Case Quiz #12
Veterinary Dentistry Case Quiz #12
This 9-month-old mixed breed dog has had 4 months of chronic regurgitation with no nasal discharge or sneezing following repair of a defect of the secondary palate.
Question: What is your first diagnostic step?
Answer: Complete oral examination, CBC, Chemistry, U/A
Results: Blood and urine WNL (See image for oral exam)
Question: What is your finding?
Incomplete healing/closure of the caudal oral mucosal. Nasal mucosa still intact.
Question: Is this involved with the regurgitation?
No. The nasal layer is intact and no clinical signs are present. Further diagnostics are needed to evaluate the regurgitation.
Question: What is the next step?
Diagnostic evaluation for common rule outs such as esophagitis, esophageal stricture and megaesophagus is recommended for regurgitation.
In this case, upper gastrointestinal endoscopy was used as one of the diagnostic modalities. Endoscopy revealed an open lower esophageal sphincter with severe esophageal and gastric hyperemia.. The patient was empirically treated with sucralfate and Panacur which resolved the clinical signs.
The risk of medial repositioned flaps for the hard palatal portion of these defect is that the suture line is not supported by bone but instead is over the defect. Although this was not an issue with this patient or any patient managed by this author, this technique has been described in association with a higher frequency of dehiscence. Removing a zone of epithelium along the suture margin and burying simple interrupted sutures may decrease or eliminate problems with dehiscence.
An overlapping flap technique provides an alternative and while exposing more bone allows for hard palatal sutures to be placed over bone.