Feline sialocoele: clinical presentation, treatment and outcome in 19 cases

Objectives The aim of this retrospective observational study was to describe the clinical presentation, treatment and outcome of cats with sialocoele. Methods Clinical records from seven referral hospitals were retrospectively searched to identify cats with sialocoele between 2007 and 2021. Results Nineteen cats were identified. The most common clinical signs were ptyalism, dysphagia and anorexia. Localisation of the sialocoele was cervical (n = 6), sublingual (n = 6), cervical/sublingual (n = 3), facial (n = 2), cervical/pharyngeal (n = 1) and zygomatic (n = 1). The affected salivary glands were mandibular–sublingual (n = 15), mandibular–sublingual/parotid (n = 1), zygomatic/parotid (n = 1) and parotid (n = 2). The aetiology of the sialocoele was traumatic in two cases, neoplastic in one cat and unknown in 16 cats. Sialoadenectomy was performed in 11 cats. Other treatments included ranula marsupialisation (n = 3), needle drainage (n = 2), single stab incision (n = 2) and parotid duct ligation (n = 1). The median follow-up time was 399 days (range 15–1460). Postoperative seroma was the only complication observed in one cat. No recurrence was reported. Conclusions and relevance Feline salivary sialocoele are relatively rare and have a good prognosis. They can be managed successfully with sialoadenectomy; however, a more conservative approach can be used with appropriate case selection.

An Endonasal Incision Adds a Second Vector of Manipulation During Percutaneous Reduction of Fractures Involving the Frontonasal Region

Study Design: A case report. Objective: To describe a modification of percutaneous reduction of frontal sinus and/or naso-orbito-ethmoid (NOE) fractures, adding an endonasal intercartilaginous incision to provide a second vector of manipulation. Methods: Case report with particular attention paid to surgical technique, followed by a brief review of relevant literature. Results: Technique: A Carroll-Girard screw is used to engage the thickest part of the anterior wall of the frontal bone through a stab incision just superior to the frontonasal junction. An endonasal intercartilaginous incision is then made and a Cottle elevator is introduced to manipulate the fracture from the inferior aspect of the frontonasal junction. The percutaneous screw and the endonasal elevator provide perpendicular vectors for manipulation, thereby improving ability to reduce fractures when percutaneous traction alone is not successful. The technique is described here in a patient with anterior table frontal sinus fractures combined with posteriorly displaced Markowitz type 1 NOE fractures. Conclusion: While percutaneous reduction of frontal sinus fractures has been previously described, this report adds a subtle but important modification both in indication and technique for optimizing reduction while maintaining surgical simplicity and minimizing morbidity.

Placement of Guide-Wireless Sharp Percutaneous Pedicle Screws Utilizing Computed Tomography-Navigation and Sentinel Fluoroscopy: 2-Dimensional Operative Video

Many established techniques exist for minimally invasive pedicle screw placement. Nearly all techniques incorporate the use of a Kershner wire (K-wire) at various points in the work-flow. The use of a K-wire adds an additional step. If its position is lost, it requires repeating all previous steps, and placement is not without complication. The use of a guide-wireless sharp screws allows the surgeon to place a pedicle screw in 1 step with several fluid maneuvers.1 The patient underwent Institutional Review Board-approved consent for this study. Following traditional computed tomography-based navigation, a stab incision is made, followed by fascial dissection with monopolar cautery. The sharp screw is placed percutaneously at the facet-transverse process junction. The precise entry point is confirmed with navigation, followed by a sentinel anterior-posterior fluoroscopic image, verifying the accuracy of the navigation. The cortical bone is traversed by malleting the sharp tip through the cortex. When the cancellous bone is engaged, the screw is then advanced through the pedicle. This set of steps allows for safe, efficient placement of percutaneous pedicle screws without the need for a guidewire. Mal-placement regarding sharp pedicle screw insertion is similar to K-wire-dependent screw placement. Surgeons must be cognoscente of exceptionally sclerotic bone, which can prove difficult to cannulate. Conversely, osteoporotic bone that is liable to a cortical pedicle breach, transverse process fracture, and/or maltrajectory are all considerations when placing a K-wireless, sharp pedicle screw. Anterior-posterior fluoroscopy is utilized to confirm accuracy of image-guided navigation and mitigate malplacement of pedicle screws.

Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study

Background: Minimally invasive dorsal cheilectomy (MIDC) for hallus rigidus is gaining in popularity. The optimal position for the stab incision for MIDC is dorsomedial to allow an ergonomic sweeping movement of the burr, potentially putting the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. We aimed to quantify the risk of using this minimally invasive technique with a cadaveric study. Methods: A total of 13 fresh-frozen cadaveric specimens amputated below the knee were obtained for this study. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The DMCN to the hallux was cut completely in 2 specimens (15%). All the extensor hallucis longus tendons were intact, although in 1 specimen, the tendon showed some fraying on the underside of the tendon. The average distance of the stab incision from the first metatarsophalangeal (MTP) joint was 17.7 (range, 10-23) mm. The relationship of the DMCN to the stab incision was variable. The average distance of the DMCN to the incision was 3.8 (range, 0-7) mm. The danger zone for damaging the DMCN was at one-third the length of the first metatarsal proximal to the first MTP joint. Conclusion: The DMCN has been well studied by several authors and has a variable course. This nerve was damaged in 15% of our specimens following MIDC. Clinical Relevance: We believe patients should be made aware of this risk when considering surgery. A carefully made working capsular pocket for the burr and marking this nerve before making the incision if palpable could mitigate this risk.

Minimally Invasive Dorsal Cheilectomy of the first metatarsal

Category: Other Introduction/Purpose: Traditionally, a dorsal cheilectomy of the first metatarsophalangeal (MTP) joint is performed with an open approach through a dorsomedial or midmedial incision. It is now possible to perform minimally invasive dorsal cheilectomy (MIDC) of the first metatarsal with a wedge burr. The stab incision for MIDC needs to be dorsomedial to allow an ergonomic sweeping movement of the burr. This potentially puts the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. There have been no clinical or cadaveric studies to date quantifying the risk to the DMCN and the surrounding structures when a Wedge burr was used for MIDC. We aim to determine this by using fresh-frozen cadaveric specimens in a “high-risk” situation in which most of the surgeons were novices to the technique. Methods: A total of 13 fresh-frozen cadaveric specimens (7 right, 6 left) amputated below the knee were obtained for this study. 13 foot and ankle surgeons (2 left handed, 11 right handed) who had no or minimal experience in MI surgery participated in this study. After a demonstration by an experienced MI surgeon and a practice on sawbones by participants, each surgeon performed a MIDC over the first metatarsal. Fluoroscopic guidance was available throughout the procedure. After the procedure, the specimens were dissected and the DMCN and the extensor hallucis longus (EHL) were inspected for damage. The same dissection steps were used for each specimen. The relationship of the DMCN to landmarks were measured. All measurements were made to the nearest millimetre. Results: Dissection of the specimens revealed that the DMCN to the hallux was cut completely in two specimens (15%). All the EHL tendon were intact, although in one specimen, the tendon showed some fraying on the underside of the tendon, estimated to be 15%. The average distance of the stab incision from the first MTP joint was 17.7 (range: 10 – 23) mm. In terms of the relationship of the DMCN to the stab incision in specimens where the DMCN was not cut, the DMCN was superior in five specimens and inferior in six specimens. The distance of the DMCN to the incision was 3.8 (range: 0 -7) mm. Conclusion: The DMCN to the hallux has been well studied by several authors and has a variable course. This nerve is at high risk of being damaged with open surgery and is a commonly reported complication of surgery to the hallux with rates reportedly as high as 45%. This nerve was damaged in 15% of our specimens following MIDC in a “high-risk” situation. Patients need to be specifically made aware of this risk when being consented for surgery. A carefully made working capsular pocket for the burr and marking this nerve before placing the incision if palpable could mitigate this risk.