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84 Cards in this Set
- Front
- Back
What are the two most common causes of upper airway obstruction in the DOG?
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Brachycephalic Syndrome
Layngeal Paralysis |
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Lesions rostral to the thoracic inlet cause a ______________ noise.
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Inspiratory
Expiratory noises or 'can't tell which one' noises are caudal to the thoracic inlet |
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What is a potentially fatal consequence of upper airway obstruction?
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Non-cardiogenic Pulmonary Edema
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In a Brachycephalic dog, where does the soft palate lie?
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In the lumen of the trachea
In normal dogs its over the epiglottis |
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What is the most commonly affected breed in Brachy. Synd.?
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English Bulldog
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Name the four compnents of Brachycephalic Syndrome.
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Stenotic nares
Elongated soft palate Everted laryngeal sacccules Hypoplastic trachea |
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What are some clinical signs you see in brachycephalic dogs with upper airway problems?
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Dyspnea
Cyanosis Stridor Exercise Intolerance Hyperthermia Death |
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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 |
d. is a primary cause not a secondary change
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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 |
b. You see RIGHT sided heart failure with BS
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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. |
TRUE
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What are the two easiest things we can do surgically for a BS dog?
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Trim the soft palate
Open up the nares |
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What are the main complications associated with temporary tracheostomy?
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gagging,retchhing
vomiting or plugging displacement of tube ** this is why oxygen administration is so important before and after surgery |
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What percent of brachycephalic dogs have stenotic nares?
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50%
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Describe the ventral wedge technique to a client.
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Purpose: to widen the nostrils
Steps: #11 blade to remove two wedges on either side of the nostril and then sew the space together. |
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True of False
When installing a temporary tracheostomy you want to place a few sutures arounf the tube to create an airtight seal. |
FALSE
If you create an airtight seal then subcutaneous emphysema will result |
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What pair of muscles must you separate in order to visualize the trachea for installing a trachostomy tube?
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Sternohyoideus muscles
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What is a staphlectomy?
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Trimming the soft palate
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What structures do you sew together in a simple continuous pattern when performing a staphlectomy?
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the oral and nasopharyngeal mucosas
sew-as-you-go technique 4.0 Vicryl/Monocryl |
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What is the purpose of the soft palate? This is important when considering how much to trim off.
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It needs to be able to occlue the nasopharynx when swallowing or food will go down the wrong pipe!
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True or False
You could use one of Dr. Tate's lasers to do a staphlectomy. |
True but not electrocautery
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True or False
Hemorrghage is rarely a problem with removing everted larygeal saccules. |
True - it's easy
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What structure is almost invisible when a dog present with severe laryngeal collapse?
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rima glottis
it's hidden by the cuniform and corniculate processes of the arytenoid cartilages during inspiration |
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Your first step in a dog presenting with laryngeal collapse is what?
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Tracheostomy
Probably permanent |
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True of False
Dogs with permanent tracheostomys do quite well so long as skin folds don't occlue the opening |
True
But no swimming! |
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What age is most appropriate to address BS issues?
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When they are skeletally mature
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Overshortening of the soft palate will result in what condition?
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nasopharyngitis rhinitis
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What procedure is often done at the same time we shorted the soft palate?
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take out the laryngeal saccules
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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 |
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 |
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What is the most common cause of laryngeal paralysis?
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Idiopathic
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What are the two techniques used today to treat laryngeal collapse?
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Laryngeal tie back
Permanent Tracheostomy |
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What muscle is responsible for abducting the arytenoid cartilages and vocal folds?
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cricoarytenoideus dorsalis
innervated by the recurrent laryngeal nerves |
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Which three breeds have a cogenital laryngeal paralysis problem? This is bar trivia....
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Husky
Dalmation Bouvier de Flanders |
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All of the following can cause laryngeal paralysis EXCEPT:
a. Neoplasia b. Hypothyroidism c. Cushings d. Dalmation or Lab e. Idiopathic |
c. Cushings
You should do thoracic rads and a thyroid function test to work up the case. |
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The vocal cord and arytenoideus muscles should _______________ on inspiration.
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Abduct
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What's the most common neoplasia in the larynx?
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Squamous Cell Carcinoma
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What is the surgical treatment of choice for laryngeal paralysis?
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Arytenoid Lateralization
(Unilateral tie-back) |
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Which side of the larynx tends to be more affected than the other?
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LEFT side
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What is the number one complication with a unilateral tie-back procedure?
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Aspitation
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What is meant by the term "webbing" when speaking about complications of larynx surgeries?
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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 |
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What do you "tie" the arytenoid cartilages to when you do a tie back procedure?
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thyroid and cricoid cartilages
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What drug is commonly given when tracheostomies are installed?
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steroids
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Where do you make your incision for a unilateral tie back procedure?
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ventral to jugular vein
caudal to angle of mandible aim for the thyroid cartilages |
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What muscles do you need to cut in a tie back surgery?
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In order of appraoch:
thyropharyngeus muscle cricopharyngeus muscles cricoarytenoideus dorsalis muscle (to get to joint) |
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What two structures are sutured together in an arytenoid lateralization procedure?
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cricoid to the muscular process of the arytenoid cartilage
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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. |
TRUE
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Bulldog was treated for brachycephalic syndrome
2 years ago, now dyspneic again. Possible causes? |
Tracheal collapse
Tracheal Hypoplasia Neoplasia Soft Palate restretches Saccules re-evert |
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Overtightening of the sutures in a tie back surgery causes what?
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Aspiration pneumonia
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True or False
A cat that stops purring could have laryngeal paralysis. |
True
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What is the most common type of laryngeal tumor in a CAT?
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lymphosarcoma
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Suggested treatment for intrathoracic Grade IV
tracheal collapse that has failed medical management? |
Intraluminal Tracheal Stent
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True or False
Tracheal collapse occurs primarily in older small breed dogs. |
True --> Yorkies
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What are some reasons the trachea might collapse?
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Congenital defect in tracheal rings + irritant
Excessive coughing from allergy or bronchitis Obesity Heart Disease Smoker in the House |
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How does a dog present with tracheal collapse?
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Goose Honking cough
Cyanosis Exercise Intolerance |
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In you suspect an intrathoracic collapse, what kind of radiographs do you want to take?
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Expiratory Rads
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Name five parts of a work up for a coughing dog.
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Rads (insp or expir)
Bronchoscopy / Endoscopy Bronc. Alveolar Lavage Trans tracheal wash Fluoroscopy |
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Medical management for tracheal collapse includes everything EXCEPT:
a. Antibiotics b. Cough Supressants c. Prednisone d. Tramadol e. Bronchodilator |
d. Tramadol
Hopefully the dog doesn't need a narcotic for pain but a sedative could be useful. |
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Surgery for tracheal collapse is only possible if the collapse occurs cranial to what?
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the 2nd rib
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What are two major complications asociated with the spiral ring prosthesis?
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Damage to blood supply
Damage to laryngeal nerves |
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True of False
At NCSU CVM the total ring prosthesis is done instead of the spiral ring prosthesis |
True
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What are the intraluminal tracheal stents made of?
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Nitinol
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What's the most critical step in installing a tracheal stent?
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Sizing
It should extend from carina to larynx Use a scope to see how you did If its wrong you'll get pressure necrosis |
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Are stents permanent?
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Yes
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What's the biggest complication to installing a tracheal stent?
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Coughing until the tracheal mucosa grows over the stent
necrosis if not sized correctly kinks and fractures of the stent |
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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 |
e. laryngitis
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What are the top 3 complications from a permanent tracheostomy?
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Skin fold occlusion
Stenosis Mucosa Plugging |
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Why is it so important to suture the tracheal mucosa over the cartilage and to the skin?
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If granulation tissue froms in that gap it will cause stenosis of the trachea
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If you had to resect a part of the traches to remove a mass, what type of suture pattern would be most appropriate?
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any tension relieving suture
place all the sutures first and then tighten them |
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What's the most common tracheal tumor in the DOG
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osteochondroma
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What is more common, a tracheal tear or a tracheal avulsion?
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Tracheal Tear from overinflation of the cuff in the cats especially
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What activity should be avoided following
permanent tracheostomy? |
Swimming
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Why do cats do so poorly with temporary
tracheostomies? |
Cats produce a ton more mucous than dogs so the tube gets plugged up and they get lymphoplasmacytic laryngitis
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Describe the at home care for a permanent
tracheostomy. |
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 |
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Which salivary glands most commonly get impacted?
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mandibular and sublingual
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Should you drain a mucocele?
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No
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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? |
Digastricus mm
Capsule is attached to vessels (maxillay and lingofacial veins) and lingual n- easier to leave them untouched |
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What's the #1 tumor of the oral cavity in the DOG?
Prognosis? |
Melanoma
60-80% have mets and only live 9 months longer |
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What is the #1 oral tumor in CATS?
Prognosis? |
Squamous Cell Carcinoma
(Fibrosarcoma) Slower to met and they will live 1-2 years more life |
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What's the #1 BENIGN oral tumor in dogs?
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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 |
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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?
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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 |
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What are the typical signs of nasal disease
in general? |
Sneezing, nasal discharge, ulceration, masses
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When you see nasal planum ulceration think
_______________ |
Fungal Disease
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When you here a reverse sneeze, think
_______________. |
tracheal collapse
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Describe the workup for an oral tumor
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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 |
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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. |
True
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