Use of a barrier membrane to repair congenital hard palate defects and to close oronasal fistulae remaining after cleft palate repair: seven dogs (2019-2022).

OBJECTIVE: To describe the use of a barrier membrane in dogs for repair of congenital hard palate defects and closure of oronasal fistulae (ONF) remaining after previous cleft palate (CFP) repair. ANIMALS: 7 client-owned dogs. METHODS: The hard palate defect was closed with medially positioned flaps (Von Langenbeck technique) or pedicle flaps (2-flap palatoplasty) and a membrane composed of autologous auricular cartilage from the pinna or allogenous fascia lata underlying the mucoperiosteal flaps. RESULTS: All palate defects were considered to have a high risk of dehiscence based on their type and size and the characteristics of the surrounding tissue. The barrier membrane was used in 5 dogs for repair of congenital hard palate defects and in 2 dogs for closure of ONF remaining after previous CFP repair. Resolution of clinical signs occurred in all cases. Complete success (ie, complete closure of the palate defect and absence of clinical signs) was achieved in 5 dogs (4 with congenital hard palate defects and 1 with an ONF remaining after previous CFP repair). The persistent ONF in 1 dog with functional success (incomplete closure, but no clinical signs) was smaller than prior to surgery. CLINICAL RELEVANCE: Barrier membranes underlying mucoperiosteal flaps may constitute an alternative technique in dogs for repair of congenital hard palate defects and closure of ONF remaining after previous CFP repair.

Etiology, clinical presentation, and outcome of temporomandibular joint luxation in cats: 21 cases (2000-2018).

This study was performed to report etiology, clinical presentation, treatment, and outcome of temporomandibular joint (TMJ) luxation in 21 cats (2000-2018). TMJ luxation was diagnosed by either dental radiography or computed tomography (CT). Causes for TMJ luxation included altercation with a dog (38%), hit-by-car (19%), unknown (19%), fall (19%), and ran into inanimate object (5%). The most common complication was development of permanent malocclusion (24%), followed by reduced vertical mandibular range of motion (5%). Reduction of TMJ luxation was successful in 94.7% of the cases. Reduction of the TMJ luxation was significantly associated with time from injury to treatment. No other significant associations were observed between cause of injury, type of TMJ stabilization, and outcome. TMJ luxation in cats carries an excellent prognosis with early joint reduction and supportive care. Concurrent dental trauma and maxillofacial injuries are common, and all patients with head trauma must be stabilized and evaluated with a thorough examination.

Surgical treatment for cleft palate in dogs yields excellent outcomes despite high rates of oronasal fistula formation: a narrative review.

Cleft palate is the most common congenital orofacial defect in dogs. Although this topic has been extensively studied in experimental dogs, current literature on clinical patients is limited to case reports and small case series studies with many individual opinions based on experience. This narrative review summarizes the literature of the last 10 years with application to clinical practice, focusing on the preparation of the patient until surgery, options for surgical management, and perioperative complications. Surgical treatment must be performed to obtain separation between the nasal/nasopharyngeal and oral/oropharyngeal passages. This will allow the dog to have independent function and reduce clinical signs associated with food, water, and other foreign material entering the respiratory tract. Surgical treatment has good to excellent outcomes when the procedure is carefully planned and appropriately executed despite the high rates of postoperative oronasal fistula reported.

Morphometry and Morphology of the Articular Surfaces of the Medial Region of the Temporomandibular Joint in the Felis Catus (Domestic cat) - A Cone Beam Computed Tomography Study.

The articular surfaces of the temporomandibular joint (TMJ) in the cat consist of the articular head of the condylar process of the ramus of the mandible and the mandibular fossa of the petrous part of the temporal bone. Anatomic conformation of the TMJ articular surfaces can vary; however, this has not been studied in the cat. Thus, the aim of this study was to characterize the conformation of the medial region of the TMJ in mesocephalic adult cats as well as to determine the articular relationship by measurement of the degree of coverage of the mandibular fossa over the articular head. This was accomplished by assessing 60 TMJs from 30 mesocephalic adult cats by means of cone-beam computed tomography (CBCT). The width and depth of the mandibular fossa, and the degree of coverage of the mandibular fossa were evaluated using parasagittal reconstructions of the medial aspect of the TMJ by two observers. No statistically significant difference was observed during the intra and interobserver evaluation of the mandibular fossa width and depth and the degree of coverage of the mandibular fossa over the articular head. P-values for the studied variables were greater than 0.05. The resulting measurements demonstrated a concave mandibular fossa with a prominent retroarticular process and a poorly developed articular eminence; a well-defined rounded articular surface, and a high degree of coverage (171°) of the mandibular fossa over the articular head. In conclusion, the articular surfaces at the medial aspect of the TMJ displayed elevated geometric similarity, with an articular head of the condylar process deeply seated in the mandibular fossa.

Surgical Treatment and Outcome of Acquired Midline Palate Defects in Cats.

Acquired midline palate defects (PDE) affect the hard palate and/or soft palate, and result from trauma, commonly falling from a height or being hit by a motor vehicle. Additional life-threating injuries and costs associated with the treatment may delay the surgical treatment. This retrospective study describes signalment, cause, and extent of the PDE, and treatment in 25 cats. In addition, the outcome of the surgical repair is described in 19 (76%) cats. All defects were repaired within 5 days of the injury. Twenty (80%) cats were 4 years of age or younger. The most common rostral extent of the PDE was to the level of the third premolar tooth (n = 8; 32%), incisor teeth (n = 7; 28%), and fourth premolar tooth (n = 5; 20%). The soft palate laceration was present in all cases. Surgical therapy was successful in all cases with follow-up. The most common techniques used for the closure of the hard palate defect were bilateral pedicle flaps with lateral releasing incisions (n = 8; 32%), direct apposition of the oral mucosa (n = 7; 28%), bilateral pedicle flaps with lateral releasing incisions and interquadrant splinting (n = 5; 20%), and unilateral pedicle flap with one lateral releasing incision (n = 4; 16%). A tension-free closure by direct apposition of the edges was possible for the soft palate laceration. No oronasal fistulae were identified at follow-up. The only complication was malocclusion. The interquadrant splinting was most often used for PDE extending to the rostral portion of the hard palate (p < 0.05). The cats that suffered postoperative malocclusion were significantly more likely to have sustained temporomandibular joint injury, underwent CT scan, or had a feeding tube placed before discharge. The results of this retrospective study indicate that the early treatment (within 5 days) of the acquired longitudinal defects in the midline of the hard and soft palates is highly successful.

Caudal and middle segmental mandibulectomies for the treatment of unilateral temporomandibular joint ankylosis in cats.

Case series summary: Three cats affected by unilateral temporomandibular joint ankylosis underwent segmental mandibulectomy, while one cat with bilateral ankylosis underwent right temporomandibular joint gap arthroplasty and left segmental mandibulectomy. Minimal intraoperative complications were linked to the segmental mandibulectomies in the cases reported. All cats recovered their ability to open the mouth, and the vertical range of motion was unaltered during the postoperative period. Mandibular drift and dental malocclusion were the main postoperative complications related to the segmental mandibulectomies. Relevance and novel information: Surgical excision of ankylotic tissue at the temporomandibular joint region may be technically challenging and associated with severe iatrogenic trauma of surrounding tissues. The results of this case series suggest that middle or caudal segmental mandibulectomy is a safe, feasible and effective surgical procedure to treat unilateral temporomandibular ankylosis in cats and could be considered as an alternative surgical technique to surgical excision of ankylotic tissue at the temporomandibular joint.

Dental Abnormalities in Immature Dogs with a History of Mandibular Fractures.

This study was performed to report the dental abnormalities encountered in immature dogs with a history of mandibular fracture. Dogs were included in the study if mandibular fractures were diagnosed by means of oral examination and diagnostic imaging, they were treated with non-invasive or minimally invasive methods, and there was a follow-up examination of at least 90 days after the initial presentation with the last follow-up visit occurring at 6 months of age or older. Eleven dogs met the inclusion criteria. Dental abnormalities occurred exclusively in those dogs that had sustained fracture of the mandibular body or fracture at the transition of mandibular body and mandibular ramus. A high number of developing permanent teeth located in or near the mandibular fracture were affected (73.5%). The most common dental abnormalities were failure of eruption or partial eruption (29.0%), resorption (22.6%), abnormal shape (19.4%), and enamel hypoplasia (16.1%). The majority of deciduous teeth (64.3%) in or near the mandibular fracture exfoliated uneventfully. Ten out of 11 dogs needed a surgical procedure to treat dental abnormalities after mandibular fracture healing. The development of the tooth germs located in or near a mandibular fracture is frequently affected. Radiographic evaluation of the area of trauma is recommended until eruption and full development of the teeth are completed.

Etiology, Clinical Presentation, and Outcome of Mandibular Fractures in Immature Dogs Treated with non-Invasive or Minimally Invasive Techniques.

This study was performed to report etiology, clinical presentation, and outcome of mandibular fractures in immature dogs treated with non-invasive or minimally invasive techniques. Immature dogs diagnosed with mandibular fractures from 2001 to 2016 were included in this study. Diagnosis of the mandibular fracture was achieved by oral examination and diagnostic imaging in the anesthetized dog. Twenty-nine immature dogs with 54 mandibular fractures were selected. Within the mandibular body, the regions of the developing permanent canine and first molar teeth were most commonly involved (46.4% and 35.0%, respectively). Within the mandibular ramus, 53.8% of the fractures were located in its ventral half, and 38.5% in the condylar process. Muzzling was applied in 72.4% of the dogs. All dogs had clinical healing with resolution of signs of pain and recovery of mandibular function. Mean time for clinical healing was 21 ± 9 days. Age of the dog and duration of muzzling were significantly associated with the time needed for clinical healing. In immature dogs, fractures of the mandibular body occur most commonly in the regions of the developing permanent canine and first molar teeth, while fractures of the mandibular ramus are most commonly found in its ventral half and the condylar process. Non-invasive or minimally invasive management of mandibular fractures in immature dogs carries a good prognosis regarding clinical healing and recovery of mandibular function. Dogs should be monitored for the development of dental abnormalities and/or skeletal malocclusion until permanent teeth have erupted and jaw growth is completed.

Oral and Maxillofacial Tumor Management - From Biopsy to Surgical Removal.

The main objective of oral and maxillofacial (OMF) tumor resection is to get local control of the disease. Many OMF tumors can be cured with wide or radical surgery, whereas others might only achieve temporary local control of the disease by removing infection and the source of pain, thereby improving the quality of life of the patient while keeping masticatory function. The standard of care on managing OMF tumors includes the diagnosis and identification of the local and distant extension of the disease to establish an appropriate treatment plan tailored for each patient. In this article, we provide a practical review of the current information related to staging, biopsy, and main surgical techniques for OMF tumor removal.

Radiographic Assessment of the Feline Temporomandibular Joint with Oblique Projections: A Preliminary Ex Vivo Study.

Radiographic assessment of the temporomandibular joint in the domestic cat using conventional radiographic views can be challenging due to superimposition of overlying structures and the complex anatomy of the skull. The use of computed tomography, magnetic resonance imaging, and cone beam computed tomography to assess the temporomandibular joint in the cat has increased, but these modalities are not always available in general veterinary practices. Conventional radiography is still commonly used for first line assessment of the temporomandibular joint. The aim of this preliminary study was to determine optimal angle of obliquity of lateroventral-laterodorsal and laterorostral-laterocaudal (nose up lateral oblique) oblique radiographic views in the assessment of the temporomandibular joints in five feline mesaticephalic dry skulls. Visibility of the mandibular head, mandibular fossa, retroarticular process, and temporomandibular joint space were evaluated and scored by two veterinary radiologists. The results of this study identified that the dependent temporomandibular joint anatomy was best seen on the latero-10°-ventral-laterodorsal, latero-15°-ventral-laterodorsal, and latero-20°-ventral-laterodorsal, oblique views, and opposite lateral oblique views at these angulations may be helpful in characterization of this anatomy in clinical patients. The results also indicate that the laterorostral-laterocaudal (nose up lateral oblique) oblique view did not allow adequate discrimination of all TMJ anatomy at any angle, and is not recommended.

Characterization of Oral Microbiota in Cats: Novel Insights on the Potential Role of Fungi in Feline Chronic Gingivostomatitis.

Previous studies have suggested the involvement of viral and bacterial components in the initiation and progression of feline chronic gingivostomatitis (FCGS), but the role of fungi remains entirely unknown. This pilot study aimed to investigate the bacteriome and mycobiome in feline oral health and disease. Physical exams, including oral health assessment, of privately owned, clinically healthy (CH) cats (n = 14) and cats affected by FCGS (n = 14) were performed. Using a sterile swab, oral tissue surfaces of CH and FCGS cats were sampled and submitted for 16S rRNA and ITS-2 next-generation DNA sequencing. A high number of fungal species (n = 186) was detected, with Malassezia restricta, Malassezia arunalokei, Cladosporium penidielloides/salinae, and Aspergillaceae sp. being significantly enriched in FCGS samples, and Saccharomyces cerevisiae in CH samples. The bacteriome was significantly distinct between groups, and significant inter-kingdom interactions were documented. Bergeyella zoohelcum was identified as a potential biomarker of a healthy feline oral microbiome. These data suggest that fungi might play a role in the etiology and pathogenesis of FCGS, and that oral health should not simply be regarded as the absence of microbial infections. Instead, it may be viewed as the biological interactions between bacterial and fungal populations that coexist to preserve a complex equilibrium in the microenvironment of the mouth. Additional investigations are needed to improve our understanding of the feline oral ecosystem and the potential interactions between viruses, bacteria, and fungi in FCGS.

Immunohistochemical evaluation of suspected oral malignant melanoma in cats.

Oral malignant melanoma (OMM) is considered the third most common oral malignant neoplasm in cats, but its variable morphology and frequent lack of melanin pigment make it a diagnostic challenge. Twenty-two cases of cats with malignant oral neoplasms that were diagnosed as OMM or listed OMM as a suspected differential diagnosis on the biopsy report were examined using an immunohistochemistry (IHC) panel for S100, melan-A, PNL2, laminin, CD34, and pan-cytokeratin. Although OMM was suspected (n = 14) or previously diagnosed (n = 8), only 2 cases were immunohistochemically confirmed as OMM. Seven cases were classified as soft tissue sarcoma based on positive expression of CD34 or laminin, and one was classified as carcinoma based on positive expression of pan-cytokeratin. The majority of cases (n = 12) were categorized as unclassified malignant neoplasms because they did not express melan-A, PNL2, laminin, CD34, or pan-cytokeratin; however, a proportion of these did express S100 (n = 7). Long-term prognosis of all 22 cats was poor, with a median survival time of 87 days (range = 2-249 days). Cases with longer survival times (>100 days) were treated with surgery, radiation therapy, or a combination. For feline oral malignant neoplasms thought to be OMM, routine use of IHC is required for an accurate diagnosis.

Comparison of unilateral rostral, middle and caudal segmental mandibulectomies as an alternative treatment for unilateral temporomandibular joint ankylosis in cats: an ex vivo study.

OBJECTIVES: Temporomandibular joint ankylosis (TMJA) is the partial or complete inability to open the mouth due to intra- or extra-articular fibrous, bony or fibro-osseous tissue proliferation. Surgical procedures such as gap arthroplasty, condylectomy or wide extra-articular osteotomy have been recommended to treat this condition; these techniques are challenging, time-consuming and have been occasionally associated with postoperative recurrence, severe periarticular neurovascular iatrogenic trauma and death. Segmental mandibulectomy had previously been recommended as an alternative option for unilateral TMJA, but the location of mandibulectomy and extent of bone removal from the mandible region have not been mentioned in the literature. This study aimed to validate the area of the mandibular body (rostral, middle or caudal) and amount of bony tissue that should be osteotomized during a segmental mandibulectomy for treatment of unilateral TMJA in cats. METHODS: In this block study, 30 cadaver heads of domestic shorthair cats were randomly divided into three groups of 10 specimens each based on the mandibular region that would undergo segmental mandibulectomy (rostral, middle and caudal). The size of the removed mandibular segment and pre- and postoperative vertical range of mandibular motion were compared for statistical purposes. RESULTS: A significant statistical difference was observed between the pre- and postoperative vertical range of mandibular motion between the rostral, middle and caudal segmental mandibulectomies (P <0.001). The mean postoperative recovered range of mandibular motion for the rostral, middle and caudal segmental mandibulectomies was 50.4%, 81.9% and 90.4%, respectively. CONCLUSIONS AND RELEVANCE: The caudal segmental mandibulectomy showed the highest postoperative vertical range of mandibular motion. The removal of a minimum of 1.2 cm of the caudal mandibular body was required to achieve nearly full recovery of presurgical mouth opening in the specimens of this study. The caudal segmental mandibulectomy may eliminate the risk of iatrogenic periarticular neurovascular damage inherent to more invasive surgeries performed at the temporomandibular joint area. When performed unilaterally, the caudal segmental mandibulectomy is a viable surgical alternative that may show a similar outcome to other surgical techniques.

Diagnostic Yield of Micro-Computed Tomography (micro-CT) Versus Histopathology of a Canine Oral Fibrosarcoma.

Micro-computed tomography (micro-CT) imaging currently gains increased interest in human as well as veterinary medicine. The ability to image 3-dimensional (3D) biopsy specimens nondestructively down to 1 µm spatial resolution makes it a promising tool for microscopic tissue evaluation in addition to histopathology. Visualizing tumor margins and calculating tumor load on 3D reconstructions may also enhance oncological therapies. The objective of this study was to describe the workflow from tumor resection to histopathological diagnosis, using both routine hematoxylin-eosin (HE)-stained sections and micro-CT tomograms on a stage II oral fibrosarcoma in a 7-year-old Hovawart dog. The maxillectomy specimen was fixed with formalin and stained with an X-ray dense soft tissue contrast agent. Micro-CT imaging was done using an ex vivo specimen micro-CT device. Tumor margins could not be exactly determined on micro-CT tomograms due to limited image resolution and contrast. Histopathology was performed after washing out the contrast agent. It showed neoplastic cells infiltrating the surrounding tissue further than assumed from micro-CT images. A total tumor volume of 10.3 cm3 could be calculated based on correlating micro-CT tomograms with HE-stained sections. This correlative approach may be of particular interest for oncological therapy. More than that, micro-CT imaging technology supported histopathology by means of 3D orientation and selection of slices to be cut on determining tumor margins. In this clinical case report, micro-CT imaging did not provide unambiguous clinical evidence for oncological decision-making, but it showed potential to support histopathology and calculate tumor volume for further clinical use.

Locoregional Anesthesia of the Head.

Locoregional (local and regional) anesthesia is used routinely during surgical procedures of the head. The goal of this article is to provide a practical guide for the clinician to safely perform different techniques in dogs and cats and to minimize the risk of complications associated with locoregional anesthesia.

Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016).

The objectives of this study were to retrospectively describe clinicopathological features of eosinophilic oral disease in dogs, to identify possible risk factors or predispositions to the condition, and to report overall treatment response. Canine medical records from a veterinary teaching hospital and private referral practice over a 17-year period were reviewed for a diagnosis of eosinophilic oral disease. Twenty-four dogs with 26 lesions met the inclusion criteria. Patient mean age and body weight were 6.8 (3.8) years and 13.4 kg, respectively. Fifteen breeds were represented including Cavalier King Charles spaniel (16.7%), Labrador retriever (12.5%), and West Highland white terrier (12.5%). Eosinophilic lesions were found in the palate (65.4%), tongue (26.9%), and other oral locations (7.7%). Median follow-up time was 5 months. Analysis revealed statistically significant associations between lesion location and body weight (palatal and tongue lesions were more likely in smaller dogs, whereas lesions in the other category [lip or mucosa] were more likely in larger dogs). There was a correlation in lesion location and resolution (all dogs with palatal lesions became asymptomatic at their last recheck), and resolution and the use of antibiotics plus prednisone (greater likelihood of resolution without the use of this combination). Seventy percent of asymptomatic dogs resolved without medication or with allergen therapy alone, suggesting that asymptomatic dogs may respond well to conservative management. No associations were found between lesion location and breed, signalment and response to therapy, lesion resolution and the use of glucocorticoids, or significance of peripheral eosinophilia.

Continuous online process analytics with multiplexing gas chromatography by using calibrated convolution matrices.

The development of fast and precise measurement techniques for process analytical technology is important to operate chemical processes safely and efficiently. For quantitative measurements of multiple components at a trace level, often gas chromatographic methods are used which have a response time of several minutes or of up to one hour. For fast changing processes, this can be too slow for efficient control. For reducing the dead time of a control loop by increasing the measurement frequency, a multiplexing gas chromatography (mpGC) technique for a chromatographic system exhibiting a systematic non-linear response has been developed. For mpGC, superimposed chromatograms are measured by injecting consecutive samples before all components of previous samples have eluted from the column. The deconvolution of a superimposed chromatogram yields a computed chromatogram which is an average over the single chromatograms forming the superimposed chromatogram. Such a computed chromatogram typically shows so called correlation noise depending on the degree by which the single chromatograms forming the superimposed chromatogram will differ from each other (non-linear response). A technique is presented to calibrate the convolution matrix in order to suppress correlation noise introduced by systematic errors of the chromatographic system. The remaining correlation noise in the computed chromatogram is then exclusively caused by changing concentrations in the sample stream. For the method presented here, the sample is injected five times during the run time of a single chromatogram. The computed chromatogram is obtained three times within this timespan while representing each time an averaged chromatogram over the last five injections. Therefore, the sample throughput is increased by a factor of three compared to conventional GC.

Management and Outcome of Maxillofacial Trauma in a 9-Week-Old Dog.

This case report describes diagnosis, treatment, and outcome of maxillofacial trauma in a 9-week-old shih tzu. In addition to an open left mandibular body fracture and a right condylar process fracture, there were several relatively stable and minimally displaced right maxillary fractures. The torn soft tissues associated with the left mandibular body fracture were sutured closed, and a tape muzzle was placed. Due to sufficient fracture healing at the 2-week recheck examination, the tape muzzle was removed. The 6-week reexamination confirmed continued healing and recovery. Anesthesia was performed at the 5.5-month reexamination when the dog was 8 months old, revealing the presence of persistent deciduous teeth, linguoverted, malformed, and partially erupted permanent teeth, and asymmetric skeletal malocclusion (in addition to the breed-specific mandibular mesioclusion). Persistent deciduous teeth and linguoverted and malformed permanent teeth were extracted to allow for normal opening and closing of the mouth without traumatic occlusion. Long-term follow-up is recommended in juvenile dogs with maxillofacial injuries in order to prevent, recognize, and treat dental complications resulting from the trauma.

Corrigendum: Clinical Presentation, Causes, Treatment, and Outcome of Lip Avulsion Injuries in Dogs and Cats: 24 Cases (2001-2017).

[This corrects the article DOI: 10.3389/fvets.2018.00144.].