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· Lateral area of the soft palate
· Hypoplastic soft palate
Attempts should be made to have the repair supported by underlying bone. This is where a CT is of value in pre-operative assessment. The oral fistula may appear relatively small, however the defect in the supportive bone shelf can be much larger. Flaps should be
1.5x larger than the required defect, electrosurgical equipment or lasers should be avoided, and closure should take place with no significant tension.
Rostral defects
Congenital defects of the primary palate (rostral to the incisive papilla) require flaps of oral and nasal soft tissue. Advancement, rotation, transposition or overlapping flaps are followed by reconstruction of the cutaneous tissues.
Overlapping flap technique for hard palate repair.
An incision is made in the mucoperiosteum 1-2mm away from the dentition on one side of the defect laterally. The second incision is made in the mucoperiosteum at the defect. Elevation of the tissues is performed bilaterally while attempting to preserve the major palatine artery. The first flap is then rotated medially across midline and under the second flap before being secured.
Medially positioned flap technique for the hard palate
Bipedicle flaps are directly elevated from each side of the oral mucosa and centrally apposed. This is used only for minor reconstructions as there is no underlying bone to support the closure. In cases of trauma the bone apposition can sometimes be improved by direct digital pressure on each side of the maxilla or twisting orthopaedic wire between the maxillary canines (and then covering in a self-curing composite).
Medially positioned flap technique for soft palate repair
Incisions should be made along the medial margins of the defect to the level of the caudal end of the tonsils. By cutting the margins of the defect two separate sets of flaps are created, one in the nasopharynx and one in the oropharynx. Separate clsoure of the two flaps creates a double layered closure.
Labial based mucoperiosteal flap for repair of oronasal fistula
Either a single (labial based only) or double (labial based over a reflected palatine mucosal flap) repair can be used to close these defects.
Elongated soft palate
Elongated soft palates are typically resected with laser, blade or vessel sealing device to the level of the caudal tonsils.
Your Singapore, the Tropical Garden City
WSV18-0171
WSAVA GLOBAL NUTRITION
WATER, WATER EVERYWHERE: NUTRITION AND HYDRATION IN THE MANAGEMENT OF FELINE CKD
C. Villaverde1
1Ciencia Animal I Dels Aliments, Universitat Autonoma De Barcelona, Spain
Introduction
Chronic kidney disease (CKD) is the most common
renal disease in the cat. The prevalence of CKD
seems to be increasing over time; estimates are that
it affects about one-third of all cats over 15 years of
age. It is an important cause of mortality, especially in older cats. CKD is typically a progressive disease and can be accompanied by a wide range of clinical and pathological changes. However, the clinical presentation is variable from patient to patient.
The International Renal Interest Society (IRIS) has published guidelines for clinical staging and treatment targets for both canine and feline kidney disease (http:// www.iris-kidney.com). As well, the International Society of Feline Medicine published Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease in 2016 (http://jfm.sagepub.com/site/Guidelines/ Guidelines.xhtml). The reader is referred to these documents for a complete discussion of CKD diagnosis and management.
The goals of CKD therapy are to:
· Minimize clinical signs of uremia
· Minimize disturbances of electrolytes, vitamins, and minerals
· Provide adequate nutrition and hydration
· Improve quality of life (QOL), especially in International Renal Interest Society (IRIS) stages 3 and 4
· Modify disease progression
Wherever possible, potential therapies should be evaluated considering a specific treatment goal and based on available evidence. In some patients, multiple treatments may be indicated, but administration
of multiple therapies must be balanced with QOL; prioritizing therapies most likely to benefit each patient is important.
This session will focus on keeping CKD cats well hydrated and nourished as it is critical for their survival and well-being.
Importance of dietary management
The use of diets specifically formulated for CKD results in improved survival and quality of life1.
The key nutritional factors in CKD diets for cats are as
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