Soft Tissue Surgery

This encompasses all body systems except bones, joints and neurological system.  

Head and neck:

Eyes:

Most ocular diseases can be diagnosed here by one of our veterinarians. Although some disease of the eye will require more intensive diagnositics  and therapy which will be best  handled by a board certified ophthalmologist.  Our doctors will know when referral is necessary and work with you to achieve a successful outcome.  

Common Diseases of the eye:

Dry Eye or Keratoconjunctivitis sicca occurs then an inflammatory process causes decreased secretion of tears from the lacrimal gland.  This will commonly cause a yellowish green discharge.  Severe cases can develop secondary corneal ulcers.  This disease can be diagnosed by measuring tear production.  Treatment is often a combination of cyclosporine ointment and artificial tears such as gentile or refresh.  

Uveitis is inflammation of the interior of the eye.  It can have many causes.  Dogs will often have red painful eyes that are sensitive to light.  Uveitis treatment is based on the underlying cause.  

Corneal ulcers are a defect in the outer layer of the eye the cornea.  There are many different reasons a corneal ulcer can occur.  Some ulcers are so deep and severe they require immediate referral for emergency treatment or surgery.  Untreated ulcers can lead to rupture of the eye and severe infection.  Once the eye is ruptured it should be removed.  

Glaucoma is the elevation of intraocular pressures.  Glaucoma causes a squinty, red and very painful eye.  There are primary and secondary reasons for glaucoma in dog and cats.  Glaucoma should be diagnosed by your veterinarian and referral to a specialist should be discussed to identify the cause and best treatment plan.  

Cataracts are an opacity in the lens of the eye.  They occur in both dogs and cats for a host of reasons.  Cataracts can cause secondary uveitis which may require treatment.  Cataracts can also cause blindness.  Cataracts can in many cases be removed by a board certified veterinary ophthalmologist.  

Entropion is a common problem seen most commonly in dogs but can be seen in cats as well.  Entropion is when the upper, lower or both eyelids roll in and rub on the cornea.  Entropion is painful, causes corneal ulcers and is worsened by spasms caused by the pain of hair and skin rubbing on the cornea.  Surgical correction of this problem is recommended to mitigate secondary problems and pain.
 
Ectropion is a common problem seen in some breeds of dog.  These are the droopy eyelids that fall away from the cornea.  This can cause pain and inflammation in the eye as the purpose of the lids are to protect the eye and move the tear film during the blink.  Ectropion can be surgically corrected.  

Distichia are small little hairs in the eyelid margin that rub on the cornea.  These hairs are often difficult to see without magnification.  They cause pain (red squinty eye) and corneal ulcers.  We do not recommend plucking these hairs as there will be recurrence of growth from follicle.  These are best dealt with using cryotherapy to freeze and destroy the hair follicle.  Sometimes these hairs require multiple treatments.  These cases should be seen by an ophthalmologist after diagnosis.  

Meibomian gland tumors are masses that grow in the eyelid margin and rub on the cornea.  They will get large enough to rub on the cornea and cause pain.  These masses are benign and should be removed before they get to large and encompass too much of the eyelid margins.  Large masses can be removed but it is more difficult.  

Proptosed Globe is when after trauma an eye ball is sitting outside of the orbit.  This occurs most commonly after trauma in brachycephalic dogs.  If the eye is visual and not perforated it may be replaced and a temporary procedure is used to hold it in place until healed.  

Corneal Foreign Bodies are not common but do occur.  These are sharp objects like thorns ect.. stuck in cornea which must be removed .  These are an emergency and very painful.  You should not try and pull it out because you may leave fragments behind or cause catastrophic damage to the eye.  We feel these are surgical emergencies best handled by an ophthalmologist.  

This is not an all encompassing list of eye diseases just a few of the most common.  

Ears:
The most common problem is ear infections.  These occur in both dogs and cats but are definitely more in dogs.  Ear infections can occur for a myriad of reasons.  Most can be diagnosed with cytology (ear swab and examination of a slide of material), then cleared up with proper therapy based on cytology.  There are however exceptions in some dogs and cats that have complications secondary to chronic difficult to control and resolve infections.  

Ear Hematoma/ Ear Infection

Aural (ear) Hematoma is a fluid filled pocket in the pinna or ear flap.  If occurs secondary to scratching at ears, shaking head secondary to ear infection or mass in ear.  When this occurs a diagnosis of underlying cause of ear pain is necessary.  Surgery is indicated to drain fluid (hematoma) and reattach skin to cartilage. 

Total Ear Canal Ablation and Bulla Osteotomy (TECABO) 

Severe chronic ear infections can lead to end-stage ear disease.  This is characterized by calcification of both the horizontal and vertical ear canal, proliferation of tissue lining the canal causing stenosis of the canal.  The inner or boney portion of the ear or the bulla can become filled with infected and proliferative material which can lead to vestibular (neurological) signs, loss of balance in worst cases.  When this occurs these dogs can become very painful, resentful or aggressive when their ears are cleaned and medicated.  Usually at this point topical and oral medications are no longer helping.  Many of these dogs are deaf due to damage in their inner ear.  A total ear canal ablation and bulla osteotomy (TECA-BO) is a salvage procedure required to resolve both infection and pain associated with their ears.  A TECABO involves removing the entire ear canal both horizontal and vertical canals.  The facial nerve courses around ear canal and must be carefully removed from the inflamed tissue adhered to the canal.  It can be stretched or inflamed during this process.  It is critical to remove the lining  and infected material from the bulla.  It is best to obtain a culture from the bulla.  The incision is closed the ear remains relatively normal in appearance.  The difference is when the pinna (ear flap) is lifted there is no canal or opening.  These dogs are kept on antibiotics based on culture and sensitivity results for up to 60 days.  Some infections are very resistant to common antibiotics.  This is why culture and sensitivity are crucial to choosing the appropriate antibiotic.  Some dogs may have a delayed blink until facial nerve recovers.  These patients may require eye drops for lubrication of the cornea 3-4 times a day until a normal blink returns.  In rare cases if infection recurs draining tracts can occur.  Most of these dogs are deaf after surgery.  

We recognize this seems like a scary step and a big surgery.   These dogs are so painful and their ear disease is diminishing their quality of life.  After surgery the majority of these dogs feel good again.  The pain associated with chronic infection and medication is gone.  Now they can return to being the dog everyone remembered before the ear infections.  
Inflammatory Polyp

Young cats can develop inflammatory polyps which grow in the canal and lead to ear infections, sneezing, very loud or can sit in back of the throat on top of the soft palpate and extend into the ear through eustachian tube.  The cause of inflammatory polyps is unknown and they are benign masses.  These polyps can be diagnosed with otic and oral examination with the patient under anesthesia.  Some cases require more advanced imaging such as CT or MRI.  These masses may be removed without surgery using traction.  However, they may recur with this method of removal.  The best method of removal is ventral bulla osteotomy.  With this method recurrence is less than 2%.  

Neoplasia, Cancer or Tumors in Ear

Neoplasia (Cancerous) Tumors of the ear an occur in dogs and cats of any age but are most common in older pets.  These masses may be on the pinna (ear flap) or within the ear canal or bulla.  Pinnas (ear flaps) can be removed so cancer is completely removed with adequate margins.  Masses that occur within the ear canal an outside the bulla can be completely removed with a total ear canal ablation and bulla osteotomy (TECABO).  Large invasive tumors may require advanced imaging such as CT scan or MRI to determine if surgical resection is possible and if it is possible these images are required to plan surgical intervention.  

Mouth:

Masses, Cancer, Neoplasia

Dogs and cats can develop masses in their mouths.  The mouth is the 4th most common area to see cancer in dogs and cats.  Your pet should have an oral examination at their annual examination to try and detect any changes.  Masses can occur on lips, around teeth, on tongue or in the upper or lower jaws.  These masses can cause pain, bleeding and loss of teeth.  

The work-up is to determine if your pet does not have spread of tumor to any distant sites.  This is done with  thorough physical examination, chest radiographs(x-rays).  We also perform blood work to assure there are no abnormalities that would make anesthesia a concern.  Depending on the size and location of the mass or tumor an incisional biopsy may be recommended.  This will allow us to determine the kind of cancer.   The information gleaned from a biopsy will allow us to discuss prognosis, the surgery required and any potential concerns.  

Mandibulectomy is the removal of a portion of the lower jaw.  

Maxillectomy is the removal of a portion of the lower jaw.

Glossectomy is the removal of a portion of the tongue.  

The most common malignant tumors in the dog are malignant melanoma, squamous cell carcinoma, and fibrosarcoma.  Squamous cell carcinoma is the most common type in cats.  Osteosarcomas are tumor of bone cells and they account for only about 10 %  of tumors in the upper and lower jaws of dogs.  The most common benign tumor in dogs arise from the teeth and gingiva (epulides).  

Dogs that have surgical resection of tumors that involve maxillectomy, mandibulectomy are hospitalized for 2-4 days.  They tend to recovery very well and go back to eating and drinking during their hospital stay.  Some dogs with loss a portion of the mandible will drool for a while after surgery and their tongue may hang out until they learn to hold it in their mouth.  These issues usually resolve.  

Salivary Mucoceles:

These are soft fluctuant swellings that fill with saliva.  They occur most commonly secondary to damage to ducts of mandibular or sublingual salivary glands.  

Cervical mucocele is a swelling at the top of the neck just behind the lower jaw.  These are diagnosed by location, aspiration of saliva from the mass or swelling.  These usually develop slowly over time and do not appear to be painful.  Cervical mucoceles are treated by removing the mandibular and sublingual salivary glands.  These dogs have a good recovery and go home after an overnight stay in the hospital.  Complications after surgery are uncommon but may include seroma formation, infection or recurrence.  In rare cases mucoceles will resolve without surgery.  The prognosis is excellent.  Dogs produce enough saliva without these glands.  

Rannula is a swelling under the tongue that is filled with saliva.  Dogs frequently bite or traumatize these swellings leading to blood in the mouth and bloody saliva.  Rannulas may be treated by marsupialization.  This is done by making an incision in the swelling allowing it to drain and then suturing the edges to the mucosa leaving it open.  Some rannulas will recur and then require removal of the associated mandibular and sublingual gland.  So we may decide to marsupialize and remove the glands in the same surgical session to avoid a second surgery  These dogs have a good prognosis.  They will have some bloody drainage for a few days after surgery.  

Pharyngeal and zygomatic mucoceles occur and are occasionally seen clinically.  

Congenital oronasal fistula (Cleft Palate)

These are abnormal communications between mouth and nose.  These can be found in hard palate, soft palate, premaxilla (lip).  

These malformations will be noticed in young animals when they see water or food as a nasal discharge.  Young animals can have a failure to thrive and develop severe respiratory infection.  

Young animals can be tube fed until they can have surgical repair.  We try to repair these patients at 8-12 weeks of age.  These clefts are closed using a series of flaps and releasing incisions.  We place feeding tubes in some of these patients to provide adequate nutrition while surgery heals.  

It is not unusual for young growing animals to require multiple surgeries to completely close these defects.  Once defects are closed or very small patients can have a normal life.  

Acquired oronasal fistulas are opening between mouth and nose that occur secondary to dental disease or trauma.  These fistulas are closed using flaps.  They will heal nicely if they can be closed without tension, patients do not damage repair with their tongue.  Should your pet suffer dehiscence or recurrence we should allow 4-6 weeks to repair the fistula to allow tissues to heal and hold suture.  
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