Page 42 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 3 · Surgery of the oral cavity and oropharynx

the secondary palate are surgically repaired, using the
overlapping flap or medially positioned flap (Langenbeck)
VetBooks.ir always be warned that multiple procedures may be
technique (see Operative Technique 3.3). Owners should
required to close a cleft completely.

Acquired palate defects
ronasal stula
The most common cause of acquired palate defects is
loss of upper jaw bone, associated with severe perio-
dontal disease or tooth extraction. An acute oronasal
fistula following tooth extraction (Figure 3.9) is diagnosed
by direct visualization of the nasal cavity or observing
nasal haemorrhage at the nares. Clinical signs of a
chronic oronasal fistula include sneezing and ipsilateral
nasal discharge. A defect at the rostral aspect of the
maxillary dental arch that communicates with the nasal
cavity noted during the oral examination confirms the
diagnosis. Elevating and positioning a labial mucosa flap
over the defect repairs the oronasal fistula (see Operative
Technique 3.5).

Cleft of the primary palate in a Bulldog. There are no rugae on
3.8
the left side of the hard palate indicating previous repair of a
cleft of the secondary palate.
The most rostral palate and the floor of the nasal vesti-
bule are reconstructed by creating flaps of both oral and
nasal tissue or flaps that are harvested from oral tissue
only. This is often complicated by the presence of teeth in
the tissue, and removal of one or more incisors and also
the canine tooth on the affected side will facilitate flap
management. Successful repair is achieved by creating
overlapping double flaps, followed by reconstructive cuta-
neous surgery to provide symmetry. These can be very
challenging operations and require careful planning.
cute oronasal fistula follo ing e traction of the right
3.9
Cleft palate ma illary canine tooth.
Clefts of the secondary palate (cleft hard and/or soft pal-
ate) are more serious. They are almost always along the
midline, and cleft hard palate is usually associated with a Other
midline soft palate abnormality. Soft palate defects without Other causes of palate defects are: trauma (e.g. ‘high-rise
hard palate defects may occur in the midline or can be uni- syndrome’, electric cord and gunshot injuries, dog bites,
lateral. The prognosis for congenital hypoplasia or aplasia foreign body penetration, pressure wounds); neoplasms;
of the soft palate, as opposed to cleft soft palate, is poor, severe chronic infections; and surgical and radiation
because restoration of a pharyngeal sphincteric ring and therapy (Bonner et al., 2012). Pressure necrosis is often
normal swallowing function may not be achieved despite secondary to malocclusion. In all cases, the cause of the
careful surgical planning and meticulous technique. defect must be removed prior to repair.
Clinical signs and history associated with secondary
palate defects include failure to create negative pressure
for nursing, nasal discharge, coughing, gagging, sneezing, Techniques for palate surgery
nasal reflux, tonsillitis, rhinitis, aspiration pneumonia, poor The choice of technique will depend on the location and
weight gain and general failure to thrive. The prognosis size of the defect and the amount of tissue available for
without surgical repair is guarded because of the risk of flap procedures. Usually, there is considerable haemor-
aspiration. Surgical correction is usually possible if the rhage during palate surgery because of the rich blood
animal can survive and grow to a suitable size for anaes- supply to the tissues involved. Digital pressure is often
thesia and surgery. Management requires intensive nurs- sufficient to control bleeding.
ing care by the owner, which includes transoral tube
feeding to avoid aspiration pneumonia.
Most procedures for correction of congenital palate Principles
defects are performed on animals at 3–4 months of age • The best chance of success is with the first procedure.
(Harvey and Emily, 1993). A prolonged interval between • Avoid electrocoagulation for haemostasis.
diagnosis and an attempt at repair may result in a wider • Make flaps larger than the defect they will cover.
cleft as the animal grows, and also in compounded • Retain blood supply to the flaps.
management problems, which are not desirable. Clefts of • Handle flaps as carefully as possible.

33

Ch03 HNT.indd 33 31/08/2018 10:39