Adnexal surgery in dogs and cats

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.     

Lip commissure to eyelid transposition for repair of feline eyelid agenesis

Repair of eyelid agenesis in nine eyes of five cats using a lip commissure to eyelid transposition is described. The procedure is a modification of the technique described by Pavletic for reconstruction of the canine inferior eyelid and provides skin, mucosa, a mucocutaneous junction, and muscle to reconstruct the superior and inferior eyelid and lateral canthus. The technique was successful in all eyes and resulted in improvement in corneal protection, cosmesis and in several cats a return of the palpebral reflex.     

Use of an axial pattern flap and nictitans to reconstruct medial eyelids and canthus in a dog

A 10-year-old male neutered Boxer presented with recurrence of a mast cell tumor at the right medial canthal area. Following excision including 2 cm margins, the medial one-half of the upper and lower eyelids and the medial canthus were reconstructed using an axial pattern flap based on the cutaneous branch of the superficial temporal artery. The bulbar conjunctiva of the nictitans was preserved and sutured to the medial flap edge, thus creating a conjunctival lining to the deep aspect of the flap, protecting corneal epithelium. This is a valuable surgical technique for closing a large skin defect and reconstructing the medial eyelids, thus preserving the globe.     

Use of the lip-to-lid flap for replacement of the lower eyelid in five cats

OBJECTIVE: To report outcomes after reconstruction of the lower eyelid following resection of squamous cell carcinoma (SCC). STUDY DESIGN: Retrospective study. ANIMALS: Five cats (6 eyelids). METHODS: Case records were reviewed for breed, sex, surgical findings, complications, and outcome. RESULTS: Six eyelids were reconstructed in 5 cats; functional outcome was excellent. Neither wound breakdown nor flap failure occurred. An area of superficial necrosis occurred in 1 cat; this spared the eyelid margin and healed by secondary intention without any cosmetic or functional effect. One cat was euthanatized 18 months later because of a nasal mass. The relationship between the nasal mass and the previously excised SCC was not established. CONCLUSIONS: Reconstruction of the lower eyelid using a lip-to-lid flap yields satisfactory functional and cosmetic results in cats. CLINICAL RELEVANCE: A lip to lid flap is a successful form of single-stage reconstruction after lower eyelid excision in cats.     

Standard and modified glabellar flap for medial canthus reconstruction following mass removal in three dogs and two cats

Purpose

To describe the surgical technique and clinical outcomes of the glabellar flap and its modification for the reconstruction of the medial canthus following resection of tumors in three dogs and two cats.

Methods

Three dogs (7-, 7-, and 12.5-year-old mixed breeds) and two cats (10- and 14-year-old Domestic shorthair) presented with a 7–13 mm tumor affecting the eyelid and/or conjunctiva in the medial canthal region. Following en bloc mass excision, an inverted V-shaped skin incision was made in the glabellar region (i.e., the area between the eyebrows in humans). The apex of the inverted V-shaped flap was rotated in three cases, whereas a horizontal sliding movement was performed in the other two cases to better cover the surgical wound. The surgical flap was then trimmed to fit the surgical wound and sutured in place in two layers (subcutaneous and cutaneous).

Results

Tumors were diagnosed as mast cell tumors (n = 3), amelanotic conjunctival melanoma (n = 1), and apocrine ductal adenoma (n = 1). No recurrence was noted in a follow-up time of 146 ± 84 days. Satisfactory cosmetic outcome with normal eyelids closure was achieved in all cases. Mild trichiasis was present in all patients and mild epiphora was noted in 2/5 patients, but there were no associated clinical signs such as discomfort or keratitis.

Conclusions

The glabellar flap was easy to perform and provided a good outcome in terms of cosmetic, eyelid function, and corneal health. Postoperative complications from trichiasis appear to be minimized by the presence of the third eyelid in this region.     

Surgical management and outcome of lower eyelid entropion in 124 cats

Objectives To evaluate the success rate of various surgical techniques for the management of lower eyelid entropion in cats. Design Retrospective study. Animals studied One hundred and twenty‐four cats with surgical correction of lower eyelid entropion of 200 eyes over a 13 year period. Methods Records of 124 cats were reviewed for signalment, type of entropion, surgical procedure performed and post‐operative result. Results Combinations of the Hotz‐Celsus (HC), lateral canthal closure and full thickness wedge resection techniques were used to treat 64 bilateral and 60 unilateral cases of lower lid entropion. Twenty‐three cats were under a year of age, 52 cats were aged between 2 and 8 years and 49 were over 8 years old. The overall success rate for a single surgical procedure (which may consist of multiple techniques) to correct lower eyelid entropion was 96.0% per eye. The remaining 4.0% had the entropion resolved with a second surgery. A combined HC and lateral canthal closure had a 99.21% success rate of resolving lower lid entropion. Geriatric cats were the most likely age group to develop corneal sequestra; 37% of cats in this group presented with entropion and corneal sequestra concurrently. Seventeen percent of cats that presented with unilateral entropion and did not have prophylactic surgery on the fellow eye went on to develop entropion in the fellow eye. Conclusions A combined HC and lateral canthal closure was the most effective surgical technique in managing lower eyelid entropion of cats in our study. Prophylactic lateral canthal closure in the unaffected eye is recommended.     

Entropion correction in dogs and cats using a combination Hotz-Celsus and lateral eyelid wedge resection: results in 311 eyes

A novel surgical combination technique for the correction of lateral lower lid entropion in dogs and cats is described, involving a combination of Hotz-Celsus and lateral eyelid wedge resection procedures. The technique was used to treat 311 eyes with lower lid entropion: 269 canine (109 bilateral, 51 unilateral) and 42 feline (16 bilateral, 10 unilateral). The most common canine breeds were the Shar Pei, Rottweiler, Bull Mastiff and Labrador Retriever. Domestic cats made up the majority of feline cases. The overall success rate for a single surgical procedure to correct lower lid entropion with this technique was 94.2% per eye.     

Temporal skin plastic surgery, a possible method for eyelid reconstruction

Eyelid reconstruction of large defects is a difficult undertaking in small animal surgery. Instead of performing the well known Roberts and Bistner or Cuttler and Beard methods, we have introduced the following method for eyelid correction in case of large lid defects. On the temporal part, laterally (about the width of the eye) from the eye an uneffected skin flap is identified, mobilized, rotated and placed into the missing part of the eyelid. Conjunctiva (with slow resorbing) and skin (with non resorbing) 1 metric material are separately adapted. In a large number of patients this method has been proven to be superior to the other methods mentioned.     

A modification of the Mustardé technique for the surgical repair of a large feline eyelid coloboma

A one‐year‐old male domestic short haired cat was referred because of an area of keratitis that had developed adjacent to a particularly large unilateral eyelid coloboma. The defect was repaired using an undescribed three‐stage surgical technique, which is essentially a combination of existing techniques and consists of using the lower lid to re‐construct the upper lid and replacing the resultant lower lid defect with a full thickness graft from the upper lip. This technique is described and the results illustrated by photographs. A good functional and cosmetic result was achieved.     

Canine eyelid granular cell tumor: a report of eight cases

To describe a previously unreported neoplasm of the medial canthus and eyelid in dogs. Clinical and pathologic features of granular cell tumors in the dog were reviewed. Granular cell tumors, arising from the medial canthal eyelid of eight dogs, were identified from the archives of the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW). The affected dogs ranged in age from 5 to 12 years (mean of 9.25 years). Follow‐up information was available for seven of the eight cases. The clinical presentation included swollen hyperemic lids (4/8), ulcerated skin overlying the mass (2/8), and red conjunctiva (7/8). All eight of the cases had firm masses extending from the palpebral conjunctiva to the eyelid margin at the medial canthus. Histologically, the tissue was composed of a highly collagenous neoplastic growth. The neoplastic cells were oval to strap‐like cells with an oval bland appearing nucleus and abundant amounts of granular cytoplasm with very distinct cell boundaries. These granular cells were embedded in a dense collagen matrix. A PAS stain faintly highlighted the granular appearance of the neoplastic cells, which is a defining characteristic of this tumor. There was no recurrence in the seven cases available for follow‐up. Canine granular cell tumors of the medial canthus present clinically and histologically as a benign neoplasm. Granular cell tumors have a characteristic histological appearance. Granular cell tumors should be on the differential list for nodules of the medial canthus in dogs.     

Use of the scrotum as a transposition flap for closure of surgical wounds in three dogs

OBJECTIVE: To describe use of the scrotum as a pedicle flap to cover defects created by tumor excision in the perineum or caudal and medial aspect of the thigh. STUDY DESIGN: Clinical study. ANIMALS: Three dogs. METHODS: After tumor excision and prescrotal castration, an incision was made around the base of the scrotum, leaving a pedicle on the side opposite the skin defect. After removal of the tunica dartos and abdominal fascia, the scrotal skin was stretched and shaped to the defect, then sutured in position with a simple interrupted pattern. Bandages that were changed every 48 hours compressed the flaps, and healing was observed until sutures were removed. RESULTS: Two dogs had first intention healing in 15 days, whereas 1 dog developed necrosis of 10% of the flap, and this area healed by second intention. CONCLUSION: In male dogs, the scrotal skin can be used as a pedicle flap for reconstructive surgery of wounds in the perineum and the proximomedial and caudal aspect of the thigh. CLINICAL RELEVANCE: The perineal region remains a surgical challenge because of the lack of the available skin for reconstruction of surgical wounds. The scrotal skin should be considered for use as a transposition flap to cover skin defects in this region.     

Canine mesenchymal hamartoma of the eyelid

Objective Characterization of a benign disease syndrome involving the eyelids of dogs, describing the signalment, clinical appearance, anatomic location, and pathologic features. Animal studied The records and submitted tissue of 10 dogs with mesenchymal hamartomatous lesions of the periocular connective tissues were retrieved from the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) database. Procedure The submitted tissue in each case was stained with hematoxilyn & eosin and Masson’s Trichrome stain and examined histopathologically. Clinical information was collected from the submission requests. The clinical history, treatment, and follow‐up are described in more detail for one of the 10 dogs. Results Seven different breeds, including four Golden Retrievers, were represented. The ages of affected dogs ranged from 6 to 11 years. Eight of 10 lesions were located at the temporal canthus, ranging in diameter from 0.6 to 3 cm. Clinically, the masses were subcutaneous, firm, lobular soft‐tissue growths, which were in some cases adherent to the underlying orbital rim, and in others, freely palpable between the skin and conjunctiva of the eyelid. Histologically, all had distinct margins but were not encapsulated and contained normal appearing collagen‐rich connective tissue with some adipose tissue. Five also contained fully differentiated skeletal muscle tissue arranged in poorly formed aggregates or as individual muscle fibers. Conclusion Mesenchymal hamartoma of the eyelid has not been previously described. The mass has a predisposition to occur at the temporal canthus and should be included in the list of differential diagnoses of benign eyelid masses in dogs.     

Nature and cause of bilateral ocular dermoids in Hereford cattle

Nature and cause of bilateral ocular dermoids were investigated by field studies, pedigree analysis, clinical examination, light microscopy, scanning electron microscopy, and transmission electron microscopy. It was determined that ocular dermoids in Hereford cattle are a genetically transmitted defect; characteristics of autosomal recessive and polygenic inheritance were observed. Calves typically were affected bilaterally with multiple, connected ocular growths that clinically, histologically, and ultrastructurally mimicked normal haired skin. Sites most commonly involved included ventro-lateral limbus, third eyelid, medial canthus, eyelid and conjunctiva. Centro-corneal and anterior segmental dermoids also were observed.     

Evaluation of primary critical ischemia time for the deep circumflex iliac cutaneous flap in cats

OBJECTIVE: To evaluate the primary critical ischemia time for the deep circumflex iliac (DCI) cutaneous flap in cats. STUDY DESIGN: In vivo model. ANIMALS: Thirteen young adult female cats. METHODS: An island skin flap was created on the right side of each cat based on the angiosome of the ventral branches of the DCI vessels. The cats were randomly assigned to a flap ischemia time ranging from 1 to 3 hours in 10-minute intervals. Microvascular clamps were used to occlude the artery and vein for the designated time. Flaps were sutured into position after the ischemic period. On day 3, fluorescein dye was administered and the flaps were evaluated under ultraviolet light to assess percent area of perfusion. On days 7 and 14, the percent area of survival was determined for each flap based on cutaneous morphometry. RESULTS: All flaps had 100 percent area of survival throughout the study. On day 3, all flaps fluoresced uniformly compared with the surrounding skin. On days 7 and 14, all flaps were uniformly viable as confirmed by skin color, consistency, bleeding, and hair re-growth. CONCLUSION: The DCI cutaneous flap in cats can withstand up to 3 hours of ischemia with predictable survival. CLINICAL RELEVANCE: In a clinical setting, high success rates can be expected with microvascular transfer of the DCI cutaneous flap in cats when the ischemia time is <3 hours and precise surgical technique is used.     

Axial pattern flap based on a cutaneous branch of the facial artery in cats

Objective: To describe the cutaneous portion of the facial artery in cats and an axial pattern flap based on a branch of this artery. Study Design: Ex vivo study. Sample Population: Cat cadavers (n=12). Methods: The common carotid artery was identified, cannulated, and infused with methylene blue to assist in the identification of the facial artery, which was subsequently cannulated and selectively infused with methylene blue. The main trunk of the artery and its branches were dissected. The extent of blue coloration of the skin was evaluated on the contralateral side of the same specimen after infusing methylene blue into the facial artery. In 4 specimens, the flap was raised along previously defined borders and adequacy of perfusion was evaluated. Results: The area of skin perfused by the facial artery extended from the lower eyelid dorsally, to the angularis oris cranially, and the wing of the atlas caudally. Borders of the skin flap were defined on the basis of the anatomic dissection and skin coloration after selective infusion of the facial artery with methylene blue. A skin flap of 6 cm × 3.4 cm, based on the first caudally directed cutaneous branch of the facial artery was shown to be well perfused. The viability of this flap was confirmed in a clinical case. Conclusion: The facial artery flap is useful for repair of skin defects of the head in cats.     

CT and Cross-sectional Anatomy of the Normal Head of the Loggerhead Sea Turtle (Caretta caretta)

The third eyelid protects the eye, contribute to the aqueous portion of the pre-ocular film and its distribution over the corneal surface, as well as removal of foreign material from the anterior surface of the eye. It is rather vulnerable during fights and clinicians often have to perform surgery for third eyelid neoplasia. In dogs, this lid has a triangular shape, being widest at its free margin. It is vascularized by branches of the malar artery. Being of such importance as an adnexa of the eye, the authors concentrated their attention on its vascularization, which is not well defined.
Methods:  Scanning Electronic Microscopy of vascular corrosion casts and intact tissue.
Observations:  It was quite interesting to notice the presence of two patterns of vascularization inside the third eyelid. One can say that there are two segmental levels of vessels. In one of these there is a predominance of arteries and veins, while in the other a meshwork of third order arteries, capillaries and post-capillary venules are present. In fact, the branch of the malar artery that reaches the base of the third eyelid divides into smaller branches that cross almost the complete length of the lid giving only a few collateral vessels, in a monopodical way, and only near the free margin of the lid is possible to observe dicothomical ramifications that became rather anastomotic (being anastomoses of type I and II are present) and contribute to the microvascular meshwork. This microvascular net is drained by post-capillary venules and veins that empty as a brush into bigger veins that occupy the same segmental level as the third eyelid artery.
Remarks:  This uncommon angioarchitecture is probably an adaptation to the fact that in the medial canthus of the eye this lid has a smaller space and the way of obtaining an efficient vascularization is by going straight to the top of the lid.     

Microvascularization of the Third Eyelid in Dogs

The third eyelid protects the eye, contribute to the aqueous portion of the pre‐ocular film and its distribution over the corneal surface, as well as removal of foreign material from the anterior surface of the eye. It is rather vulnerable during fights and clinicians often have to perform surgery for third eyelid neoplasia. In dogs, this lid has a triangular shape, being widest at its free margin. It is vascularized by branches of the malar artery. Being of such importance as an adnexa of the eye, the authors concentrated their attention on its vascularization, which is not well defined. Methods: Scanning Electronic Microscopy of vascular corrosion casts and intact tissue. Observations: It was quite interesting to notice the presence of two patterns of vascularization inside the third eyelid. One can say that there are two segmental levels of vessels. In one of these there is a predominance of arteries and veins, while in the other a meshwork of third order arteries, capillaries and post‐capillary venules are present. In fact, the branch of the malar artery that reaches the base of the third eyelid divides into smaller branches that cross almost the complete length of the lid giving only a few collateral vessels, in a monopodical way, and only near the free margin of the lid is possible to observe dicothomical ramifications that became rather anastomotic (being anastomoses of type I and II are present) and contribute to the microvascular meshwork. This microvascular net is drained by post‐capillary venules and veins that empty as a brush into bigger veins that occupy the same segmental level as the third eyelid artery. Remarks: This uncommon angioarchitecture is probably an adaptation to the fact that in the medial canthus of the eye this lid has a smaller space and the way of obtaining an efficient vascularization is by going straight to the top of the lid.     

Leiomyoma of the third eyelid in a dog

A 14‐year‐old neutered male Dachshund presented for the evaluation of oculus dexter (OD) third eyelid elevation ongoing for approximately 2 months. Complete ophthalmic examination revealed a large, nonpainful, well‐demarcated, soft mass at the base of the right third eyelid causing elevation and mild hyperemia. The mass was freely moveable with the third eyelid, and no right globe deviation was noted. No other abnormalities were noted on physical examination, routine blood chemistry, complete blood count, serum T4, urinalysis, or urine cortisol/creatinine ratio. Ocular B‐mode ultrasonography showed an anechoic, well‐demarcated, homogenous, soft tissue mass at the base of the third eyelid with no orbital extension. A leiomyoma was diagnosed after multiple punch biopsies were obtained from the palpebral surface of the mass. The right third eyelid was excised surgically. Histopathology confirmed a completely excised, nodular, unencapsulated, expansile mass within the third eyelid. Positive smooth muscle actin and negative S‐100 immunohistochemistry confirmed a leiomyoma. Bundles of normal smooth muscle were also present adjacent to the mass. The mass was compressing the adjacent lacrimal gland and associated with moderate dacryoadenitis. Twelve months postoperatively, the right globe position and motility remain normal with no evidence of mass regrowth. To the author's knowledge, this is the first reported case of a leiomyoma of the third eyelid in any species. In this case, the mass was completely excised and no regrowth has occurred twelve months after surgery. This case along with independently reviewed canine third eyelids clearly demonstrates the presence of smooth muscle within the canine third eyelid.     

Excision of Neoplasms of the Bovine Lower Eyelid by H-Blepharoplasty

Neoplasms of the lower eyelid in 14 cattle were treated by wide surgical excision and H-blepharoplasty. Healing was by first intention, and cosmetic results were satisfactory in all cases. Lid function was satisfactory in 12 cattle, and there was no evidence of recurrence after at least 6 months in 12 cattle. This therapy can be recommended for large infiltrative masses on the lower lid if there is no evidence of bony involvement, metastasis, or involvement of both puncta at the medial canthus.     

Hemangiosarcoma of the third eyelid in a dog

Abstract A case of hemangiosarcoma of the third eyelid in a 7-year-old Caucasian Sheepdog is reported. A voluminous red mass protruding from the free edge of the third eyelid in the right eye was present. The mass and the free edge of the third eyelid were surgically excised. On histopathologic examination the tumor was seen to infiltrate the propria of the third eyelid and was composed of neoplastic mesenchymal cells forming irregular channels containing blood. These plump cells showed moderate anisocytosis and anisokaryosis with a low mitotic index. The surgical wound healed successfully and after 9 months there had been no recurrence. To the authors' knowledge, this is the first hemangiosarcoma of the third eyelid reported in the dog.