BOOK
Oral and Maxillofacial Surgery in Dogs and Cats - E-Book
Frank J M Verstraete | Milinda J Lommer
(2012)
Additional Information
Book Details
Abstract
Oral and Maxillofacial Surgery in Dogs and Cats offers a unique, detailed, comprehensive and highly illustrated account of surgical procedures that will improve outcomes for all surgical and dental specialists. In drawing together the expertise of specialists worldwide, it will also prove indispensable for general practitioners with a dental and oral caseload. Basic principles are considered prior to in-depth treatment of surgical conditions. The book combines expertise from both human and veterinary oral surgeons to provide an authoritative reference with a strongly practical slant. It is likely to become the standard work in the field for many years.
- Authoritative: over 30 international contributors who between them represent the peak of professional expertise in the field.
- Unique: the only book available devoted to a surgical specialty of growing relevance.
- Practical: profuse illustrations of the highest quality combine with step-by-step textual guidance to give clearest possible practical instruction.
- Detailed: presents in-depth descriptions of surgical conditions and detailed surgical explanations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Oral and Maxillofacial Surgery in Dogs and Cats | i | ||
| Copyright page | iv | ||
| Table of contents | v | ||
| Foreword | ix | ||
| Preface | xi | ||
| Acknowledgments | xiii | ||
| Contributors | xv | ||
| Chapter 1 Oral soft tissue wound healing | 1 | ||
| Definitions | 1 | ||
| General considerations | 1 | ||
| Wound healing phases | 1 | ||
| Inflammatory phase | 1 | ||
| Proliferation phase | 2 | ||
| Maturation/remodeling phase | 2 | ||
| Healing of extraction wounds | 2 | ||
| Factors affecting healing | 3 | ||
| Infection | 3 | ||
| Tissue perfusion and oxygenation | 3 | ||
| Age | 3 | ||
| Diabetes mellitus | 3 | ||
| Malnutrition | 3 | ||
| Current trends in wound care | 4 | ||
| Growth factors | 4 | ||
| Hyperbaric oxygen therapy | 4 | ||
| Skin substitutes | 4 | ||
| References | 4 | ||
| Chapter 2 Maxillofacial bone healing | 7 | ||
| Structure of facial bone | 7 | ||
| Osteoblast | 7 | ||
| Osteocyte | 7 | ||
| Osteoclast | 7 | ||
| Osteon (Haversian canal) | 7 | ||
| Fracture healing | 7 | ||
| Indirect bone healing | 8 | ||
| Direct bone healing | 10 | ||
| Contact healing | 10 | ||
| Gap healing | 11 | ||
| Craniomaxillofacial bone healing | 11 | ||
| References | 13 | ||
| Chapter 3 Use of antibiotics and antiseptics | 15 | ||
| Definitions | 15 | ||
| Antibiotic prophylaxis | 15 | ||
| Infective endocarditis | 15 | ||
| Prophylactic antibiotic treatment for patients with orthopedic implants | 16 | ||
| Prophylactic antibiotic treatment for patients with other conditions | 16 | ||
| Antibiotics in oral surgery | 16 | ||
| Extractions | 16 | ||
| Maxillary and mandibular fractures | 17 | ||
| Maxillectomy and mandibulectomy | 17 | ||
| Luxated or avulsed teeth | 17 | ||
| Antibiotic use in periodontal surgery | 17 | ||
| Locally delivered antibiotics | 17 | ||
| Side effects of antimicrobial treatment | 18 | ||
| Bacterial resistance to antimicrobials | 18 | ||
| Oral antiseptics | 18 | ||
| Chlorhexidine | 18 | ||
| Zinc ascorbate | 19 | ||
| Povidone-iodine | 19 | ||
| References | 19 | ||
| Chapter 4 Anesthesia and pain management | 23 | ||
| Definitions | 23 | ||
| Principles of pain management | 23 | ||
| Assessment of pain | 23 | ||
| Management of pain | 24 | ||
| Reducing the input | 24 | ||
| Reducing the result of the input | 24 | ||
| Minimizing facilitation | 24 | ||
| Blocking perception | 24 | ||
| Preoperative concerns | 24 | ||
| Induction and maintenance of anesthesia | 25 | ||
| General anesthetics | 25 | ||
| Venous access and intubation | 25 | ||
| Maintenance of anesthesia | 25 | ||
| Monitoring the patient | 26 | ||
| Monitoring cardiovascular function | 26 | ||
| Central venous pressure | 27 | ||
| Monitoring respiratory function | 27 | ||
| Temperature and renal function | 28 | ||
| Local anesthetics | 28 | ||
| Pharmacology | 28 | ||
| Technique | 29 | ||
| Neuroanatomy | 30 | ||
| Technique for performing regional intraoral nerve blocks | 31 | ||
| Middle mental nerve | 31 | ||
| Inferior alveolar nerve | 32 | ||
| Infraorbital nerve | 33 | ||
| Maxillary nerve | 33 | ||
| Major palatine foramen approach to the maxillary nerve | 33 | ||
| Local infiltration | 34 | ||
| Postoperative care | 34 | ||
| Use of opioids for the maintenance of analgesia | 36 | ||
| Oral administration | 36 | ||
| Transdermal administration | 36 | ||
| Local administration | 37 | ||
| Nonsteroidal antiinflammatory drugs (NSAIDs) | 37 | ||
| Carprofen | 38 | ||
| Ketorolac | 38 | ||
| Ketoprofen | 38 | ||
| Etodolac | 38 | ||
| Meloxicam | 38 | ||
| Deracoxib | 38 | ||
| Firocoxib | 38 | ||
| Tepoxalin | 38 | ||
| Balanced analgesia | 38 | ||
| References | 39 | ||
| Chapter 5 Enteral nutritional support | 43 | ||
| Therapeutic decision-making | 43 | ||
| Rationale for enteral nutritional support | 43 | ||
| Patient selection for nutritional support | 43 | ||
| Enteral feeding access devices | 43 | ||
| Nasoesophageal tubes | 44 | ||
| Pharyngostomy tubes | 45 | ||
| Esophagostomy tubes | 45 | ||
| Technique using curved Rochester–Carmalt, Mixter, or Schnidt forceps | 45 | ||
| Percutaneous feeding tube applicator technique | 46 | ||
| Percutaneous needle catheter technique | 46 | ||
| Complications | 46 | ||
| Gastrostomy tubes | 46 | ||
| Percutaneous endoscopic gastrostomy (PEG) technique | 47 | ||
| Blind percutaneous gastrostomy (BPG) technique | 47 | ||
| Surgical tube gastrostomy technique | 49 | ||
| Enterostomy tubes | 49 | ||
| Postoperative care and assessment | 49 | ||
| Nutrition | 49 | ||
| Calculation of nutritional requirements | 49 | ||
| Diet selection | 50 | ||
| Removal and replacement | 50 | ||
| Esophagostomy tube removal | 50 | ||
| Gastrostomy tube removal | 50 | ||
| Gastrostomy and esophagostomy tube replacement | 51 | ||
| Complications | 51 | ||
| Gastric pressure necrosis | 51 | ||
| Feeding tube displacement | 52 | ||
| Tube obstruction | 52 | ||
| Leakage through ostomy sites | 52 | ||
| Aspiration | 52 | ||
| Diarrhea | 53 | ||
| References | 53 | ||
| Chapter 6 Instrumentation, patient positioning and aseptic technique | 55 | ||
| Definitions1–3 | 55 | ||
| Instrumentation | 55 | ||
| Basic oral surgery instruments | 55 | ||
| Scalpel handles and blades | 55 | ||
| Scissors | 55 | ||
| Tissue forceps | 56 | ||
| Periosteal elevators | 56 | ||
| Retractors | 57 | ||
| Needle holders | 58 | ||
| Ancillary instruments | 59 | ||
| Suction tips | 59 | ||
| Surgical curette | 60 | ||
| Surgical marker pen | 60 | ||
| Instrument organization | 60 | ||
| Power equipment | 60 | ||
| Rotary instruments | 60 | ||
| Electrosurgery and radiosurgery | 61 | ||
| Piezosurgery | 61 | ||
| Surgical loupe and headlamp | 61 | ||
| Aseptic technique | 61 | ||
| Aseptic technique in dentistry | 61 | ||
| Surgical infection | 62 | ||
| Achieving asepsis | 62 | ||
| Sanitization | 62 | ||
| Disinfection | 62 | ||
| Sterilization | 62 | ||
| Use of sterilizers | 63 | ||
| Sterilizers | 63 | ||
| Instrument preparation and packs | 63 | ||
| Monitoring sterility | 63 | ||
| Storage | 63 | ||
| Routine maintenance of the surgical area | 64 | ||
| Cleaning procedures | 64 | ||
| Waterlines | 64 | ||
| Preparation of the surgical team | 64 | ||
| Preparation of the patient | 64 | ||
| Patient positioning | 65 | ||
| Lateral recumbency | 65 | ||
| Dorsal recumbency | 65 | ||
| Sternal recumbency | 65 | ||
| Preparation of the maxillofacial skin and oral cavity | 65 | ||
| Pharyngeal pack and speculum | 65 | ||
| Preparation of the oral cavity | 65 | ||
| Maxillofacial skin preparation | 66 | ||
| Draping of the patient | 66 | ||
| References | 67 | ||
| Chapter 7 Suture materials and biomaterials | 69 | ||
| General principles | 69 | ||
| Suture characteristics | 69 | ||
| Physical properties | 69 | ||
| Handling characteristics | 69 | ||
| Capillarity | 69 | ||
| Tensile strength, knot-pull tensile strength and knot security | 70 | ||
| Biologic properties | 70 | ||
| Biofilm | 70 | ||
| Tissue reactivity | 70 | ||
| Influence of wound infection | 70 | ||
| Influence of pH | 70 | ||
| Suture materials | 70 | ||
| Catgut | 70 | ||
| Synthetic absorbable suture materials | 72 | ||
| Polyglycolic acid | 72 | ||
| Polyglactin 910 | 72 | ||
| Polydioxanone | 72 | ||
| Polytrimethylene carbonate | 72 | ||
| Poliglecaprone 25 | 72 | ||
| Synthetic monofilament nonabsorbable suture materials | 73 | ||
| Polyamide | 73 | ||
| Polybutester | 73 | ||
| Polypropylene | 73 | ||
| Hexafluoropropylene-VDF | 73 | ||
| Synthetic multifilament nonabsorbable suture materials | 73 | ||
| Polyester | 73 | ||
| Stainless steel | 73 | ||
| Silk | 73 | ||
| Suture size | 73 | ||
| Suture needles | 74 | ||
| Suture recommendations for specific tissues | 74 | ||
| Intraoral tissue | 74 | ||
| Skin and subcutaneous tissue | 75 | ||
| Surgical adhesive tape | 75 | ||
| Surgical staples | 75 | ||
| Tissue adhesives | 75 | ||
| Cyanoacrylates | 75 | ||
| Fibrin tissue adhesive | 75 | ||
| Biomaterials for hemostasis | 75 | ||
| Bone wax | 75 | ||
| Absorbable gelatin sponge | 75 | ||
| Oxidized cellulose | 76 | ||
| Oxidized regenerated cellulose | 76 | ||
| Microfibrillar collagen | 76 | ||
| Thrombin-based hemostatic agents | 76 | ||
| Microporous polysaccharide hemospheres | 76 | ||
| References | 76 | ||
| Chapter 8 Laser surgery | 79 | ||
| Definitions | 79 | ||
| System selection and applica8tion | 80 | ||
| Laser–tissue interaction | 80 | ||
| Mechanisms of action | 80 | ||
| Wavelength selection | 80 | ||
| Beam intensity | 81 | ||
| Time domains of energy delivery | 82 | ||
| Tissue handling | 82 | ||
| Beam delivery | 83 | ||
| Optical fibers | 83 | ||
| Articulated arm | 83 | ||
| Waveguide | 83 | ||
| Surgical considerations | 84 | ||
| Surgical approach | 84 | ||
| Wound healing | 84 | ||
| Anesthetic considerations | 84 | ||
| Oral and maxillofacial surgical applications | 84 | ||
| Correction of overlong soft palate | 84 | ||
| Tonsillectomy | 85 | ||
| Gingivectomy/gingivoplasty | 85 | ||
| Excision of oral mass lesions | 85 | ||
| Feline chronic stomatitis | 85 | ||
| References | 87 | ||
| Chapter 9 Microvascular techniques in maxillofacial surgery | 89 | ||
| Introduction | 89 | ||
| Preoperative considerations | 89 | ||
| Patient selection | 89 | ||
| Diagnostic imaging | 89 | ||
| Recipient vessels | 89 | ||
| Patient positioning | 90 | ||
| Donor tissue | 90 | ||
| Anesthetic considerations | 90 | ||
| Instrumentation and equipment | 90 | ||
| Surgical techniques | 90 | ||
| Transversus abdominis myoperitoneal free flap | 90 | ||
| Trapezius osteomusculocutanoues free flap | 91 | ||
| Medial saphenous fasciocutaneous free flap | 91 | ||
| Free vascularized medial tibial bone graft | 92 | ||
| Postoperative assessment and complications | 92 | ||
| References | 92 | ||
| Chapter 10 Use of the dog and cat in experimental maxillofacial surgery | 93 | ||
| Dogs | 93 | ||
| Bone turnover | 93 | ||
| Facial growth | 94 | ||
| Periodontal disease | 94 | ||
| Implants | 94 | ||
| Distraction | 94 | ||
| Cats | 94 | ||
| Nerve studies | 94 | ||
| References | 94 | ||
| Chapter 11 Principles of exodontics | 97 | ||
| Definitions | 97 | ||
| Indications for extraction | 97 | ||
| Periodontitis | 97 | ||
| Pulp necrosis | 97 | ||
| Dental fractures | 97 | ||
| Tooth resorption | 98 | ||
| Chronic gingivostomatitis | 98 | ||
| Fractured deciduous teeth | 99 | ||
| Persistent deciduous teeth | 99 | ||
| Malocclusion | 99 | ||
| Supernumerary teeth | 99 | ||
| Unerupted teeth | 99 | ||
| Teeth associated with pathologic lesions | 100 | ||
| Teeth involved in jaw fractures | 100 | ||
| Failed endodontic treatment | 100 | ||
| Contraindications for extraction | 100 | ||
| General contraindications | 100 | ||
| Systemic contraindications | 100 | ||
| Local contraindications | 100 | ||
| Clinical evaluation of teeth for extraction | 100 | ||
| Mobility | 100 | ||
| Condition of crown | 100 | ||
| Radiographic evaluation of teeth for extraction | 101 | ||
| Configuration of the roots | 101 | ||
| Proximity to adjacent teeth and other important structures | 101 | ||
| Condition of the surrounding bone | 102 | ||
| Patient and surgeon preparation | 102 | ||
| Instruments and materials | 103 | ||
| Instruments for creating mucogingival flaps | 103 | ||
| Tissue retractors | 103 | ||
| Instruments for sectioning teeth and removing alveolar bone | 103 | ||
| Dental elevators | 103 | ||
| Luxators | 104 | ||
| Root tip picks | 104 | ||
| Extraction forceps | 105 | ||
| Instruments for suturing flaps | 105 | ||
| Treatment planning | 106 | ||
| Simple versus surgical extraction | 106 | ||
| Principles of flap design, development and management | 106 | ||
| Design parameters for soft tissue flaps | 106 | ||
| Sulcular Incision versus excision of the free gingiva and sulcus epithelium | 106 | ||
| Types of gingival and mucogingival flaps | 107 | ||
| Technique for developing a mucogingival flap | 107 | ||
| Bone removal (alveolotomy or partial alveolectomy) | 107 | ||
| Alveoloplasty | 107 | ||
| Management of the alveolus | 108 | ||
| Principles of suturing | 108 | ||
| Mechanical principles involved in tooth extraction | 109 | ||
| Principles and techniques for tooth extraction | 110 | ||
| Removal of root fragments | 110 | ||
| Intentional root retention | 111 | ||
| Postoperative care and assessment | 111 | ||
| Pain management | 111 | ||
| Nutritional support | 112 | ||
| Oral hygiene | 112 | ||
| Postoperative assessment | 112 | ||
| References | 112 | ||
| Chapter 12 Simple extraction of single-rooted teeth | 115 | ||
| Preoperative concerns | 115 | ||
| General health status | 115 | ||
| Periodontal status | 115 | ||
| Surgical anatomy | 115 | ||
| Permanent teeth | 115 | ||
| Incisor teeth | 115 | ||
| First premolar teeth in the dog | 116 | ||
| Maxillary second premolar teeth in the cat | 116 | ||
| Maxillary first molar teeth in the cat | 116 | ||
| Mandibular third molar teeth in the dog | 116 | ||
| Deciduous teeth | 117 | ||
| Therapeutic decision-making | 117 | ||
| Simple versus surgical extraction | 117 | ||
| Suturing | 117 | ||
| Simple extraction technique | 117 | ||
| Elevation technique | 117 | ||
| Luxation technique | 118 | ||
| Use of forceps | 119 | ||
| Specific teeth | 119 | ||
| Incisor teeth of the cat and mandibular incisor teeth of the dog | 119 | ||
| Maxillary first and second incisor teeth of the dog | 119 | ||
| Maxillary third incisor teeth of the dog | 119 | ||
| Maxillary first premolar and mandibular third molar teeth of the dog and maxillary second premolar teeth of the cat | 119 | ||
| Maxillary first molar teeth of the cat | 120 | ||
| Deciduous teeth | 120 | ||
| Postextraction care of the alveolus | 120 | ||
| Postoperative care and assessment | 120 | ||
| Use of oral rinses | 120 | ||
| Dietary change | 120 | ||
| Recheck examination | 120 | ||
| Anticipating delayed wound healing | 120 | ||
| References | 120 | ||
| Chapter 13 Extraction of canine teeth in dogs | 121 | ||
| Indications for extraction | 121 | ||
| Surgical anatomy | 121 | ||
| Maxillary canine tooth | 121 | ||
| Mandibular canine tooth | 122 | ||
| Deciduous canine teeth | 123 | ||
| Therapeutic decision-making | 123 | ||
| Simple or surgical extraction technique | 123 | ||
| Selection of flap design | 123 | ||
| Maxillary canine tooth | 123 | ||
| Mandibular canine tooth – buccal approach | 124 | ||
| Mandibular canine tooth – lingual approach | 125 | ||
| Deciduous canine teeth – special considerations | 125 | ||
| Complications | 126 | ||
| Intraoperative complications | 126 | ||
| Postoperative complications | 127 | ||
| Oronasal fistula | 127 | ||
| Flap dehiscence | 127 | ||
| Maxillary lip entrapment | 127 | ||
| Weakening of the mandible | 128 | ||
| Glossoptosis | 128 | ||
| Prognosis | 128 | ||
| References | 128 | ||
| Chapter 14 Extraction of multirooted teeth in dogs | 131 | ||
| Indications for extraction | 131 | ||
| Preoperative concerns | 131 | ||
| General health status | 131 | ||
| Surgical anatomy (Fig. 14.2) | 131 | ||
| Maxillary premolar and molar teeth | 131 | ||
| Mandibular premolar and molar teeth | 132 | ||
| Adjacent structures | 132 | ||
| Therapeutic decision-making | 132 | ||
| Surgical or simple (nonsurgical) extraction | 132 | ||
| Flap design | 132 | ||
| Surgical technique | 132 | ||
| Extraction of maxillary second and third premolar, and mandibular second, third and fourth premolar teeth | 132 | ||
| Extraction of maxillary fourth premolar teeth | 134 | ||
| Extraction of maxillary first molar teeth | 138 | ||
| Extraction of maxillary second molar teeth | 138 | ||
| Extraction of mandibular first molar teeth | 138 | ||
| Complications | 139 | ||
| References | 139 | ||
| Chapter 15 Special considerations in feline exodontics | 141 | ||
| Indications for extraction | 141 | ||
| Preoperative concerns | 141 | ||
| General health status | 141 | ||
| Viral status | 141 | ||
| Surgical anatomy | 141 | ||
| Special instruments and materials | 142 | ||
| Instruments suitable for feline exodontics | 142 | ||
| Therapeutic decision-making | 142 | ||
| Extraction versus coronectomy (crown amputation with intentional root retention) for tooth resorption | 143 | ||
| Simple versus surgical extraction | 143 | ||
| Flap design | 143 | ||
| Full-mouth and premolar–molar extractions | 143 | ||
| Surgical technique | 145 | ||
| Extraction of incisor teeth | 145 | ||
| Extraction of maxillary canine teeth | 145 | ||
| Extraction of mandibular canine teeth | 147 | ||
| Extraction of premolar and molar teeth | 147 | ||
| Premolar–molar and full-mouth extractions | 147 | ||
| Coronectomy (crown amputation with intentional root retention) | 149 | ||
| Postoperative care and assessment | 151 | ||
| Pain management | 151 | ||
| Nutritional support | 151 | ||
| Postoperative assessment | 151 | ||
| Complications | 151 | ||
| References | 151 | ||
| Chapter 16 Complications of extractions | 153 | ||
| Definitions | 153 | ||
| Prevention of complications | 153 | ||
| Perioperative complications | 153 | ||
| Hemorrhage | 153 | ||
| Root fracture | 153 | ||
| Displacement of a root or root tip into the mandibular canal, nasal cavity or maxillary recess | 154 | ||
| Soft tissue injuries | 154 | ||
| Fracture of the alveolar process | 155 | ||
| Fracture of an instrument in the tissues | 155 | ||
| Fracture of the crown of an adjacent tooth | 155 | ||
| Mandibular fracture | 155 | ||
| Nerve damage | 156 | ||
| Air embolism | 156 | ||
| Postoperative complications | 156 | ||
| Swelling | 156 | ||
| Pain | 156 | ||
| Infection | 157 | ||
| Delayed healing or wound dehiscence | 157 | ||
| Occlusal trauma | 158 | ||
| Oronasal communication and fistula | 158 | ||
| Alveolar margin recession | 158 | ||
| Summary | 158 | ||
| References | 158 | ||
| Chapter 17 Principles of periodontal surgery | 161 | ||
| Definitions | 161 | ||
| Preoperative concerns | 161 | ||
| Client | 162 | ||
| Patient – health status | 162 | ||
| Environment | 162 | ||
| To treat or extract? | 162 | ||
| Therapeutic-decision making | 163 | ||
| Objectives of periodontal surgery | 163 | ||
| Selection of surgical technique | 163 | ||
| Chapter 18 Gingivectomy and gingivoplasty | 167 | ||
| Definitions | 167 | ||
| Preoperative concerns | 167 | ||
| Surgical anatomy | 167 | ||
| Instrumentation and equipment | 168 | ||
| Cold steel | 168 | ||
| Diamond or fluted carbide bur | 169 | ||
| Electrosurgery and radiosurgery | 169 | ||
| Lasers | 170 | ||
| Therapeutic decision-making | 171 | ||
| Surgical techniques | 171 | ||
| Postoperative care and assessment | 172 | ||
| Complications | 173 | ||
| Prognosis | 174 | ||
| References | 174 | ||
| Chapter 19 Periodontal flaps and mucogingival surgery | 175 | ||
| Definitions | 175 | ||
| Preoperative considerations | 175 | ||
| Periodontal flap | 175 | ||
| Mucogingival surgery | 175 | ||
| Surgical anatomy | 176 | ||
| Periodontal flap and mucogingival surgery | 176 | ||
| Landmarks | 176 | ||
| Differences between dogs and cats | 176 | ||
| Special instruments | 176 | ||
| Therapeutic decision-making | 176 | ||
| Periodontal flaps | 176 | ||
| Mucogingival surgery | 177 | ||
| Surgical techniques | 177 | ||
| Periodontal flap surgery | 177 | ||
| Apically positioned flap | 177 | ||
| Initial incision and releasing incisions | 177 | ||
| Chapter 20 Osteoconductive and osteoinductive agents in periodontal surgery | 185 | ||
| Definitions | 185 | ||
| Introduction | 185 | ||
| Guided tissue regeneration | 185 | ||
| Patient and client selection | 186 | ||
| Patient preparation | 186 | ||
| Site selection | 186 | ||
| Flap creation | 187 | ||
| Pocket preparation | 187 | ||
| Barrier selection | 187 | ||
| Graft materials | 188 | ||
| Membrane barriers | 188 | ||
| Synthetic absorbable membranes | 189 | ||
| Naturally-derived absorbable membranes | 189 | ||
| Proposed guided tissue regeneration technique using allograft and absorbable membrane (fig. 20.3) | 189 | ||
| Bioactive agents | 190 | ||
| Postoperative considerations | 190 | ||
| References | 190 | ||
| Chapter 21 Crown-lengthening | 193 | ||
| Definitions | 193 | ||
| Preoperative considerations | 193 | ||
| Indications | 193 | ||
| Surgical anatomy | 194 | ||
| Periodontium | 194 | ||
| Topographical anatomy | 194 | ||
| Special instruments and materials | 194 | ||
| Therapeutic decision-making | 194 | ||
| Staging | 194 | ||
| Prosthetic crown retention | 195 | ||
| Surgical techniques | 195 | ||
| Maxillary canine tooth5 | 195 | ||
| Mandibular canine tooth5 | 195 | ||
| Maxillary fourth premolar tooth | 198 | ||
| Postoperative care and assessment | 198 | ||
| Complications | 198 | ||
| References | 199 | ||
| Chapter 22 Management of periodontal trauma | 201 | ||
| Classification and definitions | 201 | ||
| Concussion | 201 | ||
| Subluxation | 201 | ||
| Luxation | 201 | ||
| Lateral luxation | 201 | ||
| Intrusive luxation | 201 | ||
| Extrusive luxation | 202 | ||
| Avulsion (exarticulation) | 203 | ||
| Replantation | 203 | ||
| Incidence of periodontal traumatic injuries | 203 | ||
| Preoperative concerns | 204 | ||
| Special instruments and materials | 204 | ||
| Diagnosis, treatment guidelines and techniques | 204 | ||
| Diagnosis | 204 | ||
| Treatment guidelines (Fig. 22.4) | 204 | ||
| Storage media for avulsed teeth | 206 | ||
| Prereplantation treatment of the tooth and alveolus | 207 | ||
| Splinting | 207 | ||
| Systemic antibiotic treatment | 210 | ||
| Endodontic treatment | 210 | ||
| Complications following trauma and replantation | 210 | ||
| Pulpal healing complications | 210 | ||
| Coronal discoloration | 210 | ||
| Pulp necrosis | 210 | ||
| Root canal obliteration | 211 | ||
| Root resorption | 212 | ||
| Surface resorption | 212 | ||
| Inflammatory resorption | 212 | ||
| Dentoalveolar ankylosis and replacement resorption | 212 | ||
| Loss of marginal bone | 213 | ||
| Prognosis | 213 | ||
| References | 213 | ||
| Chapter 23 Principles of endodontic surgery | 217 | ||
| Definitions1–3 | 217 | ||
| Introduction | 217 | ||
| Therapeutic decision-making | 217 | ||
| Surgical endodontics versus other treatment options | 217 | ||
| Surgical endodontics versus re-treatment | 217 | ||
| Root amputation/hemisection versus surgical endodontics | 218 | ||
| Indications | 218 | ||
| Anatomical problems preventing standard normograde root canal treatment | 218 | ||
| Transverse fracture of the apical third of the root with pulp necrosis | 218 | ||
| Advanced apical root resorption | 218 | ||
| Endodontic instrument separation and procedural errors | 218 | ||
| Large unresolved periapical lesion or pain following root canal treatment | 218 | ||
| Contraindications for surgical root canal therapy | 219 | ||
| Unidentifiable cause of root canal treatment failure | 219 | ||
| Re-treatment is possible | 219 | ||
| Medical concerns | 219 | ||
| Anatomical limitations | 219 | ||
| Other dental considerations | 219 | ||
| References | 219 | ||
| Chapter 24 Apicoectomy techniques | 221 | ||
| Definitions1–4 | 221 | ||
| Preoperative concerns | 221 | ||
| Standard root canal therapy first | 221 | ||
| Surgical anatomy | 221 | ||
| Dog | 221 | ||
| Maxillary canine tooth in the dog | 221 | ||
| Mandibular canine tooth in the dog | 222 | ||
| Maxillary fourth premolar tooth in the dog | 222 | ||
| Mandibular first molar tooth in the dog | 222 | ||
| Cat | 224 | ||
| Maxillary canine tooth in the cat | 224 | ||
| Mandibular canine tooth in the cat | 224 | ||
| Special instruments and materials | 224 | ||
| Surgical technique – apicoectomy and retrograde filling | 224 | ||
| Flap design | 224 | ||
| Triangular (three-cornered) flap | 224 | ||
| Pedicle (four-cornered) flap | 227 | ||
| Semilunar flap | 227 | ||
| Approach and exposure | 227 | ||
| Maxillary canine tooth in the dog | 227 | ||
| Mandibular canine tooth in the dog | 227 | ||
| Maxillary fourth premolar tooth in the dog | 227 | ||
| Mandibular first molar tooth in the dog | 228 | ||
| Bone removal and debridement | 228 | ||
| Apicoectomy | 228 | ||
| Retrograde preparation, filling and restoration | 229 | ||
| Choice of materials for retrofilling | 229 | ||
| Wound closure | 230 | ||
| Surgical technique – amputation of the palatal root of the maxillary fourth premolar TOOTH | 230 | ||
| Postoperative care and assessment | 230 | ||
| Complications | 230 | ||
| Complications related to the surgical approach | 230 | ||
| Damage to adjacent anatomical structures | 231 | ||
| Incomplete apicoectomy | 231 | ||
| Failure of the retrograde filling | 231 | ||
| Prognosis | 231 | ||
| References | 231 | ||
| Chapter 25 Principles of maxillofacial trauma repair | 233 | ||
| Anatomy1,2 | 233 | ||
| General considerations | 233 | ||
| Initial management | 233 | ||
| Assessment of teeth | 235 | ||
| Anesthetic and surgical positioning | 237 | ||
| Surgical goals | 237 | ||
| Biomechanics | 239 | ||
| Mandible | 239 | ||
| Maxilla | 239 | ||
| Surgical approaches | 240 | ||
| Treatment planning | 240 | ||
| Mandibular fractures | 241 | ||
| Maxillary fractures | 241 | ||
| Summary | 241 | ||
| References | 241 | ||
| Chapter 26 Facial soft tissue injuries | 243 | ||
| Definitions1 | 243 | ||
| Preoperative concerns | 243 | ||
| Perioperative wound management | 243 | ||
| Surgical anatomy | 243 | ||
| Surgical techniques | 243 | ||
| Lip lacerations and defects | 244 | ||
| Minor lip lacerations | 244 | ||
| Wedge closure | 244 | ||
| Square and rectangular defects | 244 | ||
| Flap closure | 244 | ||
| Rotation flap | 244 | ||
| Chapter 27 Surgical approaches for mandibular and maxillofacial trauma repair | 259 | ||
| Principles and classification | 259 | ||
| Principles | 259 | ||
| Extraoral approaches | 259 | ||
| Intraoral approaches | 259 | ||
| Approach through a traumatic wound | 259 | ||
| Anesthetic considerations4 | 259 | ||
| Surgical anatomy | 260 | ||
| Regional anatomy | 260 | ||
| Surgical approaches | 260 | ||
| Approach to the incisive part and mandibular symphysis | 260 | ||
| Ventral approach to the body of the mandible | 260 | ||
| Ventral approach to the caudal part of the body and to the ramus of the mandible | 261 | ||
| Lateral approach to the zygomatic arch | 262 | ||
| Lateral approach to the temporomandibular joint (TMJ)4 | 262 | ||
| Extraoral approach to the maxillae, nasal bones and frontal sinuses7 | 263 | ||
| Intraoral approach to the maxilla2,3,5 | 263 | ||
| Postoperative care and assessment | 264 | ||
| References | 264 | ||
| Chapter 28 Symphyseal separation and fractures involving the incisive region | 265 | ||
| Classification and incidence | 265 | ||
| Mandible | 265 | ||
| Maxilla and incisive bone | 265 | ||
| Concomitant injuries | 265 | ||
| Diagnosis | 265 | ||
| Clinical findings | 265 | ||
| Diagnostic imaging | 265 | ||
| Anesthetic considerations | 266 | ||
| Surgical anatomy | 266 | ||
| Topographical anatomy | 266 | ||
| Biomechanical considerations | 266 | ||
| Therapeutic decision-making | 267 | ||
| Conservative management versus surgical treatment | 267 | ||
| Surgical techniques | 267 | ||
| Separation of the mandibular symphysis | 267 | ||
| Cerclage wiring | 267 | ||
| Chapter 29 Maxillofacial fracture repair using noninvasive techniques | 275 | ||
| Definitions | 275 | ||
| Preoperative concerns | 275 | ||
| Surgical anatomy | 275 | ||
| Special instruments and materials | 276 | ||
| Therapeutic decision-making and techniques | 276 | ||
| Muzzle coaptation | 276 | ||
| Interdental wiring techniques | 277 | ||
| Ivy loop wiring technique | 277 | ||
| Stout loop wiring technique | 277 | ||
| Risdon wiring technique | 277 | ||
| Essig wiring technique | 278 | ||
| Intraoral splints combined with interdental wiring techniques | 278 | ||
| Application of intraoral acrylic and composite splints | 279 | ||
| Intraoral splints combined with cerclage wires | 280 | ||
| Intraoral splints for treatment of maxillary fractures | 280 | ||
| Intraoral splints for salvage treatment of fractures of edentulous mandibles | 280 | ||
| Maxillomandibular fixation – interdental bonding | 281 | ||
| Postoperative care and assessment | 283 | ||
| Postoperative care | 283 | ||
| Appliance removal | 283 | ||
| Complications | 283 | ||
| References | 283 | ||
| Chapter 30 Maxillofacial fracture repair using intraosseous wires | 285 | ||
| Preoperative concerns | 285 | ||
| Objectives | 285 | ||
| Biomechanical, anatomical and technical considerations | 285 | ||
| Lines of stress | 285 | ||
| Mandible | 286 | ||
| Maxilla | 286 | ||
| Anatomical considerations | 286 | ||
| Bone shape and thickness | 286 | ||
| Avoiding dental trauma | 286 | ||
| Blood supply and bone healing | 286 | ||
| Intraosseous wire fixation | 286 | ||
| Wire placement | 286 | ||
| Wire-tightening | 287 | ||
| Wire patterns | 288 | ||
| Therapeutic decision-making | 288 | ||
| Surgical approaches | 288 | ||
| Sequence of repair | 288 | ||
| Surgical techniques | 289 | ||
| Fractures involving the incisive, nasal and maxillary bones | 289 | ||
| Fractures of the mandible | 289 | ||
| Body of the mandible | 289 | ||
| Ramus of the mandible | 290 | ||
| Postoperative care and assessment | 290 | ||
| Activity restriction and diet | 290 | ||
| Postoperative assessment and wire removal | 290 | ||
| Complications | 291 | ||
| Technical failures | 291 | ||
| Failure of anatomic reduction | 291 | ||
| Incorrect wire location | 291 | ||
| Inadequate wire tightening | 291 | ||
| Inappropriate case selection | 291 | ||
| Wound healing complications | 291 | ||
| Soft tissue coverage dehiscence | 291 | ||
| Infection | 291 | ||
| Delayed/nonunion | 291 | ||
| Teeth | 291 | ||
| References | 291 | ||
| Chapter 31 Maxillofacial fracture repair using miniplates and screws | 293 | ||
| Preoperative concerns | 293 | ||
| Cosmetic appearance versus function | 293 | ||
| Other head trauma | 294 | ||
| Anesthetic considerations | 294 | ||
| Biomechanics | 294 | ||
| Lines of stress | 294 | ||
| Maxilla | 294 | ||
| Mandible | 295 | ||
| Anatomy | 295 | ||
| Bone shape and thickness | 295 | ||
| Avoiding dental trauma | 295 | ||
| Blood supply and bone healing | 296 | ||
| Rigid fixation with plates | 296 | ||
| Three-dimensional fixation | 296 | ||
| Implant purchase | 296 | ||
| Special instruments and materials: miniplate systems | 296 | ||
| Titanium versus stainless steel40–42 | 296 | ||
| Miniplate systems | 296 | ||
| Screw design | 296 | ||
| Plate design | 297 | ||
| Mesh implants | 297 | ||
| Martin system (Walter Lorenz Surgical, Inc., Jacksonville, FL)44 | 297 | ||
| Synthes maxillofacial system (Synthes, Paoli, PA)45,47 | 298 | ||
| Therapeutic decision-making | 299 | ||
| Surgical approaches | 299 | ||
| Sequence of repair | 299 | ||
| Surgical techniques | 300 | ||
| Fractures involving the incisive and maxillary bones | 300 | ||
| Fractures involving the nasal and frontal bones | 300 | ||
| Fractures involving the zygomatic arch | 301 | ||
| Fractures involving the maxillary (medial and lateral) buttresses | 301 | ||
| Fractures of the mandible | 302 | ||
| Body of the mandible | 302 | ||
| Ramus of the mandible | 302 | ||
| Condylar process | 302 | ||
| Postoperative care and assessment | 302 | ||
| Antibiotics | 302 | ||
| Diet and activity restriction | 302 | ||
| Complications | 302 | ||
| Technical failures | 303 | ||
| Incorrect plate/location (mandible) | 303 | ||
| Incorrect plate/location (maxilla) | 304 | ||
| Plate contour | 305 | ||
| Screw insertion | 305 | ||
| Fracture gaps | 305 | ||
| Malocclusion | 305 | ||
| Soft tissue coverage/dehiscence | 305 | ||
| Infection | 306 | ||
| Delayed/Nonunion | 306 | ||
| Teeth | 306 | ||
| Acknowledgments | 306 | ||
| References | 307 | ||
| Chapter 32 Maxillofacial fracture repair using external skeletal fixation | 309 | ||
| Definitions | 309 | ||
| Preoperative concerns | 309 | ||
| Surgical anatomy | 309 | ||
| Special instruments and materials | 310 | ||
| Historical background | 310 | ||
| Components | 310 | ||
| Fixation pins | 310 | ||
| Connecting bars and clamps | 311 | ||
| External fixator systems | 311 | ||
| Linear | 311 | ||
| Free-form | 311 | ||
| External fixator systems for distraction osteogenesis | 311 | ||
| Therapeutic decision-making | 312 | ||
| Indications | 312 | ||
| Biomechanical considerations | 313 | ||
| Pin–bone interface | 313 | ||
| Pin selection | 313 | ||
| Pin placement | 313 | ||
| Surgical considerations | 313 | ||
| Open versus closed fracture reduction | 313 | ||
| Clinical applications of external skeletal fixation | 313 | ||
| Fractures of the mandible | 313 | ||
| Fractures of the maxilla | 314 | ||
| Other | 314 | ||
| Postoperative care and assessment | 315 | ||
| Aftercare | 315 | ||
| Radiography | 315 | ||
| Fixator removal | 315 | ||
| Complications | 317 | ||
| References | 317 | ||
| Chapter 33 Fractures and luxations involving the temporomandibular joint | 321 | ||
| Definitions | 321 | ||
| Clinical presentation | 321 | ||
| History and physical findings | 321 | ||
| Oral examination | 321 | ||
| Anesthetic considerations | 321 | ||
| Pre-anesthesia evaluation | 321 | ||
| Diagnostic imaging | 321 | ||
| Radiographic findings | 321 | ||
| Computed tomography | 323 | ||
| Surgical anatomy13,14 | 323 | ||
| Therapeutic decision-making | 323 | ||
| Differential diagnoses | 323 | ||
| Closed versus open reduction of subluxations and luxations | 325 | ||
| Nonsurgical versus surgical treatment of condylar and pericondylar fractures | 325 | ||
| Closed reduction and nonsurgical techniques | 325 | ||
| Closed reduction of luxations | 325 | ||
| Nonsurgical treatment of minimally displaced fractures | 326 | ||
| Surgical techniques | 326 | ||
| Open reduction of luxations | 326 | ||
| Condylectomy19,26 | 327 | ||
| Other techniques | 327 | ||
| Luxations | 327 | ||
| Condylar and subcondylar fractures | 327 | ||
| Postoperative care and assessment | 327 | ||
| Immobilization | 327 | ||
| Physiotherapy | 327 | ||
| Prognosis | 328 | ||
| Conservative treatment | 328 | ||
| Condylectomy | 328 | ||
| Complications | 328 | ||
| Intraoperative complications | 328 | ||
| Postoperative complications | 328 | ||
| Degenerative joint disease | 328 | ||
| Temporomandibular joint ankylosis | 329 | ||
| Zygomaticomandibular ankylosis | 329 | ||
| References | 331 | ||
| Chapter 34 Maxillofacial fracture complications | 333 | ||
| Definitions | 333 | ||
| Preoperative concerns | 333 | ||
| Therapeutic decision-making | 333 | ||
| Maxillofacial fracture complications | 333 | ||
| Age-related complications | 333 | ||
| Juvenile patients | 333 | ||
| Geriatric patients | 334 | ||
| Complications related to adjacent anatomical structures | 335 | ||
| Trauma to the inferior alveolar nerve and blood vessels | 335 | ||
| Oronasal fistula | 335 | ||
| Trauma to the nasal passages and maxillary recesses | 335 | ||
| Complications related to implants | 336 | ||
| Implant exposure, loosening, and migration and implant failure | 336 | ||
| Healing complications | 336 | ||
| Delayed union and nonunion | 336 | ||
| Malunion | 337 | ||
| Infectious complications | 337 | ||
| Wound infection | 337 | ||
| Osteomyelitis and bone sequestra | 337 | ||
| Complications related to teeth | 338 | ||
| Malocclusion | 338 | ||
| Dental pathology | 338 | ||
| Complications associated with extensive callus formation | 340 | ||
| Postoperative care and assessment | 341 | ||
| Prognosis | 341 | ||
| References | 341 | ||
| Chapter 35 Biologic basis of cleft palate and palatal surgery | 343 | ||
| Definitions | 343 | ||
| Palatogenesis | 343 | ||
| Palatal clefts | 343 | ||
| Congenital clefts | 344 | ||
| Genetic factors | 344 | ||
| Environmental teratogens | 344 | ||
| Mechanical forces | 344 | ||
| Induced clefts | 344 | ||
| Surgical correction | 345 | ||
| Palatoplasty in humans | 345 | ||
| von Langenbeck technique | 345 | ||
| V-Y push-back procedure | 345 | ||
| Two-flap palatoplasty | 345 | ||
| Experimental research in dogs and cats | 345 | ||
| Wound contraction | 345 | ||
| Two-flap palatoplasty | 346 | ||
| von Langenbeck technique | 346 | ||
| Studies in cats | 348 | ||
| References | 348 | ||
| Chapter 36 Cleft palate repair techniques | 351 | ||
| Definitions | 351 | ||
| Preoperative concerns | 351 | ||
| Anesthetic considerations | 351 | ||
| Surgical anatomy | 352 | ||
| Special instruments and materials | 352 | ||
| Therapeutic decision-making | 352 | ||
| Surgical techniques | 352 | ||
| Dentoalveolar cleft and cleft lip repair | 352 | ||
| Cleft hard palate repair | 355 | ||
| von Langenbeck technique | 355 | ||
| Overlapping-flap technique | 355 | ||
| Cleft soft palate repair | 357 | ||
| Double-layer appositional technique | 357 | ||
| Bilateral overlapping single-pedicle flap technique | 357 | ||
| Repair of unilateral hypoplasia of the soft palate | 357 | ||
| Bilateral hypoplasia of the soft palate | 357 | ||
| Postoperative care and assessment | 360 | ||
| Complications | 360 | ||
| Prognosis | 360 | ||
| References | 360 | ||
| Chapter 37 Repair of acquired palatal defects | 363 | ||
| Definitions | 363 | ||
| Preoperative concerns | 363 | ||
| Anesthetic considerations | 363 | ||
| Surgical anatomy | 363 | ||
| Special instruments and materials | 364 | ||
| Therapeutic decision-making | 365 | ||
| Surgical techniques | 365 | ||
| Primary closure of a midline palatal fracture/separation11 | 365 | ||
| Single-layer techniques | 365 | ||
| Vestibular flaps | 365 | ||
| Transposition flaps | 366 | ||
| Advancement flaps | 367 | ||
| Partial-thickness transposition flaps | 367 | ||
| Tongue flaps | 367 | ||
| Split palatal U-flap | 367 | ||
| Island palatal flap | 368 | ||
| Double-layer techniques | 368 | ||
| Vestibular-mucosal/perifistula/hard palatal flaps | 369 | ||
| Miscellaneous techniques | 370 | ||
| Myoperitoneal microvascular free flaps | 370 | ||
| Obturators | 370 | ||
| Postoperative care and assessment | 372 | ||
| Complications | 372 | ||
| Prognosis | 372 | ||
| References | 372 | ||
| Chapter 38 Clinical staging and biopsy of maxillofacial tumors | 373 | ||
| General considerations | 373 | ||
| Clinical staging | 373 | ||
| Primary tumor | 373 | ||
| Diagnostic imaging of oral tumors | 374 | ||
| Regional lymph nodes | 374 | ||
| Distant metastasis | 375 | ||
| Histopathologic staging | 375 | ||
| Principles of oral and maxillofacial biopsy | 375 | ||
| Developing the biopsy strategy | 375 | ||
| Open and closed biopsy | 376 | ||
| Open biopsy procedures | 377 | ||
| Soft tissue biopsy | 377 | ||
| Hard tissue biopsy | 377 | ||
| Osteotome technique | 377 | ||
| Michele trephine technique37 | 377 | ||
| Tissue handling and submission of the specimen | 378 | ||
| Frozen sections | 378 | ||
| Postoperative considerations | 379 | ||
| References | 379 | ||
| Chapter 39 Clinical–pathologic correlations | 381 | ||
| Clinical–pathologic correlations | 381 | ||
| Case 1 | 381 | ||
| Case 2 | 382 | ||
| Case 3 | 383 | ||
| References | 385 | ||
| Chapter 40 Clinical behavior of nonodontogenic tumors | 387 | ||
| General considerations | 387 | ||
| Incidence | 387 | ||
| Dogs | 387 | ||
| Cats | 387 | ||
| Signalment | 387 | ||
| Etiology and risk factors | 388 | ||
| Squamous cell carcinoma | 388 | ||
| Mandibular/maxillary squamous cell carcinoma in dogs | 389 | ||
| Lingual/sublingual squamous cell carcinoma in dogs | 389 | ||
| Tonsillar squamous cell carcinoma in dogs | 389 | ||
| Papillary squamous cell carcinoma of young dogs | 390 | ||
| Mandibular/maxillary squamous cell carcinoma in cats | 390 | ||
| Lingual/sublingual squamous cell carcinoma in cats | 391 | ||
| Tonsillar squamous cell carcinoma in cats | 392 | ||
| Malignant melanoma | 392 | ||
| Malignant melanoma in dogs | 392 | ||
| Malignant melanoma in cats | 393 | ||
| Fibrosarcoma | 394 | ||
| Mandibular/maxillary fibrosarcoma | 394 | ||
| Histologically low-grade, biologically high-grade fibrosarcoma | 395 | ||
| Bone tumors | 395 | ||
| Osteosarcoma | 395 | ||
| Multilobular osteochondrosarcoma | 396 | ||
| Other nonodontogenic tumor types | 396 | ||
| Undifferentiated malignant tumor of young dogs | 396 | ||
| Extramedullary plasmacytoma | 397 | ||
| Oral lymphoma | 397 | ||
| Miscellaneous tumor types | 397 | ||
| Merkel cell tumor | 397 | ||
| Mast cell tumor | 398 | ||
| Granular cell myoblastoma | 398 | ||
| Hemangiosarcoma | 398 | ||
| Papillomatosis | 398 | ||
| Salivary gland tumors | 398 | ||
| References | 399 | ||
| Chapter 41 Clinical behavior of odontogenic tumors | 403 | ||
| General considerations | 403 | ||
| Epithelial tumors | 404 | ||
| Ameloblastoma | 404 | ||
| Central (or intraosseous) ameloblastoma | 404 | ||
| Clinical features | 404 | ||
| Chapter 42 Non-neoplastic proliferative oral lesions | 411 | ||
| Gingival hyperplasia and related lesions | 411 | ||
| General considerations | 411 | ||
| Disease entities | 411 | ||
| Gingival hyperplasia | 411 | ||
| Drug-induced gingival enlargement | 411 | ||
| Focal fibrous hyperplasia | 412 | ||
| Pyogenic granuloma | 412 | ||
| Peripheral giant cell granuloma | 412 | ||
| Reactive exostosis | 412 | ||
| Therapeutic decision-making | 412 | ||
| Postoperative care and assessment | 413 | ||
| Prognosis | 413 | ||
| Traumatic buccal or sublingual mucosal hyperplasia | 413 | ||
| Chapter 43 Principles of oral oncologic surgery | 423 | ||
| Introduction | 423 | ||
| Diagnostic imaging | 423 | ||
| Nomenclature | 423 | ||
| Surgical treatment objectives | 424 | ||
| Treatment planning | 424 | ||
| Anesthesia and analgesia | 424 | ||
| Surgical excision | 424 | ||
| Patient positioning | 426 | ||
| Management of adjacent teeth | 427 | ||
| Preservation of local blood supply | 427 | ||
| Tension-free closure | 427 | ||
| Anticipation and prevention of complications | 427 | ||
| Hemorrhage | 427 | ||
| Infection | 428 | ||
| Dehiscence | 428 | ||
| Postoperative dysfunction | 428 | ||
| References | 428 | ||
| Chapter 44 Surgical treatment of tongue, lip and cheek tumors | 431 | ||
| Definitions1,2 | 431 | ||
| Surgical anatomy | 431 | ||
| Tongue2 | 431 | ||
| Lips and cheeks | 431 | ||
| Lymphatic drainage3 | 432 | ||
| Therapeutic decision-making | 432 | ||
| Tongue tumors | 432 | ||
| Lip and cheek tumors7 | 432 | ||
| Surgical techniques – glossectomy | 433 | ||
| Marginal excision | 433 | ||
| Wedge glossectomy (Fig. 44.1) | 433 | ||
| Transverse glossectomy (Fig. 44.2) | 433 | ||
| Longitudinal glossectomy (Fig. 44.3) | 433 | ||
| Surgical techniques – excision of lip and cheek tumors and reconstruction7 | 433 | ||
| Techniques for the upper lip and cheek | 433 | ||
| Wedge excision (Fig. 44.4 and 26.3) | 433 | ||
| Rectangular excision and Y-closure (Fig. 44.5) | 433 | ||
| Full-thickness labial advancement technique (Fig. 44.6) | 433 | ||
| Buccal rotation flap (Fig. 44.7) | 433 | ||
| Lower labial pedicle rotation flap8 (Fig. 44.8) | 433 | ||
| Buccolabial pedicle flap (Fig. 44.9) | 434 | ||
| Upper labial pull-down technique (Fig. 44.10) | 441 | ||
| Transposition skin flap (Fig. 44.11) | 441 | ||
| Techniques for the lower lip | 442 | ||
| Full-thickness labial advancement technique (Fig. 44.12) | 442 | ||
| Upper labial pedicle rotation flap (Fig. 44.13) | 442 | ||
| Techniques for the lower lip, upper lip and cheek reconstruction | 447 | ||
| Labial buccal reconstruction with inverse tubed skin flap7 (Fig. 44.14) | 447 | ||
| Free microvascular skin flap grafted with oral mucosa9 | 447 | ||
| Complications | 447 | ||
| Complications following glossectomy | 447 | ||
| Complications following excision of lip and cheek tumors and reconstruction | 447 | ||
| Prognosis | 447 | ||
| Prognosis following glossectomy | 447 | ||
| Prognosis following excision of lip and cheek tumors and reconstruction | 449 | ||
| References | 449 | ||
| Chapter 45 Maxillectomy techniques | 451 | ||
| Definitions | 451 | ||
| Indications | 451 | ||
| Background | 451 | ||
| Preoperative concerns | 451 | ||
| Diagnosis | 451 | ||
| Client communications | 451 | ||
| Preoperative management | 452 | ||
| Antibiotics | 452 | ||
| Oral cavity disinfection | 452 | ||
| Anesthetic considerations | 452 | ||
| Preemptive analgesia | 452 | ||
| Patient positioning | 452 | ||
| Surgical anatomy5 | 452 | ||
| Therapeutic decision-making | 452 | ||
| Types of osseous excisions | 452 | ||
| Surgical technique | 453 | ||
| General surgical principles | 453 | ||
| Surgical plan23–26,33 | 453 | ||
| Surgical margins | 453 | ||
| Surgical incision | 453 | ||
| Management of adjacent teeth | 454 | ||
| Ostectomy and osteoplasty | 454 | ||
| Flap design | 456 | ||
| General principles | 456 | ||
| Vestibular mucosal–submucosal flap | 456 | ||
| Alveolar mucosal–periosteal transposition flap | 457 | ||
| Palatal mucoperiosteal flap | 458 | ||
| Surgical defect closure | 458 | ||
| Incisivectomy and rostral maxillectomy | 459 | ||
| Central and caudal maxillectomy | 460 | ||
| Orbitectomy2 | 461 | ||
| Additional technical considerations | 461 | ||
| Postoperative care and assessment | 461 | ||
| Extubation | 461 | ||
| Pain management | 461 | ||
| Nutritional support | 462 | ||
| Postoperative patient appearance23,26 | 462 | ||
| Homecare and follow-up | 462 | ||
| Complications | 462 | ||
| Intraoperative complications | 462 | ||
| Postoperative complications | 464 | ||
| Prognosis | 464 | ||
| References | 464 | ||
| Chapter 46 Mandibulectomy techniques | 467 | ||
| Definitions | 467 | ||
| Indications | 467 | ||
| Background | 467 | ||
| Preoperative concerns | 467 | ||
| Diagnosis | 467 | ||
| Client communication | 467 | ||
| Therapeutic decision-making | 467 | ||
| Types of osseous excisions | 467 | ||
| Preoperative management | 469 | ||
| Patient positioning | 469 | ||
| Dorsal and lateral recumbency | 469 | ||
| Sternal recumbency | 469 | ||
| Surgical anatomy26–28 | 469 | ||
| Surgical technique | 471 | ||
| General surgical principles21–23 | 471 | ||
| Surgical plan | 471 | ||
| Surgical margins | 471 | ||
| Surgical incision | 471 | ||
| Management of adjacent teeth | 471 | ||
| Ostectomy and osteoplasty | 471 | ||
| Flap design | 472 | ||
| General principles | 472 | ||
| Vestibular mucosal–submucosal flap | 472 | ||
| Surgical defect closure | 472 | ||
| Closure at the rostral mandible | 472 | ||
| Closure at the mandibular body | 472 | ||
| Unilateral rostral mandibulectomy | 472 | ||
| Bilateral rostral mandibulectomy | 473 | ||
| Central or segmental mandibulectomy | 473 | ||
| Caudal mandibulectomy | 473 | ||
| Unilateral (total) mandibulectomy | 475 | ||
| Stabilization of mandibular segments | 475 | ||
| Postoperative care and assessment | 476 | ||
| Postoperative patient appearance21–23 | 476 | ||
| Homecare and follow-up | 476 | ||
| Complications19–23 | 476 | ||
| Intraoperative complications | 476 | ||
| Dehiscence | 477 | ||
| Functional complications | 477 | ||
| Malocclusion | 477 | ||
| Prehension | 477 | ||
| Drooling | 477 | ||
| Tongue protrusion | 477 | ||
| Ranula | 477 | ||
| Dental calculus | 477 | ||
| Local tumor recurrence | 478 | ||
| Prognosis | 478 | ||
| Other considerations | 478 | ||
| Extent of mandibulectomy | 478 | ||
| Subtotal mandibulectomy | 478 | ||
| Teeth rostral to ostectomy | 478 | ||
| References | 478 | ||
| Chapter 47 Clinical behavior and management of odontogenic cysts | 481 | ||
| Introduction | 481 | ||
| Dentigerous cyst | 481 | ||
| Pathophysiology | 481 | ||
| Clinical features | 481 | ||
| Management | 482 | ||
| Periapical cyst | 482 | ||
| Pathophysiology | 482 | ||
| Clinical features | 482 | ||
| Management | 483 | ||
| Odontogenic keratocyst-like lesion (OKC-like) – keratocystic odontogenic tumor | 484 | ||
| Pathophysiology | 484 | ||
| Clinical features | 484 | ||
| Management | 485 | ||
| References | 485 | ||
| Chapter 48 Advanced maxillofacial reconstruction techniques | 487 | ||
| Definition | 487 | ||
| Therapeutic decision-making | 487 | ||
| Surgical anatomy and surgical techniques | 487 | ||
| Caudal auricular axial-pattern flap | 487 | ||
| Superficial temporal axial-pattern flap | 488 | ||
| Application and surgical closure | 488 | ||
| Other techniques | 491 | ||
| Rectus abdominis myoperitoneal flap | 491 | ||
| Skin grafts | 491 | ||
| Angularis oris axial-pattern flap | 491 | ||
| Bone reconstruction | 492 | ||
| Postoperative care and assessment | 493 | ||
| Immediate postoperative care | 493 | ||
| Assessment – viability of axial-pattern flaps | 493 | ||
| References | 493 | ||
| Chapter 49 Principles of salivary gland surgery | 495 | ||
| Definitions | 495 | ||
| Surgical anatomy | 495 | ||
| Parotid gland | 495 | ||
| Zygomatic gland | 495 | ||
| Mandibular and sublingual glands | 495 | ||
| Molar glands in the cat | 496 | ||
| Other salivary glands | 496 | ||
| Examination techniques | 496 | ||
| Diagnostic imaging | 496 | ||
| Salivary gland biopsy | 497 | ||
| Surgical diseases of the salivary glands | 497 | ||
| Salivary gland and duct injury | 497 | ||
| Salivary fistula | 497 | ||
| Sialoliths | 497 | ||
| Salivary gland neoplasia | 498 | ||
| Surgical excision of the mandibular gland | 498 | ||
| Surgical excision of the parotid gland | 499 | ||
| Surgical excision of the zygomatic gland | 499 | ||
| Salivary gland necrosis | 499 | ||
| Complications | 499 | ||
| References | 499 | ||
| Chapter 50 Surgical treatment of sialoceles | 501 | ||
| Definitions | 501 | ||
| Pathogenesis and epidemiology | 501 | ||
| Preoperative assessment | 504 | ||
| Diagnosis of sialocele | 504 | ||
| Therapeutic decision-making | 504 | ||
| Objectives of surgery | 504 | ||
| Surgical anatomy | 504 | ||
| General anatomy | 504 | ||
| Topographical anatomy | 505 | ||
| Surgical techniques | 505 | ||
| Lateral approach to excision of mandibular and sublingual glands17 | 505 | ||
| Ventral approach to excision of mandibular and sublingual glands8,18 | 505 | ||
| Advantages and disadvantages of lateral versus ventral approaches for sialoadenectomy: results of two techniques to excise the mandibular and sublingual salivary glands | 508 | ||
| Intraoral marsupialization of a ranula | 509 | ||
| Zygomatic sialoadenectomy | 509 | ||
| Postoperative care, assessment and complications | 509 | ||
| Excision of the mandibular and sublingual salivary glands | 509 | ||
| References | 510 | ||
| Chapter 51 Cheiloplasty | 511 | ||
| Lip fold resection | 511 | ||
| Clinical characteristics | 511 | ||
| Associated conditions | 512 | ||
| Chapter 52 Inferior labial frenoplasty and tight-lip syndrome | 515 | ||
| Definitions | 515 | ||
| Preoperative concerns | 515 | ||
| Surgical anatomy | 515 | ||
| Inferior labial frenoplasty | 515 | ||
| Clinical presentation | 515 | ||
| Chapter 53 Management of maxillofacial osteonecrosis | 519 | ||
| Definitions | 519 | ||
| Preoperative concerns | 519 | ||
| Etiopathogenesis | 519 | ||
| Therapeutic decision-making | 519 | ||
| Factors to consider in the surgical management of maxillofacial osteonecrosis | 520 | ||
| General principles in the surgical management of maxillofacial osteonecrosis | 521 | ||
| Postoperative care and assessment | 522 | ||
| Complications | 522 | ||
| Prognosis | 524 | ||
| References | 524 | ||
| Chapter 54 Management of unerupted teeth | 525 | ||
| Definitions | 525 | ||
| Surgical anatomy | 525 | ||
| Location of an unerupted tooth | 525 | ||
| Therapeutic decision-making | 525 | ||
| Surgical techniques | 526 | ||
| Surgical exposure | 526 | ||
| Orthodontic management | 527 | ||
| Extraction of unerupted teeth | 527 | ||
| Postoperative care | 528 | ||
| Complications | 528 | ||
| References | 529 | ||
| Chapter 55 Temporomandibular joint dysplasia | 531 | ||
| Definitions | 531 | ||
| Background | 531 | ||
| Functional anatomy of the temporomandibular joint4,13,14 | 531 | ||
| Pathophysiology | 531 | ||
| Clinical presentation | 532 | ||
| Signalment and history | 532 | ||
| Physical examination | 532 | ||
| Manipulation of the mandibles | 532 | ||
| Diagnostic imaging | 532 | ||
| Radiographic findings | 532 | ||
| Computed tomography and magnetic resonance imaging | 533 | ||
| Surgical anatomy13,22 | 533 | ||
| Therapeutic decision-making | 534 | ||
| Differential diagnoses | 534 | ||
| Surgical technique and unilateral or bilateral surgery | 534 | ||
| Surgical techniques | 534 | ||
| Partial zygomatic arch excision3,4 | 534 | ||
| Reduction of the coronoid process height | 536 | ||
| Mandibular condylectomy | 537 | ||
| Postoperative care and assessment | 537 | ||
| Complications | 537 | ||
| Prognosis | 537 | ||
| References | 537 | ||
| Chapter 56 Correction of overlong soft palate | 539 | ||
| Surgical anatomy | 539 | ||
| Special instruments and materials | 539 | ||
| Therapeutic decision-making | 539 | ||
| Indications for surgery | 540 | ||
| Surgical technique | 540 | ||
| Postoperative care and assessment | 541 | ||
| Prognosis | 541 | ||
| References | 542 | ||
| Chapter 57 Pharyngotomy and pharyngostomy | 543 | ||
| Definitions | 543 | ||
| Background | 543 | ||
| Indications and contraindications | 543 | ||
| Chapter 58 Oral approaches to the nasal cavity and nasopharynx | 547 | ||
| Surgical anatomy | 547 | ||
| Special instruments and materials | 547 | ||
| Therapeutic decision making | 547 | ||
| Indications for surgery | 547 | ||
| Surgical technique | 548 | ||
| Control of hemorrhage | 548 | ||
| Ventral approach to the rostral nasal passages | 549 | ||
| Ventral approach to the caudal nasal passages and nasopharynx | 549 | ||
| Postoperative care and assessment | 549 | ||
| Prognosis | 549 | ||
| References | 551 | ||
| Chapter 59 Tonsillectomy | 553 | ||
| Surgical anatomy | 553 | ||
| Special instruments and materials | 553 | ||
| Therapeutic decision-making | 553 | ||
| Indications for surgery | 553 | ||
| Surgical technique | 554 | ||
| Postoperative care and assessment | 555 | ||
| Prognosis | 555 | ||
| References | 555 | ||
| Index | 557 | ||
| A | 557 | ||
| B | 558 | ||
| C | 558 | ||
| D | 558 | ||
| E | 559 | ||
| F | 559 | ||
| G | 560 | ||
| H | 561 | ||
| I | 561 | ||
| J | 561 | ||
| K | 561 | ||
| L | 561 | ||
| M | 562 | ||
| N | 563 | ||
| O | 563 | ||
| P | 564 | ||
| R | 565 | ||
| S | 565 | ||
| T | 566 | ||
| U | 567 | ||
| V | 567 | ||
| W | 567 | ||
| X | 567 | ||
| Y | 567 | ||
| Z | 567 |