LA Sx, Final, II
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. What would you like to do?
A disfiguring injury of the lips/cheeks/tongue should be repaired how?
repair under suture- tension sutures
Should cuts to the tongue be repaired?
yes- repair tongue
What side of the tongue holds sutures better?
dorsal surface holds sutures better
Do we need to surgically repair cuts to teh frenulum of the tongue?
no- heal spontaneously
What is the clinical sign of a foal with a cleft palate?
milk running out of nose when foal nurses
How do we diagnose a cleft palate in a foal?
speculum, endoscope thru nostril
Is the hard or soft palate commonly involved in a foal with cleft palate?
What must we also evaluate in a foal with cleft palate?
respiratory tract- aspiration pneumonia common
Is repair of cleft palate easy? with good outcomes?
- not an easy procedure (difficulty increases with age)
- alot of post-op care
- very few are successful
In cleft palate surgery how is anesthesia managed?
need tracheotomy for ET tube
Does a cleft palate always have clinical signs?
no- sometimes we find them incidentally in adults that had no symptoms earlier
What is the general technique for cleft palate repair?
- mandibular symphysiotomy
- lower teeth are moved lateral so the upper palate is exposed
- palate incised and then apposed in 3 layer closure
What is the most common complication of cleft palate surgery?
fistula, then have to repeat surgery all over again
What is the prognosis for cleft palate surgery?
When the esophagus begins where is it located?
- median plane dorsal to the cricoid cartilage
- stays dorsal to trachea until 4th Cervical vertebrae
When the esophagus enters the thoracic cavity where is it located in relation to trachea?
ventral to trachea
In the thorax is the esophagus dorsal or ventral to the trachea?
Dorsal to trachea
In the mid-cervical region what is the esophagus dangerously close to?
carotid artery and vagosympathetic trunk
At the thoracic inlet the esophagus is located dangerously close to what?
How many layers are there in the esophagus? what are they?
- 4 layers
- fibrous, muscular, submucosa, mucosa
What is the holding layer of the esophagus?
- submucosa and mucosa
- (hard to stitch just one, so include both)
Describe the vascular supply to the esophagus? what is the relevance?
- segmental with minimal collateral circulation
- therefore dont pick esophagus up and out of incision b/c you risk damaging BVs that cant be compensated for!
What are complications of esophageal surgery?
- incision breakdown
- laryngela hemiplasia
Where is the skin incision usually made for esophageal surgery? why?
- ventral midline incision
- because drainage is key
What are some causes of esophageal obstructions?
- 1. greedy eaters- lush pasture, lots of grain
- 2. poor teeth
- 3. esoophagela stricture- from a previous choke
- 4. diverticulum
- 5. anthelmintic bolus (not used now)
Where is the most common location for esophageal obstructions?
just cranial to thoracic inlet
Shortly after the horse obstructs will it keep trying to eat? will it have food coming out the nose?
- yes keeps trying to eat (see food on mouth area)
- no food out the nose- this doesnt ever happen in horses
What do we use to diagnose esophageal obstructions? what else can we do?
- cant pass ET tube
- can use endoscope or radiology if chronic choke is a problem
What drug can we use that will sometimes help resolve a choke?
Oxytocin- contracts smooth mm
What is the problem with waiting for a choke/obstruction to resolve?
when bolus sits there it causes tissue damage in esophagus and can get secondary strictures
If the bolus/obstruction is lush grass what works best to resolve it?
Why is xylazine used to sedate choke/obstruction horses?
- good sedation and makes them lower head!
- (lower head = less chance of aspiration pneumonia)
Why doesnt the esophagus heal well?
missing serosa layer
if you must incise the esophagus to cure a choke/obstruction where should you make the cut?
- cranial or caudal to the obstruction
- thru HEALTHY esophagus
When suturing the esophagus closed where should the knots be? what suture pattern?
- in the lumen
- interrupted or dontinuous patterns
You just finished esophageal surgery on an obstructed horse and the mucosa didnt look good- how should we feed post op?
- parenteral nutrition or
- cervical esophagostomy w/ feeding tube
- (we want to bypass that bad segment)
How can we prevent recurrance of esophageal obstructions?
make horse eat slower- stones in feed bunk, spread out feed over large bunk, hay nets, dont turn out on lush pasture ect
Are esophageal strictures caused by internal or external trauma?
- can be either/or
- just irritation to the wall resulting in scar tissue
What is the difference between human choke and horse choke?
- human choke- cant breathe bc blockage in pharynx
- horse choke- in esophagus so animal can still breathe
How long should i wait to perform surgery to fix an esophageal stricture? why?
- wait about 60 days
- strictures commonly relax and stretch by this time
What are 3 surgical procedures to fix esophageal strictures?
- partial resection
- complete resection
When the stricture is mural (muscular layer involved) what surgical procedure should we use?
What is the general procedure in an esophagomyotomy?
- but NG tube in
- incise muscularis 1cm no either side of stricture
- dont suture muscularis closed
If a stricture involves only mucosa/submucosa what surgical correction do we use?
For what surgical procedures on esophageal strictures do we need drains and a cervical esophagostomy distal to the surgical site?
partial and complete resections
What is the general procedure for a complete esophageal resection?
- circumfrential incision thru all layers
- ring of esophagus removed
- mucosa & submucoas closed
- muscularies closed with horizontal mattress
What is the max amount of esophagus I can remove in a complete resection surgery?
I have a horse with an esophageal fistula secondary to a previous esophageal surgery, do i need to close this surgically right away?
no- wait several months, many will decrease in size or heal totally by then
T or F: clinical signs of an esophageal diverticulum are the same as esophageal obstruction?
true- same clinical signs as chronic choke
What is the surgical correction technique for a pulsion diverticulum?
- mucosal inversion
- (diverticulum is inverted into the lumen and muscle layer sutured closed, so the diverticulum atrophies over time)
What is the general procedure for placing a cervical esophagostomy tube?
- pass NG tube
- midline incision
- dissect down to mucosa, incise
- insert small NG tube here, and purse string in place
- suture to skin
- partially close incision
When is it too early to remove a cervical esophagostomy tube?
when the tissue planes havent closed yet
What would you like to do?
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