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Mandibulectomies in dogs and some of the most common complications-Mandibulectomiile la caine si unele dintre cele mai intalnite complicatii

Complicatiile in operatiile radicale de tip mandibulectomie nu sunt teoretice ci sunt asteptate, sunt imediate, pe termen mediu si lung. Cele mai multe necesita management rezonabil pe termen mediu iar unele necesita interventii ulterioare, eventual succesive pentru a controla sau directiona procesul de vindecare. Cele mai multe interventii determina cel putin aspecte cosmetice evidente dar acestea sunt insotite de posibilitatea infectiilor locale, expunerilor osoase, necroze, departarea marginilor de incizie, chistii salivari, dificultatile de deglutitie si de preluare a apei si hranei, miros neplacut al respiratiei, salivatie excesiva, depozite linguale, durere locala, edem, inflamatie, afectarea limfonodurilor regionale si a glandelor salivare la departare de locul interventiei, dificultati in toaletare, anxietate si, poate la fel de dificil ca orice complicatie medicala, lipsa de adeziune si schimbarea opiniei proprietarului in raport cu interventia si boala de fond ce a dus la necesarul chirurgical. Aceste complicatii se rezolva in timp, complet sau partial si sunt un efort comun si greoi. Cele mai multe interventii sunt realizate in cazul bolilor canceroase dar nu doar acestea solicita astfel de interventii complexe si radicale.

Fig. 1. One of the complications after mandibulectomy in dogs: bone edge exposure and necrosis. After surgery some wounds would heal improperly or leave some of the bone tissue exposed. This event can lay the ground for local pain, gingivitis, osteitis and necrosis.
Fig. 2. After surgery one or both of the mandibular edges can be exposed after wound dehiscence, suture fail or local soft tissue tears. Permanent local movement, saliva action on non-mucosal tissues, tongue and local muscle contrcation and salivary cysts can negatively influence tissue healing. Also, dental roots exposed on the osteotomy site may be a source of pain, abces and necrosis.

Fig. 3. Some of the many complications after mandibulectomy: salivary cyst, lymph node enlargement, abdnormal tongue position, drooling, partial or total dysphagia, improper cosmetics, xerostomy.

Fig. 4. Suture fail after mandibulectomy with pain, drooling, anorexia, bone edge exposure, dehiscence and soft tissue necrosis due to saliva action on non-mucosal tissue.

Fig. 5. Large edema and salivary cyst after mandibulectomy in a dog with SCC. Also one can observe bone edge exposure of one of the mandibular rims. After mandibulectomy maloclusion is one of the most obvious complications with rapid dental deposits and a recurrent need for dental examinations and cleaning.
Fig. 6. Local edema, inflamation, drooling after mandibulectomy in a dog.

Fig. 7. Edema, salivary cyst, partial comisure wound dehiscence after mandibulectomy in a dog.

Fig. 8. Bone edge exposure, gingivitis, dehiscence, dental deposits, drooling, mild local pain after mandibulectomy in one dog.

Fig. 9. Drooling, edema, improper tongue position, tongue deposits and questionable cosmetics after mandibulectomy in a dog. This dog is unable to drink or eat by its own without owner assistance.

Fig. 10. Local scars and soft tissue aspect after mandibulectomy in a dog.

Fig. 11. One complication after mandibulectomies in dogs can be suplementary exodontics of the roots and teeth close to the osteotomy lines.
Fig. 12. Wound dehiscence and suture fail with bone edge exposure after mandibulectomy in a dog.

Fig. 13. Long after wounds are healed following mandibulectomies in dogs, one of the most important complication is the copious dental deposit needing regular dental cleaning in order to reduce gingivitis, root exposure, dental mobility and loss.

de Dr. Daniel Lescai

Doctor in Medicina Veterinara