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Vallefuoco R, Ritson K, Taylor F, Fina C, Bello AM. A Rotation Alar Fold Flap for Cosmetic Nasal Plane Reconstruction: Description of the Technique and Outcome in Three Dogs. Vet Sci 2023; 10:647. [PMID: 37999470 PMCID: PMC10674945 DOI: 10.3390/vetsci10110647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
Nasal planum reconstruction is a surgical challenge, and several surgical techniques have been described. The objective of this study was to describe the rotation alar fold flap technique and to report clinical outcomes in a short case series. The feasibility of the technique was first assessed in a canine cadaveric model. The rotation alar fold flap was obtained by a single sharp horizontal incision of the dorsolateral nasal cartilage, preserving the caudal mucosal attachment to the ventral nasal concha. The flap was then rotated ventro-medially for the reconstruction of the ventral aspect of the nasal planum unilaterally or bilaterally. The rotation alar fold flap technique was used following a subtotal or partial planectomy for excision of a squamous cell carcinoma or mast cell tumors in three dogs. No intraoperative complications were recorded. Superficial surgical site infection was reported in two cases and minor dehiscence was reported in one case. However, survival of the flap was not affected. The cosmetic and functional outcomes were considered very satisfactory in all cases. The rotation alar fold flap technique offers a safe, valuable, feasible, functional and aesthetically satisfactory alternative surgical option for selected cases of localized tumor involving the central and ventral planum.
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Affiliation(s)
| | - Kadi Ritson
- Surgical Department, Pride Veterinary Referrals, Derby DE248HX, UK;
| | - Frances Taylor
- Oncology Department, Pride Veterinary Referrals, Derby DE248HX, UK;
| | - Caroline Fina
- Diagnostic Imaging Department, Pride Veterinary Referrals, Derby DE248HX, UK;
| | - Alba Maria Bello
- Internal Medicine Department, Pride Veterinary Referrals, Derby DE248HX, UK;
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Kokkinos P, Elliott J, Almansa Ruiz JC. A modified full-thickness labial/buccal rotational flap reconstruction technique following bilateral rostral maxillectomy and nasal planectomy for resection of maxillary tumors: Technique and results in two dogs. Vet Surg 2023; 52:1191-1201. [PMID: 37649180 DOI: 10.1111/vsu.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To describe a naso-facial reconstruction technique following bilateral rostral maxillectomy and its functional and cosmetic outcomes. ANIMALS Two dogs. STUDY DESIGN Clinical case series. METHODS Two dogs were presented with a right rostral maxillary mass. Preoperative biopsy and staging revealed a biologically high-grade and histologically low-grade fibrosarcoma (Hi-Lo FSA). A combined nasal planectomy and radical bilateral rostral maxillectomy was performed sparing the labial/buccal mucocutaneous flaps bilaterally. Surgery resulted in asymmetry of the width of the flaps; the narrower flap was rotated medially to reconstruct the lip and create an oral vestibule. The wider flap was rotated medially to cover the remaining dorsolateral opening of the nasal conchae. The flaps overlapped in a parallel manner, discretely concealing the nasal passages, and separating them from the oral cavity. Hemorrhage occurred in both dogs, with one dog requiring a blood transfusion postoperatively. RESULTS Oral Hi-Lo FSA with tumor-free margins was confirmed in both dogs. Both dogs recovered uneventfully within 4 weeks. Owners reported being very satisfied with the functional (return to normal exercise/activities and uncompromised respiration) and cosmetic outcomes. Based on the owners' telephone follow up, no tumor recurrence was noted at 15 (Dog 1) and 6 (Dog 2) months postoperatively. CONCLUSION The full-thickness bilateral labial/buccal rotational flaps were used successfully to reconstruct the rostral maxilla, external nose and facial defects involving the nasal cavity. The technique resulted in acceptable functional and cosmetic outcomes and can be considered for naso-facial reconstruction in selected cases.
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Affiliation(s)
- Panagiotis Kokkinos
- Southfields Veterinary Specialists part of Linnaeus Veterinary Limited, Essex, UK
- Northwest Veterinary Specialists part of Linnaeus Veterinary Limited, Cheshire, UK
| | - James Elliott
- Southfields Veterinary Specialists part of Linnaeus Veterinary Limited, Essex, UK
| | - José C Almansa Ruiz
- Southfields Veterinary Specialists part of Linnaeus Veterinary Limited, Essex, UK
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Albernaz VGP, Oblak ML, Quitzan JG. Angularis oris axial pattern flap as a reliable and versatile option for rostral facial reconstruction in cats. Vet Surg 2021; 50:1688-1695. [PMID: 34293186 DOI: 10.1111/vsu.13686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 05/07/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate outcomes associated with the use of an angularis oris axial pattern flap (AOAPF) for rostral facial reconstruction in cats. ANIMALS Nine adult client-owned cats. STUDY DESIGN Short case series. METHODS Ten AOAPF were performed in nine cats after resection of a tumor. Wounds were located at the nose, infraorbital, supraorbital, frontal, eye, and ear canal region. Orbital exenteration (n = 3), pinnectomy (n = 2), nasal planum resection, total ear canal ablation (n = 2), and partial eyelid reconstruction (n = 3) were performed. RESULTS Short-term postoperative complications included flap edema (n = 10), suture dehiscence (n = 3), and distal tip necrosis (n = 3). All wounds resulting from minor complications healed by second intention in 5-15 days. Long-term complications included epiphora (n = 2), frequent grooming around the eyes (n = 2), and enucleation due to corneal ulcer secondary to impaired postoperative eyelid function (n = 1). Tumor recurrence occurred in 3 cases. CONCLUSION The AOAPF was a versatile and reliable option for rostral facial reconstruction in cats with acceptable long-term outcomes.
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Affiliation(s)
- Vinicius G P Albernaz
- School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Michelle L Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Juliany G Quitzan
- School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
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Tanaka T, Ashida K, Iimori Y, Yamazaki H, Mie K, Nishida H, Akiyoshi H. MRI findings, including diffusion-weighted imaging, in seven cats with nasal lymphoma and two cats with nasal adenocarcinoma. J Feline Med Surg 2021; 23:393-399. [PMID: 32573314 PMCID: PMC10812204 DOI: 10.1177/1098612x20932819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Primary nasal tumours in cats are rare, with lymphoma being the most common feline nasal tumour, followed by adenocarcinoma. Although CT can reliably detect feline nasal tumours, there are no specific CT features that identify each tumour type. To our knowledge, there have been no reports describing MRI findings, including diffusion-weighted imaging (DWI), for nasal lymphomas and adenocarcinomas in cats. Therefore, this retrospective study aimed to evaluate the MRI findings of nasal lymphoma and adenocarcinoma, including qualitative and quantitative analysis of DWI. METHODS MRI examination was performed on seven cats with histologically confirmed lymphoma and on two with adenocarcinoma. The MRI protocol included T2-weighted imaging (T2WI), T1-weighted imaging (T1WI) and DWI. Apparent diffusion coefficient (ADC) values were measured using DWI. Contrast agent was not used in one cat with lymphoma. RESULTS Of the cats with lymphoma, three (43%) were iso- and hyperintense on T2WI, seven (100%) were isointense on T1WI, five (83%) exhibited mild heterogeneous enhancement, including a prominent region of non-enhancement on post-contrast T1WI, and seven (100%) cats exhibited hyperintensity on DWI. The median ADC values were 0.45 × 10-3 mm2/s (range 0.37-0.53 × 10-3 mm2/s). For adenocarcinoma, two (100%) were iso- and hyperintense on T2WI, two (100%) were isointense on T1WI, two (100%) exhibited marked heterogeneous enhancement on post-contrast T1WI and two (100%) were isointense on DWI. The median ADC values were 1.08 × 10-3 mm2/s (range 0.88-1.27 × 10-3 mm2/s). The median ADC values of lymphoma tended to be lower than adenocarcinoma (P = 0.056). CONCLUSIONS AND RELEVANCE Determining ADC value and tumours with a large area of non-enhancement may be helpful in differentiating nasal lymphoma from nasal adenocarcinoma.
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Affiliation(s)
- Toshiyuki Tanaka
- Department of Advanced Clinical Medicine, School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
| | - Kazuna Ashida
- Department of Advanced Clinical Medicine, School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
| | - Yasumasa Iimori
- Department of Advanced Clinical Medicine, School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
| | - Hiroki Yamazaki
- Department of Advanced Clinical Medicine, School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
| | - Keiichiro Mie
- Department of Advanced Clinical Medicine, School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
| | - Hidetaka Nishida
- Department of Advanced Clinical Medicine, School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
| | - Hideo Akiyoshi
- Department of Advanced Clinical Medicine, School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
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Goldschmidt SL, McKibben G, Rendahl A, Kiefer KM. Influence of skull biometrics on cosmetic reconstruction after incisivectomy and nasal planectomy reconstruction in dogs. Vet Surg 2020; 50:89-103. [PMID: 33225491 DOI: 10.1111/vsu.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/10/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify biometric skull measurements that are associated with tension and excess narrowing of the resultant nasal aperture during cosmetic nasal planectomy reconstruction. STUDY DESIGN Ex vivo study. ANIMALS Twenty cadavers of mesocephalic dogs. METHODS Cosmetic reconstruction was performed after incisivectomy and nasal planectomy. Preoperative and intraoperative skull measurements included width of the nasal planum, rostral and caudal maxilla, labial flap, and maxilla at ostectomy site; the length of the nose, labial flap, and philtrum incision; lip thickness; and philtrum placement. Ratios of select width to length measurements were calculated. Correlation was tested between skull biometrics and tension during reconstruction as well as resulting opening of the nasal aperture. RESULTS Breeds included golden retriever, pit bull, Labrador retriever, beagle, shepherd, basset hound, boxer mix, cocker spaniel, and Great Dane. No biometric ratios were predictive of procedural success. The most important objective measurements that were significantly correlated with inferior outcome included width of the nasal planum (>3 cm), width of the caudal maxilla (>6.2 cm), lip thickness (>0.5 cm), width of the labial flap (>2.9 cm), length of the incision created to make the cosmetic "philtrum" (longer incisions >2.8 cm), and philtrum placement (more dorsal placement). CONCLUSION Tension during reconstruction and decreased resultant nasal aperture were associated with wider facial features and thicker lips as well as directly impacted by cosmetic philtrum design and placement. CLINICAL SIGNIFICANCE Standardized preoperative measurements may help guide clinical decision making in choosing and executing a nasal planectomy reconstructive technique.
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Affiliation(s)
| | - Gavin McKibben
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Aaron Rendahl
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
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Massari F, Chiti LE, Lisi MLP, Drudi D, Montinaro V, Sommaruga P. Lip-to-nose flap for reconstruction of the nasal planum after curative intent excision of squamous cell carcinoma in cats: Description of technique and outcome in seven cases. Vet Surg 2019; 49:339-346. [PMID: 31769048 DOI: 10.1111/vsu.13359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 08/29/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the surgical technique for nasal planum reconstruction with a lip-to-nose flap after curative intent surgical excision of squamous cell carcinoma (SCC) in cats and to report the surgical outcomes. STUDY DESIGN Short case series. ANIMALS Seven cats with SCC of the lateral (n = 6) or dorsal (n = 1) aspect of the nasal planum. METHODS After tumor excision, a mucocutaneous lip-to-nose flap was harvested from the upper lip and transposed to reconstruct the nasal planum. Variables recorded included surgical time, surgical complications, healing complications, flap success rate, and cosmetic and long-term functional outcomes. RESULTS Median surgical time was 67.5 minutes (range 49-80), and no intraoperative complications occurred. Postoperatively, six cats developed self-limiting edema of the muzzle, and one cat had nasal discharge for 2 days. No major complications occurred during the healing process, and all cats went on to achieve successful healing of their flap. A small area of partial-thickness necrosis developed at the cranial edge of the flap in three cats and healed spontaneously in all cases within a few days. According to owner satisfaction and periodic clinical assessment, cosmetic and long-term functional of outcomes were considered good in all cats. CONCLUSION The lip-to-nose flap allowed for aesthetic and functional reconstruction of the nasal planum after curative intent surgical excision of feline SCC. CLINICAL SIGNIFICANCE The lip-to-nose flap is an option for a single-stage reconstruction of the nasal planum following partial nasal planectomy in cats.
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Affiliation(s)
| | - Lavinia E Chiti
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | | | - Dario Drudi
- Clinica Veterinaria Nervianese, Nerviano, Milan, Italy
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Santifort KM, Jurgens B, Grinwis GC, Gielen I, Meij BP, Mandigers PJ. Invasive nasal histiocytic sarcoma as a cause of temporal lobe epilepsy in a cat. JFMS Open Rep 2018; 4:2055116918811179. [PMID: 30450218 PMCID: PMC6236490 DOI: 10.1177/2055116918811179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Case summary A 10-year-old neutered female domestic shorthair cat was presented with an acute onset of neurological signs suggestive of a right-sided forebrain lesion, temporal lobe epilepsy and generalised seizure activity. MRI of the head revealed an expansile soft tissue mass in the caudal nasal passages (both sides but predominantly right-sided) involving the ethmoid bone and extending through the cribriform plate into the cranial vault affecting predominantly the right frontal lobe and temporal lobe. Histopathological examination of the tumour revealed a histiocytic sarcoma. Relevance and novel information This is the first report of a cat with clinical signs of temporal lobe epilepsy due to an invasive, histiocytic sarcoma. Histiocytic sarcoma, although rare, should be included in the list of differential diagnoses for soft tissue masses extending through the cribriform plate. Other differential diagnoses are primary nasal neoplasia (eg, adenocarcinoma, squamous cell carcinoma, chondrosarcoma and other types of sarcomas), lymphoma and olfactory neuroblastoma. Temporal lobe epilepsy in cats can be the consequence of primary pathology of temporal lobe structures, or it can be a consequence of pathology with an effect on these structures (eg, mass effect or disruption of interconnecting neuronal pathways).
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Affiliation(s)
- Koen M Santifort
- Veterinary Referral Practice 'de Pietersberg', Oosterbeek, The Netherlands
| | - Ben Jurgens
- Faculty of Veterinary Medicine, Department of Pathobiology, Utrecht University, The Netherlands
| | - Guy Cm Grinwis
- Faculty of Veterinary Medicine, Department of Pathobiology, Utrecht University, The Netherlands
| | - Ingrid Gielen
- Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Björn P Meij
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Utrecht University, The Netherlands
| | - Paul Jj Mandigers
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Utrecht University, The Netherlands
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de Toledo GN, Reina Moreira PR, Rolemberg DS, Facin AC, Hough Monteiro JE, Menezes MPD, Bastos Andrade Moutinho da Conceição ME, Ruiz Sueiro FA, Oliveira Vasconcelos RD, Castro Moraes PD, Costa MT, de Nardi AB. Intranasal Osteosarcoma in a Dog-A Case Report. Top Companion Anim Med 2018; 33:35-39. [PMID: 30236408 DOI: 10.1053/j.tcam.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 11/11/2022]
Abstract
Osteosarcoma is the most commonly reported bone tumor in dogs, typically affecting the axial and appendicular skeleton. Involvement of the paranasal sinuses and the nasal cavity is extremely rare. This report describes a 6-year-old, female, cross-breed dog presented with signs of 90 days duration and diagnosed with a mass located in the right nasal cavity. Radiography, rhinoscopy, and computed tomography findings suggested the presence of an intranasal tumor. Osteosarcoma in the nasal cavity was diagnosed based on histopathological examination and clinical and imaging findings. Survival time was 12 months from diagnosis.
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Affiliation(s)
- Gabriela Noronha de Toledo
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil.
| | - Pamela Rodrigues Reina Moreira
- Department of Veterinary Pathology, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP /FCAV), Jaboticabal, SP, Brazil
| | - Daniele Santos Rolemberg
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil
| | - Andréia Coutinho Facin
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil
| | - Julio Edward Hough Monteiro
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil
| | - Mareliza Possa de Menezes
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil
| | | | | | - Rosemeri de Oliveira Vasconcelos
- Department of Veterinary Pathology, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP /FCAV), Jaboticabal, SP, Brazil
| | - Paola de Castro Moraes
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil
| | - Mirela Tinucci Costa
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil
| | - Andrigo Barboza de Nardi
- Department of Clinic and Veterinary Surgery, School of Agrarian and Veterinary Sciences, São Paulo State University (UNESP/FCAV), Jaboticabal, SP, Brazil
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