Cerclage Wire for Rostral Mandibular InstabilityMay 6, 2015Originally published in the April 2015 issue of Veterinary Practice News Last month we discussed iatrogenic mandibular fractures of the rostral mandible, specifically the iatrogenic parasymphyseal fracture. One of the repair techniques for this fracture, and for traumatic symphyseal separation, is use of a cerclage wire placed behind the canine teeth. Though most practitioners are familiar with this seemingly basic procedure, there are subtle nuances of placement that will help your patients thrive following placement of the cerclage. No. 1. Not every patient with instability requires placement of a cerclage wire Some animals, especially brachycephalic small-breed dogs and some cats, may have significant symphyseal laxity as an incidental finding on anesthetized oral examination. If the patient is not showing signs of discomfort or jaw locking, symphyseal laxity is not likely causing any problems. In cases with no recent history of trauma, placement of a cerclage wire will likely not allow for a long-term decrease in laxity without a more invasive procedure such as symphysiodesis (cutting into the fibrous joint of the symphysis and encouraging scar tissue formation), and this is often not necessary. No. 2. Step-by-step: placement Before placing a cerclage wire, the intraoral soft tissues dorsal to the …
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How to Avoid the Iatrogenic Jaw FractureApril 13, 2015Originally published in the March 2015 issue of Veterinary Practice News? Not a subscriber? Subscribe today! If you extract enough firmly rooted mandibular canine teeth in your lifetime, basic anatomy suggests that you may find yourself to be the creator of an iatrogenic jaw fracture. The root of the mandibular canine tooth of dogs and cats makes up a large portion of the rostral mandible and it is nearly twice as long as the crown of the tooth. Bone is very thin between the lingual surface of the root and the caudal symphysis. Photos © 2014 John R. Lewis, NorthStar VETS. Radiograph of an iatrogenic jaw fracture that occurred during attempted extraction of the left mandibular canine tooth in a cat. Iatrogenic jaw fractures that occur during canine tooth extraction tend to be parasymphyseal fractures rather than symphyseal separations. Forces required to deliver this tooth root may also, in some cases, be sufficient to result in fracture of the bone. Here are some tips that I’ve learned on how to avoid iatrogenic fracture. Dental Rads Take dental radiographs and adjust your therapeutic approach accordingly. Dental radiographs are important from both diagnostic and therapeutic …
10 Tips for Veterinary Surgery LoversApril 7, 2015Originally published in the March 2015 issue of Veterinary Practice News You don’t have time to make every mistake in your career, especially in surgery: A mistake could cause significant harm to a pet, get you in a sticky situation or cost your patient his life. These suggestions are meant to start a reflection, not to offend anyone. They apply to new grads as well as seasoned surgery lovers. 1) Make it Big “Big surgeons make big incisions.” Unless you are performing minimally invasive surgery, don’t make mini-laparotomies. Sure, you can remove a spleen or a gastric foreign body through a short incision. However, stopping there would be a disservice to your patient; that’s only half of your job. The other half is to perform a thorough laparotomy, from the liver to the bladder. 2) Perfect Your Suture Pet owners will never appreciate how flawless a surgery you performed on Kiki. The only thing they see, and they may see for the next 10 years, is your skin suture. So work hard at crafting the prettiest skin suture possible. Learn how to close dead space. Strive to appose skin spots neatly. Strive to get rid of dog ears. Figure out where you …
Why Enthusiasm is Growing for Emerging TechnologyFebruary 17, 2015Telemedicine, 3-D printing, radiology and biotechnology are among the terms that could dominate the veterinary technology landscape in the years to come. “I see huge potential for 3-D printing in veterinary medicine,” said Diane McClure, DVM, Ph.D., Dipl. ACLAM, an associate professor in laboratory animal medicine for the College of Veterinary Medicine at Western University of Health Sciences in Pomona, Calif. Orthotic and prosthetic applications for 3-D printing technology are at the proof-of-concept stage, and they will become more conventional in the future, said Denis J. Marcellin-Little, DVM, Dipl. ACVS, Dipl. ECVS, Dipl. ACVSMR. Dr. Marcellin-Little, a professor of orthopedic surgery at the North Carolina State University College of Veterinary Medicine, collaborated with the Center for Additive Manufacturing and Logistics and the North Carolina Aquarium in Roanoke Island in the 3-D manufacture of a custom brace for a green sea turtle that suffered an open fracture to its right radius and ulna. The brace enabled the turtle, Augie, to eventually heal. According to those caring for Augie, the turtle became well enough to swim without the brace but was not yet ready to be released into the ocean. “3-D scanning and printing will revolutionize the field,” Marcellin-Little said. “It is …
The Crucial Facts You Must Remember About Intestinal SurgeryJanuary 16, 2015Originally published in the January 2015 issue of Veterinary Practice News Vomiting Cats Most cat owners and many colleagues probably consider regular vomiting to be normal in a cat. Yet cats vomiting more than twice a month should be worked up rather than treated with benign neglect. Statistically, about half have inflammatory bowel disease (IBD) and about half have intestinal cancer. Such is the revolutionary conclusion of a recent study by Dr. Gary Norsworthy, et al., at the Alamo Feline Health Center in San Antonio.1 Dr. Norsworthy reported his study in the January 2014 issue of Veterinary Practice News. An ultrasound was performed on 74 cats that presented for vomiting, diarrhea or weight loss. Also included in the study were 26 cats that went to the hospital for a yearly exam. Those 26 cats were all considered healthy by their owners in spite of ongoing vomiting or diarrhea. Weight loss was the most common sign, present in 70 percent of the cats, sometimes without vomiting or diarrhea. In all 100 cats, ultrasounds revealed that the small intestine was thicker than normal. All cats had full-thickness surgical biopsies. Endoscopic biopsies provide partial thickness biopsies, which may not reveal the disease’s extent. …
Another Zebra Diagnosis: Feline Pyogenic GranulomaJanuary 7, 2015Originally published in the December 2014 issue of Veterinary Practice News Case Discussion Fonzie, a 12-year-old neutered male domestic shorthair cat, was presented for evaluation of a proliferative, bleeding, friable mass arising from the gingiva and mucosa of the dorsolateral surface of the right caudal mandible. Appetite was normal, but the patient did have a history of occasionally exhibiting abnormal chewing motions. The mass had been present for approximately three months and was removed by Fonzie’s primary care veterinarian approximately one month before presentation to me. Biopsy submitted by the primary care veterinarian revealed ulcerated and inflamed granulation tissue. Although the mass appeared to be completely excised on histopathology, it recurred within a few weeks postoperatively. At the time of presentation to me, the mass was approximately 1.5 mm x 1.0 mm x 0.8 mm, located in the area of a missing right mandibular first molar (tooth 409, Figure 1). John R. Lewis, Northstar Vets Figure 1. Pyogenic granuloma in the area of the missing mandibular first molar tooth of a cat. A dental radiograph of the right caudal mandible revealed no osseous involvement and no evidence of retained roots (Figure 2). No other areas of the …
How to Diagnose and Treat Uroabdomen CasesNovember 3, 2014Tucker, a 3-year-old border collie, was rushed to your hospital after getting hit by a car at 9 a.m. He is lucky, as he escaped without any fracture or major laceration. He only seems to have a few skin scrapes. You stabilize Tucker throughout the day, and he looks much better by that evening. He is kept overnight for IV fluids and pain medications. By the next morning, you are disappointed to see that Tucker’s condition has worsened overnight. Blood work and abdominal X-rays make you strongly suspect a bladder rupture. Ultrasound confirms it without a doubt. Fortunately, Dr. Jennifer Stafford, a double-boarded colleague in critical care and internal medicine at VCA Veterinary Referral Associates in Gaithersburg, Md., comes to the rescue with a full write-up on uroabdomen (JR Stafford, et al. “A clinical review of pathophysiology, diagnosis, and treatment of uroabdomen in the dog and cat.” J Vet Emerg Crit Care 2013, Vol 23, N 2, p. 216-229). As in Tucker’s case, most uroabdomen cases are caused by blunt trauma to the abdomen, such as getting hit by a car. The chances of this happening depend on the degree of bladder distention at the time of the trauma. Uroabdomen …
Why You Should Go Back to the Basics to Heal WoundsOctober 15, 2014Originally published in the October 2014 issue of Veterinary Practice News In the opinion of Sam Franklin, MS, DVM, Ph.D., Dipl. ACVS, wound healing is all about the phases of an injury. Dr. Franklin, an assistant professor of small animal orthopedic surgery at the University of Georgia College of Veterinary Medicine and a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, emphasized that effective management of wounds “really requires just three general things.” To start with, it requires that a veterinarian know the healing phases. Each phase is “well defined and well described” in textbooks and articles, he said, and any practitioner interested in managing wounds can and should learn them. “There are only four or five phases—depending upon the source consulted—and so learning about them is very feasible,” Franklin added. Additionally, a practitioner should be capable of evaluating a wound and accurately determining what stage of healing it’s in, he said. Finally, “As the wound progresses to the next step of healing, the practitioner then adjusts to the next set of treatments or bandages that are appropriate for that phase,” Franklin said. No Goop Forget the goop. That’s the advice from Randy Lynn, DVM, MS, Dipl. …
Why You Should Wake up to the Realities of AnesthesiaOctober 6, 2014Originally published in the October 2014 issue of Veterinary Practice News When she wanted to offer one crystal-clear message to veterinarians about anesthesia best practices, Christina Braun, Dr. Med. Vet, Dipl. ACVAA, offered one of her favorite quotes from J.W. von Goethe: “You only see what you know.” It’s unlikely the German writer and statesman was referring to anesthesia, but Dr. Braun thinks it’s a good point nonetheless. “Monitoring is the first step to improve anesthetic outcome,” said Braun, a professor in anesthesiology and perioperative intensive care medicine at the University of Veterinary Medicine in Vienna, Austria. She encourages general practice veterinarians to reach out to the American College of Veterinary Anesthesia and Analgesia (ACVAA) if they have questions or concerns, and pet owners may be referred to the group’s website for more information. “For example, I know of old cats and dogs that had such terrible teeth that they wouldn’t eat anymore,” Braun said. “Because they were old, the fear of anesthesia was so high that the owner didn’t want the general veterinarian to perform a dental cleaning —which, in pets, absolutely [requires] general anesthesia. “Contacting a diplomate of the ACVAA can help in learning about good ways to …
12 Ways to Avoid Surgical MistakesSeptember 22, 2014 What follows might very well become my most controversial surgical column. This list of 12 surgical mistakes is hardly exhaustive. It is, however, meant to start a reflection, rather than to offend anybody. 1) Skills The challenge with surgery is that a seemingly straightforward procedure can suddenly become much more complicated. Having the necessary skills set is the whole dilemma. Examples include the “routine” cystotomy, canine or feline, which in fact required a urethrostomy; the “routine” splenic mass, which in fact was a hepatic mass; the “routine” enterotomy, which in fact turned into a resection and anastomosis of three feet of jejunum. Could you handle any of these situations? 2) Indications Just because you have a hammer, even if you are a hammer expert, does not mean that every problem is a nail. Not all fractures can be pinned; some require a plate and screws. Not all cases of otitis externa can be treated by a Zepp procedure; many require a total ear canal ablation. Not all ACL tears can be treated with lateral nylon sutures; some patients require fancier procedures, such as a tibial plateau leveling osteotomy or a tibial …
