What do you do with split hard palate after trauma in cat?

RE: What do you do with split hard palate after trauma in cat?

Beats — Sat, 08 Jun 2024 20:51:41 GMT

thanks - fantastic info and insights!

i wondered if poking through the furcation might be an option, so glad you mentioned it. Can you give me a gauge for average cat you would advise? 0.7mm?

E-collars could be a different thread - I generally detest them, but there are a number of scenarios in which I find them indispensible - this may well be my poor surgical technique or irrational fear. e.g. an indwelling urinary catheter in a cat over a weekend to ensure piece and quiet that it doesn't reblock, or after a perineal urethrostomy when I imagine devastation if wound interference leads to dehiscence; in dogs my most frequent use is in bulgy eyed dogs with an ulcer to prevent them rubbing their eye on the carpet and making things worse. Re-feeding tubes in cats, I have a bad habit of looping the tube cranially to go back over the dorsal neck - I find that makes easy to feed even a feral (as these split palate cats inevitably are in my experience) from a distance with the safety of a buster collar to separate me from the biting end, however the loop means that the cat can easily get a leg stuck in the loop and pull out the feeding tube (or at least become distressed in an attempt to, in the absence of a buster collar ).

I might try the wire again next time with a more refined technique on my previous uses - how long do you leave it on for? WOuld a piece of 40lb nylon leader line do a sufficienty good job to substitute (I have taken on board tip of using leader lines for closing medial sternotomy now) One of the things with option (2) is the cat can generally be released again within a week when eating well and no signs of issues - I wonder with the wire if needs left longer than that before needing definte removal?

Alastair has massively put me off option (2) with tales of necrosis from palantine vessel damage, so I think wire does sound a safer job overall, albeit the pokey ends of the wire within the oral cavity always seems a source of disatisfaction when I've placed before.

RE: What do you do with split hard palate after trauma in cat?

Evelyn Barbour-Hill — Sat, 08 Jun 2024 20:04:30 GMT

[quote userid="12930" url="~/f/clinical-questions/30945/what-do-you-do-with-split-hard-palate-after-trauma-in-cat/244842#244842"]Evelyn - can you explain exactly how you place your wire around the 08's so it doesnot slip off and how you tighten it - I suspect this is something where the devil is in the detail and I do remember one before where my wire was clearly loose and doing nothing when I came to remove it.[/quote]

Well... I'm not sure I can explain it without actually showing it. Don't use too thick a wire – this seems to be a common mistake for the inexperienced (also for orthopods , who should never be let near the mouth ).. It has to go deep to the cervical bulge of the tooth or it will indeed slip off. Sometimes I put it through the furcation to ensure security.. A couple of twists in the middle, not just a simple figure of 8. Tighten in the usual way by twisting the ends outside the second tooth. It needs to be just tight enough to hold things securely. Any tighter and you distort things.

Cases are not all the same, of course, but generally I find no need to put sutures in the palate soft tissue in such a case. It just heals.

By the way, I'm not criticising your management of your latest case, but I have never put an Elizabethan collar on such a case. (In fact I haven't put one on a dog since 1982 and I've only put one on a cat maybe twice, possibly three times, after ear surgery)

RE: What do you do with split hard palate after trauma in cat?

Alasdair Hotston Moore — Fri, 07 Jun 2024 10:54:09 GMT

RE: What do you do with split hard palate after trauma in cat?

Alasdair Hotston Moore — Fri, 07 Jun 2024 10:48:33 GMT

I’d go 1 if I can manual compress and it doesn’t spring open

3 plus 1 if it springs open

2 is not necessary here and can go horribly wrong (loss of mucosa due to damage to palatine arteries

RE: What do you do with split hard palate after trauma in cat?

Beats — Thu, 06 Jun 2024 20:00:05 GMT

Thanks everyone - great to get so many responses!

I had another one last week and went with option (2) again - it had been sent home with some soft food initially and had eaten it over 3 days and had a full split up into nasal cavity complete hard palate and some of soft palate - did not close very well with squeezing maxilla, so I cleaned out the nasal cavity - removied few sharp loose shards of bone and did a (2) and placed feeding tube and buster collar - took the buster collar off twice in recovery and pulled at feeding tube. Sent home next day to be tube fed at home and then it went missing for 3 days, but came back today and is eating fine - tube and buster collar were remarkably still in place, but was never tube fed. Perhaps I'm best to just stick to what I'm used to as option (1) seems to have mixed responses re success.

Evelyn - can you explain exactly how you place your wire around the 08's so it doesnot slip off and how you tighten it - I suspect this is something where the devil is in the detail and I do remember one before where my wire was clearly loose and doing nothing when I came to remove it.

RE: What do you do with split hard palate after trauma in cat?

Rachel Perry — Thu, 06 Jun 2024 18:00:14 GMT

If they're caught soon after trauma, (so there is a split in palate and communication into nasal cavity, but no epithelialisation (i.e. No ONF)) then digital pressure of either side of maxilla and horizontal mattress sutures in palatal mucosa. As Rob said ensure strict attention to restoring occlusion.

RE: What do you do with split hard palate after trauma in cat?

Evelyn Barbour-Hill — Wed, 05 Jun 2024 18:30:43 GMT

[quote userid="2235" url="~/f/clinical-questions/30945/what-do-you-do-with-split-hard-palate-after-trauma-in-cat/244815#244815"]And, without wishing to teach you to suck eggs..... please don't neglect the fractured canines which often accompany this type of injury. If there is pulp exposure they will require either extraction, or (more ideally) root canal treatment at some point, though this can be delayed until everything else has healed up.[/quote]

Thread drift maybe, but... I'd put that differently, as: never consider extracting such teeth unless there is absolutely no other option. Endodontic treatment is much much less traumatic (literally) for th patient, less traumatic (metaphorically) for the surgeon and at the end of it the tooth is still there. The cost will be not very different to that of extraction, and in a cat the cost could be considerably less than that of extraction.

RE: What do you do with split hard palate after trauma in cat?

Rob Davis — Mon, 03 Jun 2024 17:06:26 GMT

I would add that getting the occlusion right is the most important factor (more important than necessarilly reducing fractures nicely), so make sure you check this before you wake the cat up (you will need to be able to close the mouth fully, so extubation may be necessary). There are usually multiple fractures with these which require CT to assess fully, though I fully appreciate that this is not always possible.

And, without wishing to teach you to suck eggs..... please don't neglect the fractured canines which often accompany this type of injury. If there is pulp exposure they will require either extraction, or (more ideally) root canal treatment at some point, though this can be delayed until everything else has healed up.

RE: What do you do with split hard palate after trauma in cat?

Evelyn Barbour-Hill — Sat, 04 May 2024 14:18:18 GMT

It depends a bit on what is stable or not, of course, but personally: I cannot see the point or rationale of (5) at all. I cannot see the point of (4) if you have suitable wire to hand. I cannot see the point of (2) until other attempts have failed. In my experience (1) is often pointless.

So, in general, if there is any instability or malocclusion at all, the (3) is fairly easy and quick and usually successful.

Of course I place an oesophagostomy tube.

You need to use wire that's not too thick, a common mistake, nor too thin though that would be a hard mistake to make. You need to get the tension just right: reduce the fracture and double check you've got the occlusion right, and then twist up the wire just enough. If you try to tighten it more "to compress the fracture" you will squeeze the teeth palatally.

If there's no instability I might just place the oesophagotomy tube and do nothing else. Sometimes a few sutures are needed in the palate (6/0 better than 5/0) but in general the soft tissue heals very rapidly all by itself.

RE: What do you do with split hard palate after trauma in cat?

Richard Carter — Sat, 04 May 2024 06:29:42 GMT

In a cat , I might just do the oesophagostomy tube because my previous attempts to close oral injuries have caused distortion opening up the injury on the dorsal aspect of nose and hope when the inflammation resolves, the split not too large