Page 10 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 1
VetBooks.ir

Surgical principles and

instrumentation

Stephen Baines, Victoria Lipscomb and Alexander M. Reiter

Introduction systemic problems that need to be addressed. On the
other hand, patients with diseases affecting the airway or
Surgery of the head, neck and thorax forms a large part of thorax tend to have the potential for serious cardiorespira-
soft tissue surgery. It is indicated for a variety of disease tory compromise.
processes affecting a number of different organ systems,
with many surgical procedures described for their man-
agement. As ever, the standard principles of good surgical Patient assessment
practice are relevant to surgical procedures in these areas.
There are, however, a few distinguishing features that set It is essential that an accurate assessment of the patient is
the practice of surgery of the head, neck and thorax apart made to allow a preoperative diagnosis, wherever pos-
from other regions (e.g. general surgery of the abdomen). sible. This includes an assessment of the nature and stage
These include: of the disease and an assessment of how the patient is
affected by the disease. The contribution of the various
• Proximity of vital structures, primarily nerves and diagnostic aids available will differ according to the region
vessels, to the surgical site affected. Nevertheless, an attempt should be made to
• The organs involved in the disease process are vitally achieve a preoperative diagnosis so that the surgical pro-
important (e.g. heart, lungs, airways) cedure and anaesthetic management can be carefully
• The patient may show few clinical signs, and yet be planned. Anaesthetizing a patient for surgery of the air-
severely compromised ways and thorax requires particular knowledge of the
• The patient may present in severe distress (e.g. acute physiology of the cardiorespiratory system, and preopera-
upper respiratory tract obstruction) tive evaluation should focus on this system. For the patient
• Intensive preoperative stabilization and postoperative that represents an anaesthetic risk, it is advisable that
care are often required surgical correction of the lesion, where appropriate, should
• There is limited surgical access to some organs and follow on directly from anaesthesia for diagnosis. The likely
structures (e.g. soft palate) outcome, potential complications and long-term prognosis
• Many of these patients represent an increased should be identified and communicated to the client before
anaesthetic risk the surgery is performed. A correct evaluation of the
• The anaesthetic management of these cases may be problem and careful assessment of the patient is the key
more complex to a successful anaesthetic and surgical procedure.
• There is the need for the surgeon and anaesthetist to
work closely together. Signalment
The signalment of the patient may aid the diagnosis. The
The surgical techniques described in this manual fall
into six broad categories, based on location: incidence of disease differs between species (e.g. dogs
develop laryngeal paralysis more frequently than cats,
whereas a cranial mediastinal mass is more common in
• The ear cats). Many disorders have strong breed predilections
• The oral cavity
(e.g. brachycephalic airway disease), many are congenital
• The airways
and will be noted in the young animal (e.g. cleft palate)
• The head and neck, excluding the airways and many are neoplastic and occur in the older animal
• The thoracic wall
(e.g. squamous cell carcinoma of the nasal planum). Entire
• The thoracic cavity and viscera.
animals are more likely to stray and are at increased risk
of trauma.
As a general rule, patients with diseases affecting the
ear or the head and neck, excluding the airways, are rela-
tively free of severe systemic signs or physical compro- History
mise. This is not true for all patients; those animals, for Consideration of the clinical signs shown by the animal may
example, with vestibular signs, hyperthyroidism or chronic point towards a diagnosis and, more importantly, may allow
regurgitation from oesophageal disease will have their own the severity of the disease process to be identified. For

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, second edition. Edited by Daniel J. Brockman, David E. Holt and Gert ter Haar. ©BSAVA 2018 1

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