALSE

If you create an airtight seal then subcutaneous emphysema will result

Front 16

What pair of muscles must you separate in order to visualize the trachea for installing a trachostomy tube?

Back 16

Sternohyoideus muscles

Front 17

What is a staphlectomy?

Back 17

Trimming the soft palate

Front 18

What structures do you sew together in a simple continuous pattern when performing a staphlectomy?

Back 18

the oral and nasopharyngeal mucosas

sew-as-you-go technique
4.0 Vicryl/Monocryl

Front 19

What is the purpose of the soft palate? This is important when considering how much to trim off.

Back 19

It needs to be able to occlue the nasopharynx when swallowing or food will go down the wrong pipe!

Front 20

True or False
You could use one of Dr. Tate's lasers to do a staphlectomy.

Back 20

True but not electrocautery

Front 21

True or False
Hemorrghage is rarely a problem with removing everted larygeal saccules.

Back 21

True - it's easy

Front 22

What structure is almost invisible when a dog present with severe laryngeal collapse?

Back 22

rima glottis

it's hidden by the cuniform and corniculate processes of the arytenoid cartilages during inspiration

Front 23

Your first step in a dog presenting with laryngeal collapse is what?

Back 23

Tracheostomy

Probably permanent

Front 24

True of False
Dogs with permanent tracheostomys do quite well so long as skin folds don't occlue the opening

Back 24

True

But no swimming!

Front 25

What age is most appropriate to address BS issues?

Back 25

When they are skeletally mature

Front 26

Overshortening of the soft palate will result in what condition?

Back 26

nasopharyngitis rhinitis

Front 27

What procedure is often done at the same time we shorted the soft palate?

Back 27

take out the laryngeal saccules

Front 28

Name the following structures in order as you see them (as the surgeon), starting at 6 o'clock and going counterclockwise.
Epiglottis, rima glottis, vocal fold, cunniform process, corniculate process, ary-epiglottic fold

Back 28

Starting in the 6 o'clock position and going counter clockwise....
epiglottis-->vocal fold (in the middle) --> ery-epiglottic fold --> cuneiform process --> rima glottis --> corniculate process

* Yes - it's an annoying way to ask the question so look at the diagram in the power point so you can label it on the test

Front 29

What is the most common cause of laryngeal paralysis?

Back 29

Idiopathic

Front 30

What are the two techniques used today to treat laryngeal collapse?

Back 30

Laryngeal tie back

Permanent Tracheostomy

Front 31

What muscle is responsible for abducting the arytenoid cartilages and vocal folds?

Back 31

cricoarytenoideus dorsalis

innervated by the recurrent laryngeal nerves

Front 32

Which three breeds have a cogenital laryngeal paralysis problem? This is bar trivia....

Back 32

Husky
Dalmation
Bouvier de Flanders

Front 33

All of the following can cause laryngeal paralysis EXCEPT:
a. Neoplasia
b. Hypothyroidism
c. Cushings
d. Dalmation or Lab
e. Idiopathic

Back 33

c. Cushings

You should do thoracic rads and a thyroid function test to work up the case.

Front 34

The vocal cord and arytenoideus muscles should _______________ on inspiration.

Back 34

Abduct

Front 35

What's the most common neoplasia in the larynx?

Back 35

Squamous Cell Carcinoma

Front 36

What is the surgical treatment of choice for laryngeal paralysis?

Back 36

Arytenoid Lateralization
(Unilateral tie-back)

Front 37

Which side of the larynx tends to be more affected than the other?

Back 37

LEFT side

Front 38

What is the number one complication with a unilateral tie-back procedure?

Back 38

Aspitation

Front 39

What is meant by the term "webbing" when speaking about complications of larynx surgeries?

Back 39

Scar tissue that inhibits movement - especially closure of the nasophayrnx

It's one of the big reasons de-barking procedures aren't done much anymore

Front 40

What do you "tie" the arytenoid cartilages to when you do a tie back procedure?

Back 40

thyroid and cricoid cartilages

Front 41

What drug is commonly given when tracheostomies are installed?

Back 41

steroids

Front 42

Where do you make your incision for a unilateral tie back procedure?

Back 42

ventral to jugular vein
caudal to angle of mandible
aim for the thyroid cartilages

Front 43

What muscles do you need to cut in a tie back surgery?

Back 43

In order of appraoch:
thyropharyngeus muscle
cricopharyngeus muscles
cricoarytenoideus dorsalis muscle (to get to joint)

Front 44

What two structures are sutured together in an arytenoid lateralization procedure?

Back 44

cricoid to the muscular process of the arytenoid cartilage

Front 45

True of False
The ventral most suture that passes through the arcuate crest of the muscular process of the artenoid cartilage is the most critical of the two sutures placed in a unilateral tie-back procedure.

Back 45

TRUE

Front 46

Bulldog was treated for brachycephalic syndrome
2 years ago, now dyspneic again. Possible causes?

Back 46

Tracheal collapse
Tracheal Hypoplasia
Neoplasia
Soft Palate restretches
Saccules re-evert

Front 47

Overtightening of the sutures in a tie back surgery causes what?

Back 47

Aspiration pneumonia

Front 48

True or False
A cat that stops purring could have laryngeal paralysis.

Back 48

True

Front 49

What is the most common type of laryngeal tumor in a CAT?

Back 49

lymphosarcoma

Front 50

Suggested treatment for intrathoracic Grade IV
tracheal collapse that has failed medical
management?

Back 50

Intraluminal Tracheal Stent

Front 51

True or False
Tracheal collapse occurs primarily in older small breed dogs.

Back 51

True --> Yorkies

Front 52

What are some reasons the trachea might collapse?

Back 52

Congenital defect in tracheal rings + irritant
Excessive coughing from allergy or bronchitis
Obesity
Heart Disease
Smoker in the House

Front 53

How does a dog present with tracheal collapse?

Back 53

Goose Honking cough
Cyanosis
Exercise Intolerance

Front 54

In you suspect an intrathoracic collapse, what kind of radiographs do you want to take?

Back 54

Expiratory Rads

Front 55

Name five parts of a work up for a coughing dog.

Back 55

Rads (insp or expir)
Bronchoscopy / Endoscopy
Bronc. Alveolar Lavage
Trans tracheal wash
Fluoroscopy

Front 56

Medical management for tracheal collapse includes everything EXCEPT:
a. Antibiotics
b. Cough Supressants
c. Prednisone
d. Tramadol
e. Bronchodilator

Back 56

d. Tramadol

Hopefully the dog doesn't need a narcotic for pain but a sedative could be useful.

Front 57

Surgery for tracheal collapse is only possible if the collapse occurs cranial to what?

Back 57

the 2nd rib

Front 58

What are two major complications asociated with the spiral ring prosthesis?

Back 58

Damage to blood supply

Damage to laryngeal nerves

Front 59

True of False
At NCSU CVM the total ring prosthesis is done instead of the spiral ring prosthesis

Back 59

True

Front 60

What are the intraluminal tracheal stents made of?

Back 60

Nitinol

Front 61

What's the most critical step in installing a tracheal stent?

Back 61

Sizing
It should extend from carina to larynx
Use a scope to see how you did
If its wrong you'll get pressure necrosis

Front 62

Are stents permanent?

Back 62

Yes

Front 63

What's the biggest complication to installing a tracheal stent?

Back 63

Coughing until the tracheal mucosa grows over the stent
necrosis if not sized correctly
kinks and fractures of the stent

Front 64

All of the following are indications for a permanent tracheostomy EXCEPT:
a. laryngeal tumor
b. laryngeal collapse
c. tie back failed
d. recurrent laryngeal webbing
e. laryngitis

Back 64

e. laryngitis

Front 65

What are the top 3 complications from a permanent tracheostomy?

Back 65

Skin fold occlusion
Stenosis
Mucosa Plugging

Front 66

Why is it so important to suture the tracheal mucosa over the cartilage and to the skin?

Back 66

If granulation tissue froms in that gap it will cause stenosis of the trachea

Front 67

If you had to resect a part of the traches to remove a mass, what type of suture pattern would be most appropriate?

Back 67

any tension relieving suture

place all the sutures first and then tighten them

Front 68

What's the most common tracheal tumor in the DOG

Back 68

osteochondroma

Front 69

What is more common, a tracheal tear or a tracheal avulsion?

Back 69

Tracheal Tear from overinflation of the cuff in the cats especially

Front 70

What activity should be avoided following
permanent tracheostomy?

Back 70

Swimming

Front 71

Why do cats do so poorly with temporary
tracheostomies?

Back 71

Cats produce a ton more mucous than dogs so the tube gets plugged up and they get lymphoplasmacytic laryngitis

Front 72

Describe the at home care for a permanent
tracheostomy.

Back 72

Owner needs to shower daily with the dog so the steam clear stuff
keep hair clipped around the hole
clean it with q-tips and saline every day

Front 73

Which salivary glands most commonly get impacted?

Back 73

mandibular and sublingual

Front 74

Should you drain a mucocele?

Back 74

No

Front 75

When you resect the salivary gland you have to make sure you work within the capsule and dissect until the gland runs under WHAT muscle?

Why do we stay in the capsule?

Back 75

Digastricus mm

Capsule is attached to vessels (maxillay and lingofacial veins) and lingual n- easier to leave them untouched

Front 76

What's the #1 tumor of the oral cavity in the DOG?

Prognosis?

Back 76

Melanoma

60-80% have mets and only live 9 months longer

Front 77

What is the #1 oral tumor in CATS?
Prognosis?

Back 77

Squamous Cell Carcinoma

(Fibrosarcoma)

Slower to met and they will live 1-2 years more life

Front 78

What's the #1 BENIGN oral tumor in dogs?

Back 78

Epulides (from the periodontal ligament)

Three types:
fibrous
ossifying
granulomatous

You have to do a biopsy since you can't find these on radiographs (unless they are dental ones)

You can cure the dog by excising it and removing the tooth plus some bone

Front 79

You identify an oral tumor in a dog and take a biopsy to send off but it looks like surgical removal is going to be necessary no matter what. The client wants to know what to expct post surgery. Can you tell her a few things to expect?

Back 79

Depending on how much area you have to take there are some basic complications to oral surgery:
Mouths are dirty - dehiscence due to contamination can happen, may want to consider a stomach tube for a few weeks
If its malignant it has a 40% chance of coming back
There could be come deformity depending on how much needs to be removed

Front 80

What are the typical signs of nasal disease
in general?

Back 80

Sneezing, nasal discharge, ulceration, masses

Front 81

When you see nasal planum ulceration think
_______________

Back 81

Fungal Disease

Front 82

When you here a reverse sneeze, think
_______________.

Back 82

tracheal collapse

Front 83

Describe the workup for an oral tumor

Back 83

Do the CT and MRI imaging first and the dental rads because when you stick anything in there you might cause bleeding.
Biopsy mass.
Thorough discussion with owners on post-sx expectations

Front 84

True of False
You should remove part of the underlying bone when removing an epulis even if you don't see bony involvement in the dental radiograph.

Back 84

True