CAA (caudal) margins mandibulectomy?

RE: CAA (caudal) margins mandibulectomy?

Evelyn Barbour-Hill — Tue, 26 Jul 2016 22:46:42 GMT

I think in a collie there should be room, unless you have big hands, to work down the medial side and find the mandibular artery to ligate. A head light would be very helpful, and so would a nurse to hold the head and jaw just so – like that – bit wider – toward me a little – hold it there – who is not going to have to let go in order to fiddle with the isoflurane, answer the telephone, help the senior partner find his glasses..... (or, of course, you could be ingenious with sandbags, clamps, gags and ropes ). Or, you could make the rostral cut first, which means you have to temporarily get a clamp or some compression on the artery in the canal there, but does mean you can then swing the mandible way out laterally which makes burrowing down to the artery at the caudal end much easier.

RE: CAA (caudal) margins mandibulectomy?

Beats — Tue, 26 Jul 2016 19:19:11 GMT

Thanks Evelyn! That's most helpful of you to share

I'm still undecided. I like the idea of not dissecting the whole ramus (and it seems unnecessary to do so for margins) and my oscillating saw would make short work of it, however I suspect hemostasis of mandibular artery would be easier achieved if dissecting whole lot out and levering up to ligate on medial aspect. I like the idea of having neck prepped for common carotid ligation in event of crisis.

RE: CAA (caudal) margins mandibulectomy?

Evelyn Barbour-Hill — Mon, 25 Jul 2016 23:10:31 GMT

I see your point, or your dilemma.

If it were I faced with this, yes I might well take the whole mandible – or I might sever the vertical ramus and leave it in situ. Neither job would be a quick one to dash off before lunch. Dissecting out the whole vertical ramus is not easy though it seems straightforward in principle. The muscle attachments are huge and very tough. But you might prefer that to cutting through the bone. I'd have a good look at a skull if you've got one and compare it with the actual patient and have a good think. The prognosis would not differ that much if the vertical ramus were left in.

Watch out for the mandibular artery and endeavour to ligate it before you cut it . In fact watch out for the internal carotid artery! This might sound a bit over the top, but at least be acquainted with the approach to ligate the common carotid artery in the neck, if you need to in the case of otherwise uncontrollable haemorrhage. Best to be prepared.

Sorry if that's not a definite a or b answer!

I wouldn't attempt to replace or repair the mandible with anything.