Flashcards
Neck surgery
Cards in this deck (49)
- 1Give a list of the most common neck mass differentials.• Neoplasia (skin, subcutaneaous)
• Thyroid and parathyroid diseases*
• Congenital neck cysts
• Lymphadenopathy
• Foreign body-induced abscess or sinus tract*
• Salivary mucoceles*
• Oesophageal foreign body*
• Cervical expanding hematoma
• Postoperative seroma - 2What is seen with oro-pharyngeal stick injuries?- Penetration of the oropharynx/ oesophagus
- May migrate into the soft tissue ( chronic cases) - 3When are oropharyngeal stick injuries common?- Active, large breed dogs, middle aged
- History of playing with sticks - 4What is the more severe injury with stick injuries?Penetration of the oesophagus
- 5What is seen with acute cases of stick injuries?- May have no signs
- Gagging, retching
- Hypersalivation - sometimes blood tinged
- Pain
- Dysphagia - 6What do you need to rule out in all acute cases of stick injuries?Penetration of the oesophagus
- 7What is seen with chronic cases of stick injury?- Dysphagia
- Draining tract
- Swelling (firm) - 8How do you diagnose oro-pharyngeal stick injury?- Oral examination under GA
- Oesophagoscopy
- Radiography/ US -> definitely do lateral radiographs
- CT or MRI - 9What is the treatment for oropharyngeal stick injury?- IV fluids antibiotics and pain medications (acute)
- Surgical exploration of the neck if chronic or acute with signs of cervical emphysema
- If acute without signs of emphysema: intraoral approach: flush, clean, debride, close if necessary
- IF indicated culture and submit samples for histopathology - 10What is the aftercare for oropharyngeal stick injuries?- Pain relief, antiacids, and antibiotics
- May need feeding tube - 11What is the prognosis of oropharyngeal stick injury?- Acute cases: good but if large contamination and oesophageal penetration: guarded prognosis
- Chronic cases: good if FB can be found, best to explore when active (ie discharging) form - 12What is the anatomy of the salivary system in dogs?- 4 pairs
- Parotid = largest
- Mandibular and sublingual most commonly affected (mucocele)
- Salivation maintained with only one pair - 13What are salivary mucoceles?Collection of saliva that has leaked from a damaged salivary gland or salivary duct, and has accumulated in the tissues
- 14Give 3 salivary mucoceles.- Cervical (most common)
- Sublingual (or Ranula)
- Pharyngeal (=cervical except that collection is in the pharynx) - 15How do you treat cervical, pharyngeal and ranula mucoceles?Resect the sublingual and mandibular salivary glands (as most commonly the problem)
- 16What can you do for ranula if surgery isn't a feasible option?Marsupialisation of a ranula.
- Make hole in ranula and then suture the edges to the tongue to allow a hole to persist for drainage.
- This will heal quickly so recurrence is likely - 17What do you do in the excision of salivary gland?- Fluid pocket = inflammatory tissue -> needs to be drained, excised or both
- 18Give a list of common oesophageal foreign bodies.- Bones
- Rawhide chews
- Needles (cats)
- Fish hooks
- String
- Toys
- Hairballs (cats) - 19What can be used to remove object and assess mucosal damage?Oesophagoscopy
- 20How is oesophagoscopy done?- Extract orally if this can be done with minimal trauma
- Advance the object into the stomach:
i. Bones and rawhide usually dissolve once in the stomach
ii. Remove other objects via gastrotomy (easier than operating on oesophagus) - 21What are the complications with oesophagoscopy?Perforation and mediastinitis, oesophageal stricture
- 22What can be done if non invasive treatment fails?- Consider surgery but try avoid oesophageal surgery if at all possible
- 23What is the approach for surgery on the oesophagous?- Midline
- Easy muscle separation - less traumatic
- Avoid damage to important vascular and nervous structures (carotid-sympathetic trunk) - 24Give other indications for surgery in the neck.Thyroidectomy/ parathyroidectomy, Migrating foreign body (chronic injury), lymph node excision
- 25What are the challenges with oesophageal surgery?- Friable
- Poor blood supply
- Lack serosal layer
- Can not be exteriorized
- Difficult to resect (tension +++; need to use alternative techniques)
- High risk of complications (leakage, stricture) - 26What is essential for oesophageal sutures?- Good apposition (lack serosal layer and blood supply)
- 27From outside in, what are the layers of the oesophagus?- Adventicia
- Muscular layer:
i. Longitudinal layer
ii. Circular layer
- Submucosa
- Mucosa - 28What are features of oesophageal sutures?Simple interrupted/ continuous/ horizontal mattress
- Monofilament resorbable
- Round body needle
- Preferably in 2 layers - 29What are the 2 layers when suturing the oesophagus?1st: mucosa and submucosa
2nd: adventitia and muscularis layer - 30What is the anatomy of the thyroid glands?- Paired glands (small connection between the 2)
- Vascularisation
- Loosely attached to trachea
- Close to recurrent laryngeal nerve - 31What is the anatomy of parathyroid glands?- 2 pairs
- Intra and extra portions - 32What are features of thyroid neoplasia?- Dogs: non functional adenocarcinoma (ADK)
- Rare in cats
- Large cervical mass +/- adherent
- Bilateral: 30 to 40% - 33What feature makes thyroid neoplasia amenable for surgery?- Movement of thyroid neoplasia = surgery
- Fixed = not amenable for surgery - 34How do you diagnose thyroid neoplasia?- Mass palpable in the neck area
- Not always in an "anatomical position"
- Mobile = better prognosis that fixed
- Biopsy = NOT RECOMMENDED
- FNA = okay
- Metastasis (lungs, LN)- chest radiographs - 35What is the treatment for thyroid neoplasia?- Resection if mobile
- If bilateral, stages procedure or PTH reimplantation
- If not mobile: radiation therapy - 36What is the prognosis with thyroid neoplasia?- 1-3 year survival if removed surgery but recurrence or metastasis therefore adjunctive chemotherapy is necessary
- 37What are the main differential diagnoses for thyroid neoplasia?- Salivary mucocele
- Abscess
- Granuloma secondary to wounds or foreign bodies (eg ingestion of a stick)
- Cervical lymph node metastasis from another cancer (eg tonsillar squamous cell carcinoma) - 38What are features of hyperthyroidism?- Hypersecretion of thyroid hormones
- Affects older cats (>8yo)
- Cardiovascular and renal effects
- Ectopic tissue possible - 39How do you diagnose hyperthyroidism?- Clinical examination (thyroid)
- Blood work (TSH, T4)
- Imaging (US, scintigraphy) - 40What is the treatment for hyperthyroidism?- Oral anti-thyroid drugs (carbimazole, metimazole)
- Radioiodine (if bilateral)
- Surgery:
i. intra and extra capsular
ii. modified intra and extra-capsular - 41What are the 4 techniques for thyroidectomy?1. Extracapsular: entire unit removed (calcium problems)
2. Intracapular: Blood supply and capsule preserved ( recurrence issues)
3. Modified intracapsular: capsule partially removed, parathyroid left
4. Modified extracapsular: parathyroid left with blood supply, rest removed - 42What is the chosen technique for thyroidectomy?Modified extracapsular
- 43What are the potential complications for thyroidectomy?Not related to surgical technique:
- Due to GA
- Unmask chronic renal failure
- Hypothyroidism
Related to surgical technique:
- Haemorrhage
- Seroma formation
- Laryngeal paralysis
- Hypocalcaemia (extracapsular)
- Recuurence (Intracapsular - 44What is the success rate in modified extracapsular?95% control and less than 10% hypocalcaemia
- 45Give 2 ways of minimising hypocalcaemia.1. Parathyroid reimplantation
2. Staged procedures - 46What is seen with primary hyperparathyroidism?- Breed predisposition (Keeshound)
- Hypercalcemia (i and t)
- Clinical signs: PU/PD, lethargy, weakness, can be subclinical - 47How do you diagnose primary hyperparathyroidism?- Blood work (Ca, PTH and PTHrp), imaging
- Histology: adenoma, follicular hyperplasia - 48How do you treat primary hyperparathyroidism?- Parathyroidectomy (usually 1 or 2)
- Alternative: ethanol injection, heat ablation - 49What has to be monitored for in postop care for primary hyperparathyroidism?- Hypocalcemia
Information
- Description
- 4. Surgery (SA neck & oropharyngeal surgery - Guillaume Chanoit) Flashcards on Neck surgery, created by Rachael Jones on 09/10/2018.
- Created by
- Rachael Jones
- Views
- 0
- Rating