it deals with the congenital affections of hard and soft palate in canines and calves and their surgical treatment

2. Affections of palate and
their surgical management
submitted by : Safeer ahmad
submitted to : Dr. R B Kushwaha
VCP 421

3. Affections s
Cleft palate
Elongated soft palate

4. CLEFT PALATE
 A Cleft is not something that is formed,so much as it
is something that does not form.
 Cleft Palate is congenital deformity caused by
abnormal facial development during gestation.
 A Cleft is a fissure or opening gap.
 It is the non fusion of body’s natural structures that
form before birth

5. Hard & Soft Palate
Cleft Lip ( hare lip )

6. Cleft lip
(cheiloschisis)

7. Cleft hard palate
(uranoschisis)
Cleft soft palate
(staphyloschisis)

8. incidence
 Dogs, particularly brachycephalic breeds, are more
commonly affected with cleft palate .
Purebred dogs have a higher incidence than mixed
breeds.
 Breeds at high risk for cleft palate include Boston
Terriers, Pekingese, Bulldogs, Miniature Schnauzers,
Beagles, Cocker Spaniels, and Dachshunds.
 Siamese cats have a higher incidence than other cat
breeds.
 Females are more commonly affected than males

9. Aetiology
(exact cause is not known)
Genetic
NtritionalTeratogens

10. Signs and symptoms
•Poor suckling
•Nasal reflux
•Coughing,gagging,sneezing
•Stunted growth
•Rhinitis,tonsillitis

11. Complications:
•Aspiration pneumonia
•Otitis media
•Death

12. Diagnosis
•History
•Physical examination
•radiography

13. TREATMENT

14. Medical management
There is no known conservative treatment.
Treatment is always surgical.
Although surgery is delayed until 6-8 weeks
(2months) and patient is kept on tube feeding.

15. Preoperative management:
• Patient is to be kept fasting for 4-6 hours only
• Anticholinergics are given
• Patient is anaesthetised by general
anaesthesia
• Intubation through tracheotomy incision by
cuffed endotracheal tubes
• Antibiotics should be given intravenously

16. Aim of repair:
Separate the oral and nasal cavities

17. Surgical techniques
lip
straight line closure
z plasty repair
Hard palate
sliding bipedical flap technique
overlapping flap technique
Soft palate
overlapping or rotational flap technique

18. Cleft lip

19. Hard and soft palate
closure

20. Overlapping flap technique
(sandwich technique)
• The dotted lines represent the incisions
necessary to allow soft tissue closure. B, Elevate
the mucoperiosteal flap and rotate it medially to
cover the hard palate defect. C, Insert the edge of
this flap between the hard palate and the
mucoperiosteum on the opposite side of the
defect. Secure the flaps in position with
horizontal mattress sutures . D, Complete the
repair by apposing the incised edges of the cleft
soft palate in three layers. Make lateral relief
incisions (broken lines) to reduce tension on the
repair.

24. Mucoperiosteal bipedical sliding flap
technique (von-lagenback )
• Incise the margins of the defect and make bilateral
releasing incisions along the margins of the dental
arcade (Fig. 20-18, A). Elevate the mucoperiosteal layer
on both sides of the defect with a periosteal elevator
(Fig. 20-18, B). Avoid damaging the major palatine
arteries. Control hemorrhage with pressure and
suction. Appose the nasal mucosal edges or
periosteum at the margin of the defect with buried
interrupted sutures (knots within the nasal cavity) if
possible. Slide the elevated mucoperiosteal flaps across
the defect and appose with simple interrupted sutures
(Figs. 20-18, C and D). Allow the denuded hard palate
near the dental arcades to heal by secondary intention.

25. Von- Lagenback technique

28. Postoperative care
Soft food should be fed for a minimum of 2
weeks after surgery,
chewing on hard objects (e.g., bones,
sticks,chew toys) should be prevented.
Gastrostomy or esophagostomy feeding for 7
to 14 days may facilitate healing.

29. Elongated soft palate
(brachycephalic Airway syndrome)
• Brachycephalic syndrome refers to the
combination of stenotic nares, elongated soft
palate, Tracheal collapse, Pharyngeal collapse,
Epiglottic collapse and everted laryngeal
saccules causing upper airway obstruction in
brachycephalic breeds;
• it is also referred to as brachycephalic airway
obstructive syndrome.

30. Symptoms
Dyspnoea, exercise intolerance, noisy
breathing
Coughing, snoring, gagging, retching and
vomition
Symptoms worsens in hot and humid weather

31. Diagnosis
• Dog breed
• Clinical signs
• Physical examination

32. Treatment
Conservative:
 Control exercise
 Avoid hot and humid environment
 Oxygen therapy
Surgical:
resection of the elongated part
(staphylectomy)