Parotid duct is opposite to?
A- Maxillary premolar.
B- Maxillary 1st molar.
C- Maxillary 2nd molar.
D- Mandibular 1st molar.
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Parotid duct transposition:
Dry keratoconjunctivitis:
The clinical signs of an inadequate production of watery tears, called dry keratoconjunctivitis, include: matt opaque cornea with large mucous discharge and hyperemic conjunctiva. If the onset is acute, corneal ulceration often complicates the disease.
Acute dry keratoconjunctivietes may be the result of an infection or trauma of the lacrimal gland or drug intoxication. The sudden absence of watery tear secretion should be considered as an ophthalmic emergency. The cornea, privately deprived of the preocular tear film, dries early and the patient exhibits intense eye pain with blepharospasm and frequent corneal ulcers. If left unchecked, perforation and a corneal staphyloma often occur.
Acute dry keratoconjunctivitis may need both medical and surgical treatment. The first includes the administration of tear and tear gas, in addition to topical broad-spectrum antibiotics. Before a cornea that deteriorates rapidly, the conjunctival flaps and the nictitating membrane flaps can be considered. These biological bandages provide support, nutrition and oxygen to aid in the healing process.
The chronic form, the most common of dry keratoconjunctivitis, is characterized by the aforementioned signs and also by pigment infiltration and corneal neovascularization. These latter processes contribute to corneal opacification and decreased vision. In the cat, the signs of this keratoconjunctivitis are similar, but with less corneal pigmentation.
DIAGNOSTIC METHODS:
Dry keratoconjunctivitis should be distinguished from other types of conjunctivitis. In addition to a complete ophthalmic exam, the schirmer test is used to measure tear production. This test includes the placement of a commercial strip of filter paper, 5 x 35 mm. In the bottom of the lower eyelid sac. The length of this strip that gets wet in 60 seconds reflects the production of tears. Basal and reflex production is measured without topical anesthetic. Normal values for the first are 21 mm in 60 seconds in the dog and 16.9 mm. in 60 seconds in the cat. Values between 6 and 14 mm in 60 seconds are suggestive of a deficiency of the aqueous tear film. This test should be performed before excessive manipulations of eyelids or attachments and before instilling solutions, such as topical anesthetics or artificial tears, as this may alter the results.
The parotid salivary gland has the shape of a "V" and is located at the base of the atrial cartilage. Its rostral edge is located over the masseter muscle and the tempormandibular joint. The main duct is formed by the convergence of 2 or 3 small ducts, distal to the gland. In a mesocephalic dog, the duct of almost 1.5 mm. In diameter it extends around 6 cm. Rostral direction and travels the superficial face of the masseter muscle. Its secretion enters the oral cavity through a papilla located laterally to the caudal edge of the upper four premolar.
Open surgical technique:
The open approach provides optimal surgical exposure and thus facilitates dissection, reducing the possibility of sectioning or rotating the canal and allowing the identification of the buccal nerve and facial vein.
General anesthesia is performed. The parotid salivary canal is catheterized with dark monofilament nylon. The passage of the suture is difficult due to the tortuosity of the distal portion of the duct in the submucosa. This curvature can be straightened, facilitating the passage of nylon, taking the rostral mucosa to the papilla and carrying it with the conduit forward. The nylon that is exposed is passed, the peripapillary mucosa is fixed with a knot. the papilla area is cleaned with an antiseptic solution
From the oral cavity, the papilla is separated with a 5mm mucosa collar. From the rest of the oral mucosa. The papilla and 8 to 10 mm are dissected. Duct with a BishopHarmon clamp and a Stevens tenotomy scissors. The instruments used in the oral part of the surgery are discarded due to contamination; The surgeon should change gloves.
The side face of the face is prepared for aseptic surgery and the cloths are properly placed. Nylon placed inside the duct can be easily palpated through the skin and serves as a reference to find the site of skin incision. The cutaneous dieresis is performed on the skin and facial muscles at the level of the duct. Using a magnifying glass with low magnification helps to dissect the duct and reduces the possibility of sectioning it.
A- Maxillary premolar.
B- Maxillary 1st molar.
C- Maxillary 2nd molar.
D- Mandibular 1st molar.
----------------------------------
Parotid duct transposition:
Dry keratoconjunctivitis:
The clinical signs of an inadequate production of watery tears, called dry keratoconjunctivitis, include: matt opaque cornea with large mucous discharge and hyperemic conjunctiva. If the onset is acute, corneal ulceration often complicates the disease.
Acute dry keratoconjunctivietes may be the result of an infection or trauma of the lacrimal gland or drug intoxication. The sudden absence of watery tear secretion should be considered as an ophthalmic emergency. The cornea, privately deprived of the preocular tear film, dries early and the patient exhibits intense eye pain with blepharospasm and frequent corneal ulcers. If left unchecked, perforation and a corneal staphyloma often occur.
Acute dry keratoconjunctivitis may need both medical and surgical treatment. The first includes the administration of tear and tear gas, in addition to topical broad-spectrum antibiotics. Before a cornea that deteriorates rapidly, the conjunctival flaps and the nictitating membrane flaps can be considered. These biological bandages provide support, nutrition and oxygen to aid in the healing process.
The chronic form, the most common of dry keratoconjunctivitis, is characterized by the aforementioned signs and also by pigment infiltration and corneal neovascularization. These latter processes contribute to corneal opacification and decreased vision. In the cat, the signs of this keratoconjunctivitis are similar, but with less corneal pigmentation.
DIAGNOSTIC METHODS:
Dry keratoconjunctivitis should be distinguished from other types of conjunctivitis. In addition to a complete ophthalmic exam, the schirmer test is used to measure tear production. This test includes the placement of a commercial strip of filter paper, 5 x 35 mm. In the bottom of the lower eyelid sac. The length of this strip that gets wet in 60 seconds reflects the production of tears. Basal and reflex production is measured without topical anesthetic. Normal values for the first are 21 mm in 60 seconds in the dog and 16.9 mm. in 60 seconds in the cat. Values between 6 and 14 mm in 60 seconds are suggestive of a deficiency of the aqueous tear film. This test should be performed before excessive manipulations of eyelids or attachments and before instilling solutions, such as topical anesthetics or artificial tears, as this may alter the results.
The parotid salivary gland has the shape of a "V" and is located at the base of the atrial cartilage. Its rostral edge is located over the masseter muscle and the tempormandibular joint. The main duct is formed by the convergence of 2 or 3 small ducts, distal to the gland. In a mesocephalic dog, the duct of almost 1.5 mm. In diameter it extends around 6 cm. Rostral direction and travels the superficial face of the masseter muscle. Its secretion enters the oral cavity through a papilla located laterally to the caudal edge of the upper four premolar.
Open surgical technique:
The open approach provides optimal surgical exposure and thus facilitates dissection, reducing the possibility of sectioning or rotating the canal and allowing the identification of the buccal nerve and facial vein.
General anesthesia is performed. The parotid salivary canal is catheterized with dark monofilament nylon. The passage of the suture is difficult due to the tortuosity of the distal portion of the duct in the submucosa. This curvature can be straightened, facilitating the passage of nylon, taking the rostral mucosa to the papilla and carrying it with the conduit forward. The nylon that is exposed is passed, the peripapillary mucosa is fixed with a knot. the papilla area is cleaned with an antiseptic solution
From the oral cavity, the papilla is separated with a 5mm mucosa collar. From the rest of the oral mucosa. The papilla and 8 to 10 mm are dissected. Duct with a BishopHarmon clamp and a Stevens tenotomy scissors. The instruments used in the oral part of the surgery are discarded due to contamination; The surgeon should change gloves.
The side face of the face is prepared for aseptic surgery and the cloths are properly placed. Nylon placed inside the duct can be easily palpated through the skin and serves as a reference to find the site of skin incision. The cutaneous dieresis is performed on the skin and facial muscles at the level of the duct. Using a magnifying glass with low magnification helps to dissect the duct and reduces the possibility of sectioning it.
The dissection is continued proximally, to the base of the gland where the conduits converge and distally to the papilla below the buccal nerves and communicating branch and facial vein. These structures are superficial to the duct and must be left intact.
Then the duct can be released in its entirety, due to the oral dissection before performed.
A subcutaneous tunnel is created from the parotid to the ventrolateral fornix of the eye, with a straight mosquito clamp. The tunnel extends until the clamp can be observed subconjunctivally. The conjunctiva is incised and a second mosquito clamp is placed between the sheets of the first. The path is already worked, but in reverse, until the second clip appears at the site of the primary skin incision. With this clamp, a point made at the level of the papillary mucosa is taken and taken to the conjunctival fornix. Care must be taken during the manipulation of the duct and the papilla. It is necessary to avoid the torsion of the duct, due to possible compromise of the permeability of its light.
Excessive mucosa is trimmed and the papilla is fixed to the conjunctiva, with 4 or 6 interrupted single points of polyglactin.
Closed surgical technique:
The closed approach includes dissection of the paratid duct exclusively from the oral cavity. This technique produces less post-surgical edema and allows dissection of the duct without manipulation of the facial vein and branches of the buccal nerve. The disadvantages include an increased risk of contamination from the oral cavity and a blind dissection.
The pre-surgical evaluation and preparation are the same as for the open technique; duct catheterization is included. The incision of the peripapillary mucosa with a diameter of 3 to 4 mm is made. That is removed along with the papilla of the duct. Both structures are manipulated by traction. The duct is released from the mucosa and adjacent submucolsal connective tissue by tenotomy scissors. Once the papilla is free, the buccal incision extends caudally, so that it will continue with the dissection of the canal. A sufficient portion of it is isolated to allow a change of direction towards the lateral edge without straining it. A subcutaneous tunnel to the lateral edge is manufactured, as is done in the open technique.
The incision of the conjunctiva creates an opening in the ventrolateral fornix. This is where the papilla and the mucosa collar are directed carefully so as not to stretch or twist the canal. The excess mucosa of the peripapillary collar is trimmed and then sutured to it, facing the conjunctiva with interrupted single points of polyglactin 910.6-0. The oral incision is sutured with a reversal pattern with 5-0 absorbable material.
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Oral Surgery