Page 43 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

• Suture connective tissue surfaces or cut edges The benefit of this initial management outweighs the risk
together. inherent in leaving this injury to heal by second intention,
VetBooks.ir • Do not locate suture lines over a void if possible. ration is extensive, with involvement of the maxillae and
although this may be sufficient in many cases. If the sepa-
• Provide a two-layer closure if practical.
palatine bones, inter-quadrant fixation may be required to
• Avoid creating closure that is under tension.
Lewis, 2011).
Congenital defects re-establish proper occlusion (Figure 3.11) (Reiter and
The overlapping flap technique is the preferred technique
for congenital primary and secondary hard palate defects
(Figure 3.10) and is described in Operative Technique 3.3.
There is less tension on the suture line, the suture line
is not located directly over the defect and the area of
opposing connective tissue is larger, which results in a
stronger scar. It provides more reliable results than the
medially positioned flap technique, though for very narrow
congenital or traumatic hard palate clefts, the medially
positioned technique may be utilized.
The medially positioned flap technique is an alternative
technique utilized for closure of midline hard palate defects.
The technique is described in Operative Technique 3.3. If
the relieving incisions are long and tend to gape, a lateral
oronasal defect may result, particularly in narrow-nosed
dogs. Another disadvantage of this technique is that rostral
defects have a tendency to break down. For these reasons,
the overlapping flap technique is preferred for repair of
midline hard palate defects.
Congenital midline soft palate defects are corrected by
making incisions along the medial margins of the defect to Traumatic cleft palate in a cat repaired ith medially
the level of the middle aspect or caudal end of the tonsils. 3.11 positioned double flaps. n inter-arcade fi ation as
The palatal tissue is separated with blunt-ended scissors necessary to reduce bone separation and bilateral relieving incisions
to form a dorsal and a ventral flap on each side. The two ere made to accommodate the flaps.
dorsal and the two ventral flaps are sutured separately in a
simple interrupted pattern to the midpoint or caudal end of Split palatal U-flap: This technique is useful for large cau-
the tonsils (Harvey and Emily, 1993). dal defects. The original technique described the creation of
a large U-shaped mucoperiosteal flap rostral to the defect;
Acquired defects an incision was then made along the midline of the flap to
create two flaps of equal size. An alternative (see Operative
Trauma: Traumatic cleft of the hard palate associated with Technique 3.4) is to create one flap slightly longer and
‘high-rise syndrome’ in cats can be managed easily and another slightly shorter in length (Reiter and Smith, 2005).
effectively by approximating the displaced bony structures
with digital pressure, followed by suturing of the torn pala- Oronasal fistula repair: For large rostral defects following
tal soft tissues in a simple interrupted or mattress pattern.
the extraction of teeth, a labial-based flap can be formed
and sutured across the defect (see Operative Technique
3.5). Alternatively, a two-layer flap technique may be used.
The first flap must provide an epithelial surface for the nasal
cavity. The connective tissue surface of the first flap lies in
the oral cavity. The second flap is designed to cover the
connective tissue surface of the first flap and also provides
an epithelial surface for the oral cavity. Synthetic absorb-
able sutures are placed in a simple interrupted pattern.
Other techniques: An alternative for repair of defects in
the mid-portion of the hard palate is the use of a tongue
flap that is later amputated and left attached to the palate.
Another alternative is to create a permanent or removable
silicone or acrylic obturator (Harvey and Emily, 1993).

Oropharynx
Trauma

Animal bites or foreign bodies may result in penetrating
wounds of the oral cavity and oropharynx. Foreign body
Cleft of the secondary hard palate in a Bulldog repaired using
3.10 penetration can cause deep, contaminated wounds to the
the overlapping double flap techni ue. The larger ma or
palatine artery and smaller accessory palatine artery arro ed are sides and root of the tongue, suborbital area, tonsillar
*
attached to the overlapped flap. crypts or pharyngeal walls.
34

Ch03 HNT.indd 34 31/08/2018 10:39