How to Treat the Congenital Cleft PalateAugust 21, 2015Originally published in the August 2015 issue of Veterinary Practice News. Cleft palate surgeries are one of my favorite procedures in dentistry and oral surgery. Maybe it is because the opportunity to see a puppy amidst a predominately geriatric patient population. Perhaps it’s because every cleft palate is just a little bit different than the previous one. The most likely reason is the exhilaration and challenge of repairing a defect that has already had three (or more!) attempts at repair prior to presenting to a specialist. © 2009, John Lewis, University of Pennsylvania. Figure 1A: Bilateral cleft lip in a 7-month-old pit bull. Figure1B: Bilateral clefts of the primary palate in the same dog. Terminology Defects of the primary palate occur from a lack of fusion of the developing incisive bone to the palatine process of the maxilla and/or defects of development of the soft-tissue structures of the upper lip. These defects are often extending from the midline incisive papilla, radiating rostrolaterally, unilaterally or bilaterally (Figure 1A and 1B). Unilateral cleft-lip defects in dogs occur more commonly on the left side, which is also …
SPONSORED CONTENTFast Itch Relief for Canine PatientsA treatment for allergic and atopic dermatitis, given just once a day. Visibly improves itch fast. + Learn More Now
How to Provide Better Pain Control Around SurgeryAugust 12, 2015Originally published in the August 2015 issue of Veterinary Practice News. Subscribe today! American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) have recently published the "2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats." The entire article is easily found online (for free) to any interested reader. Full disclosure: What follows is not a summary of the AAHA and AAFP article, but a review of a few key points made by the authors as they relate to perioperative pain control. In addition, we interviewed the lead author, Dr. Mark Epstein. NSAIDs NSAIDs are a mainstay for chronic-pain management, as well as for perioperative use. However, "preexisting elevated liver enzymes are not a risk factor." The guidelines state that "the importance of maintaining a normotensive state during anesthesia is considered paramount when utilizing preoperative NSAIDs." Studies have shown that NSAIDs are more effective when given prior to surgery (concept of preemptive analgesia), but if IV …
10 Tips to Help You Save Time During SurgeryJuly 14, 2015Originally published in the July 2015 issue of Veterinary Practice News. Being a quick surgeon shouldn’t be a goal in itself. Being a good surgeon is a much wiser goal. However, being good and fast might be the ideal combination for the anesthetized patient’s sake. We polled four board-certified surgeons* who shared 10 pearls to become more efficient in the OR. This is a sequel to June’s column titled “How to save time before surgery.” Each suggestion may seemingly only shave off moments. But over the length of a procedure, these moments add up in such a time-sensitive environment. 1) Focus Thoroughly concentrate on the task at hand. Avoid talking about the weather, your upcoming vacation or the last episode of “Dancing with the Stars.” Avoid distractions and interruptions, such as unnecessary staff, loud music or phones in the OR. 2) Technicians During surgical procedures, appropriate staffing should never be underestimated. A well-trained, experienced technician can focus on anesthesia so that the surgeon can focus on the surgery. A good technician won’t be shy about notifying you of true concerns about the patient, as opposed to annoying beeping related to a faulty probe or electrode. The technician should be aware of the …
Vet School’s 3-D Printer Adds Personal TouchJune 17, 2015What they see is what they get at the Mississippi State University Veterinary Specialty Center, which is using a 3-D printer to construct plastic copies of patients’ damaged spines and skulls. The replicas spit out by the $2,200 LutzBot TAZ 4 3-D printer allow veterinarians and students to examine internal injuries up close and plan corrective measures. “We take CT scans of spinal injuries, convert them into three-dimensional images on a screen and convert those to files that can transmit that information to the printer,” said Andy Shores, DVM, MS, Ph.D., Dipl. ACVIM. “The result is a plastic model identical to what was on the screen.” The reproductions also assist in the education of Mississippi State veterinary students and neurosurgery residents, said Dr. Shores, chief neurosurgeon in the College of Veterinary Medicine. “The equipment prints out bony structures, so future students can see exactly how a particular injury looks and get a better appreciation for the condition we’re talking about while on rounds,” he said. “If you have a patient with a broken bone or vertebrae, to be able to put that structure in your hand goes a long way toward the students’ understanding what it is and how …
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 …
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 …
