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Surgery of the oral cavity and oropharynx
/content/chapter/10.22233/9781910443347.chap3
Surgery of the oral cavity and oropharynx
- Authors: Alexander M. Reiter and Mark M. Smith
- From: BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery
- Item: Chapter 3, pp 27 - 45
- DOI: 10.22233/9781910443347.3
- Copyright: © 2018 British Small Animal Veterinary Association
- Publication Date: October 2018
Abstract
Surgery of the oral cavity and oropharynx is required to treat neoplasia, traumatic and congenital lesions, and diseases affecting the lips and salivary glands. The clinical signs, diagnosis, surgical management, prognosis and postoperative care of these problems are addressed in this chapter. Operative Techniques: Partial rostral maxillectomy; Total mandibulectomy; Cleft palate repair; Split palatal U-flap technique; Oronasal fistula repair; Mandibular and sublingual salivary gland resection (lateral approach).
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Figures
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3.1
Punch biopsy of a fibrosarcoma at the rostral maxilla in a dog. Two previous biopsies had indicated a peripheral odontogenic fibroma. A small mucoperiosteal flap was created to obtain a deeper tissue sample. © 2018 British Small Animal Veterinary Association
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3.1
Punch biopsy of a fibrosarcoma at the rostral maxilla in a dog. Two previous biopsies had indicated a peripheral odontogenic fibroma. A small mucoperiosteal flap was created to obtain a deeper tissue sample.
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3.2
Peripheral odontogenic fibroma of the mandibular incisor area in a dog. © 2018 British Small Animal Veterinary Association
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3.2
Peripheral odontogenic fibroma of the mandibular incisor area in a dog.
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3.3
Right maxillary malignant melanoma in a dog. Note the extension of tumour tissue into alveolar and buccal mucosa. © 2018 British Small Animal Veterinary Association
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3.3
Right maxillary malignant melanoma in a dog. Note the extension of tumour tissue into alveolar and buccal mucosa.
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3.4
Squamous cell carcinoma of the right maxillary area in a dog. © 2018 British Small Animal Veterinary Association
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3.4
Squamous cell carcinoma of the right maxillary area in a dog.
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3.5
Fibrosarcoma of the left mandible in a dog. © 2018 British Small Animal Veterinary Association
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3.5
Fibrosarcoma of the left mandible in a dog.
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3.6
Lower lip avulsion in a kitten after motor vehicle trauma. © 2018 British Small Animal Veterinary Association
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3.6
Lower lip avulsion in a kitten after motor vehicle trauma.
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3.7
(a) Lingual calcinosis circumscripta in a dog. (b) A radiograph of the excised tissue showing a circumscribed lesion containing material with bone density that is arranged in lobules. © 2018 British Small Animal Veterinary Association
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3.7
(a) Lingual calcinosis circumscripta in a dog. (b) A radiograph of the excised tissue showing a circumscribed lesion containing material with bone density that is arranged in lobules.
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3.8
Cleft of the primary palate in a Bulldog. There are no rugae on the left side of the hard palate, indicating previous repair of a cleft of the secondary palate. © 2018 British Small Animal Veterinary Association
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3.8
Cleft of the primary palate in a Bulldog. There are no rugae on the left side of the hard palate, indicating previous repair of a cleft of the secondary palate.
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3.9
Acute oronasal fistula following extraction of the right maxillary canine tooth. © 2018 British Small Animal Veterinary Association
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3.9
Acute oronasal fistula following extraction of the right maxillary canine tooth.
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3.10
Cleft of the secondary hard palate in a Bulldog repaired using the overlapping double flap technique. The larger major palatine artery (*) and smaller accessory palatine artery (arrowed) are attached to the overlapped flap. © 2018 British Small Animal Veterinary Association
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3.10
Cleft of the secondary hard palate in a Bulldog repaired using the overlapping double flap technique. The larger major palatine artery (*) and smaller accessory palatine artery (arrowed) are attached to the overlapped flap.
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3.11
Traumatic cleft palate in a cat repaired with medially positioned double flaps. An inter-arcade fixation was necessary to reduce bone separation, and bilateral relieving incisions were made to accommodate the flaps. © 2018 British Small Animal Veterinary Association
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3.11
Traumatic cleft palate in a cat repaired with medially positioned double flaps. An inter-arcade fixation was necessary to reduce bone separation, and bilateral relieving incisions were made to accommodate the flaps.
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3.12
Cervical sialocele (arrowed) in a Poodle. © 2018 British Small Animal Veterinary Association
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3.12
Cervical sialocele (arrowed) in a Poodle.
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Maxillectomy with an osteotome and mallet.
Maxillectomy with an osteotome and mallet. © 2018 British Small Animal Veterinary Association
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Maxillectomy with an osteotome and mallet.
Maxillectomy with an osteotome and mallet.
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Resection of the premaxilla and/or maxilla exposes the nasal cavity.
Resection of the premaxilla and/or maxilla exposes the nasal cavity. © 2018 British Small Animal Veterinary Association
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Resection of the premaxilla and/or maxilla exposes the nasal cavity.
Resection of the premaxilla and/or maxilla exposes the nasal cavity.
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A single-layer, buccal mucosal closure is performed.
A single-layer, buccal mucosal closure is performed. © 2018 British Small Animal Veterinary Association
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A single-layer, buccal mucosal closure is performed.
A single-layer, buccal mucosal closure is performed.
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The dog is positioned in lateral recumbency. Exposure of the caudal mandible can be enhanced by retraction of the labial commissures.
The dog is positioned in lateral recumbency. Exposure of the caudal mandible can be enhanced by retraction of the labial commissures. © 2018 British Small Animal Veterinary Association
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The dog is positioned in lateral recumbency. Exposure of the caudal mandible can be enhanced by retraction of the labial commissures.
The dog is positioned in lateral recumbency. Exposure of the caudal mandible can be enhanced by retraction of the labial commissures.
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Symphyseal osteotomy must be performed early in the procedure to enhance surgical exposure of the medial mandible and associated structures. A large Backhaus towel clamp or bone-holding forceps will facilitate manipulation of the mandible.
Symphyseal osteotomy must be performed early in the procedure to enhance surgical exposure of the medial mandible and associated structures. A large Backhaus towel clamp or bone-holding forceps will facilitate manipulation of the mandible. © 2018 British Small Animal Veterinary Association
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Symphyseal osteotomy must be performed early in the procedure to enhance surgical exposure of the medial mandible and associated structures. A large Backhaus towel clamp or bone-holding forceps will facilitate manipulation of the mandible.
Symphyseal osteotomy must be performed early in the procedure to enhance surgical exposure of the medial mandible and associated structures. A large Backhaus towel clamp or bone-holding forceps will facilitate manipulation of the mandible.
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The mandible is displaced laterally and the labial incision is continued, the mylohyoid and digastricus muscles divided and the mandibular alveolar artery, vein and nerve identified and divided.
The mandible is displaced laterally and the labial incision is continued, the mylohyoid and digastricus muscles divided and the mandibular alveolar artery, vein and nerve identified and divided. © 2018 British Small Animal Veterinary Association
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The mandible is displaced laterally and the labial incision is continued, the mylohyoid and digastricus muscles divided and the mandibular alveolar artery, vein and nerve identified and divided.
The mandible is displaced laterally and the labial incision is continued, the mylohyoid and digastricus muscles divided and the mandibular alveolar artery, vein and nerve identified and divided.
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The masseter temporalis and medial pterygoid muscles are removed from the lateral mandible and coronoid process to expose the temporomandibular joint.
The masseter temporalis and medial pterygoid muscles are removed from the lateral mandible and coronoid process to expose the temporomandibular joint. © 2018 British Small Animal Veterinary Association
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The masseter temporalis and medial pterygoid muscles are removed from the lateral mandible and coronoid process to expose the temporomandibular joint.
The masseter temporalis and medial pterygoid muscles are removed from the lateral mandible and coronoid process to expose the temporomandibular joint.
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Disarticulate the temporomandibular joint and remove the final attachments of the temporalis muscle to the dorsal mandibular coronoid process to complete the mandibulectomy.
Disarticulate the temporomandibular joint and remove the final attachments of the temporalis muscle to the dorsal mandibular coronoid process to complete the mandibulectomy. © 2018 British Small Animal Veterinary Association
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Disarticulate the temporomandibular joint and remove the final attachments of the temporalis muscle to the dorsal mandibular coronoid process to complete the mandibulectomy.
Disarticulate the temporomandibular joint and remove the final attachments of the temporalis muscle to the dorsal mandibular coronoid process to complete the mandibulectomy.
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Commissuroplasty can minimize lateral tongue displacement as a complication of this procedure and is essential for brachycephalic dogs.
Commissuroplasty can minimize lateral tongue displacement as a complication of this procedure and is essential for brachycephalic dogs. © 2018 British Small Animal Veterinary Association
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Commissuroplasty can minimize lateral tongue displacement as a complication of this procedure and is essential for brachycephalic dogs.
Commissuroplasty can minimize lateral tongue displacement as a complication of this procedure and is essential for brachycephalic dogs.
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Oral mucosa is closed with synthetic absorbable suture material and the skin with non-absorbable suture material.
Oral mucosa is closed with synthetic absorbable suture material and the skin with non-absorbable suture material. © 2018 British Small Animal Veterinary Association
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Oral mucosa is closed with synthetic absorbable suture material and the skin with non-absorbable suture material.
Oral mucosa is closed with synthetic absorbable suture material and the skin with non-absorbable suture material.
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Hard palate defect.
Hard palate defect. © 2018 British Small Animal Veterinary Association
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Hard palate defect.
Hard palate defect.
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Incisions are made in the mucoperiosteum of the hard palate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made in the mucoperiosteum of the hard palate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Incisions are made in the mucoperiosteum of the hard palate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made in the mucoperiosteum of the hard palate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Elevating flap B.
Elevating flap B. © 2018 British Small Animal Veterinary Association
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Elevating flap B.
Elevating flap B.
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Elevating flap A. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Elevating flap A. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Elevating flap A. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Elevating flap A. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Elevating flap A. Note the major palatine artery (arrowed) attached to the flap. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Elevating flap A. Note the major palatine artery (arrowed) attached to the flap. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Elevating flap A. Note the major palatine artery (arrowed) attached to the flap. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Elevating flap A. Note the major palatine artery (arrowed) attached to the flap. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Flap A is turned on itself and sutured under flap B so that connective tissue surfaces are in contact. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Flap A is turned on itself and sutured under flap B so that connective tissue surfaces are in contact. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Flap A is turned on itself and sutured under flap B so that connective tissue surfaces are in contact. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Flap A is turned on itself and sutured under flap B so that connective tissue surfaces are in contact. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Incisions are made at the margins of the soft palate defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made at the margins of the soft palate defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Incisions are made at the margins of the soft palate defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made at the margins of the soft palate defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Dorsal and ventral flaps are sutured separately. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Dorsal and ventral flaps are sutured separately. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Dorsal and ventral flaps are sutured separately. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Dorsal and ventral flaps are sutured separately. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Both defects closed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Both defects closed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Both defects closed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Both defects closed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Appearance at end of operation.
Appearance at end of operation. © 2018 British Small Animal Veterinary Association
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Appearance at end of operation.
Appearance at end of operation.
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Incisions are made at the medial edges of the hard palate defect. Relieving incisions 2 mm away from the gingiva are often necessary for accommodation of the flaps. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made at the medial edges of the hard palate defect. Relieving incisions 2 mm away from the gingiva are often necessary for accommodation of the flaps. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Incisions are made at the medial edges of the hard palate defect. Relieving incisions 2 mm away from the gingiva are often necessary for accommodation of the flaps. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incisions are made at the medial edges of the hard palate defect. Relieving incisions 2 mm away from the gingiva are often necessary for accommodation of the flaps. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Undermining the mucoperiosteum. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Undermining the mucoperiosteum. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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Undermining the mucoperiosteum. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Undermining the mucoperiosteum. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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The margins of the defect are debrided, and two flaps of unequal length are created rostral to the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The margins of the defect are debrided, and two flaps of unequal length are created rostral to the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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The margins of the defect are debrided, and two flaps of unequal length are created rostral to the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The margins of the defect are debrided, and two flaps of unequal length are created rostral to the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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The mucoperiosteal flaps are raised with a periosteal elevator. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The mucoperiosteal flaps are raised with a periosteal elevator. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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The mucoperiosteal flaps are raised with a periosteal elevator. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The mucoperiosteal flaps are raised with a periosteal elevator. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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The shorter flap (B) is rotated through 90 degrees and sutured over the defect. The longer flap (A) is rotated through 90 degrees and sutured to the edge of flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The shorter flap (B) is rotated through 90 degrees and sutured over the defect. The longer flap (A) is rotated through 90 degrees and sutured to the edge of flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
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The shorter flap (B) is rotated through 90 degrees and sutured over the defect. The longer flap (A) is rotated through 90 degrees and sutured to the edge of flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The shorter flap (B) is rotated through 90 degrees and sutured over the defect. The longer flap (A) is rotated through 90 degrees and sutured to the edge of flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Chronic oronasal fistula in the area of a missing right maxillary canine tooth in a dog.
Chronic oronasal fistula in the area of a missing right maxillary canine tooth in a dog. © 2018 British Small Animal Veterinary Association
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Chronic oronasal fistula in the area of a missing right maxillary canine tooth in a dog.
Chronic oronasal fistula in the area of a missing right maxillary canine tooth in a dog.
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Appearance of the oronasal fistula once the debris and hair have been removed.
Appearance of the oronasal fistula once the debris and hair have been removed. © 2018 British Small Animal Veterinary Association
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Appearance of the oronasal fistula once the debris and hair have been removed.
Appearance of the oronasal fistula once the debris and hair have been removed.
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A labial mucosal flap has been sutured to the hard palate mucosa.
A labial mucosal flap has been sutured to the hard palate mucosa. © 2018 British Small Animal Veterinary Association
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A labial mucosal flap has been sutured to the hard palate mucosa.
A labial mucosal flap has been sutured to the hard palate mucosa.
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Position of curvilinear incision (white dotted line) from the bifurcation of the external jugular vein (shown in blue) to the caudoventral aspect of the mandibular body.
Position of curvilinear incision (white dotted line) from the bifurcation of the external jugular vein (shown in blue) to the caudoventral aspect of the mandibular body. © 2018 British Small Animal Veterinary Association
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Position of curvilinear incision (white dotted line) from the bifurcation of the external jugular vein (shown in blue) to the caudoventral aspect of the mandibular body.
Position of curvilinear incision (white dotted line) from the bifurcation of the external jugular vein (shown in blue) to the caudoventral aspect of the mandibular body.
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The mandibular salivary gland and the contiguous sublingual gland complex course between the masseter and digastricus muscles. Dissection is performed carefully rostral to the digastricus muscle in order to visualize the lingual nerve. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The mandibular salivary gland and the contiguous sublingual gland complex course between the masseter and digastricus muscles. Dissection is performed carefully rostral to the digastricus muscle in order to visualize the lingual nerve. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association
10.22233/9781910443347/pg52_2_thumb.gif
10.22233/9781910443347/pg52_2.png
The mandibular salivary gland and the contiguous sublingual gland complex course between the masseter and digastricus muscles. Dissection is performed carefully rostral to the digastricus muscle in order to visualize the lingual nerve. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The mandibular salivary gland and the contiguous sublingual gland complex course between the masseter and digastricus muscles. Dissection is performed carefully rostral to the digastricus muscle in order to visualize the lingual nerve. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.