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.     

Surgical management of bilateral,upper and lower eyelid entropion in 27 Shar Pei dogs,using the Stades forced granulation procedure of the upper eyelid only

ABSTRACT

Aims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.

Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.

Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.

Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.     

Surgical correction of periocular fat pads and entropion in a potbellied pig (Sus scrofa)

A 16-year-old Vietnamese potbellied pig was examined because of recurrent ocular discharge and reduced visual ability. Bilateral upper eyelid entropion and impaired vision secondary to periocular fat deposition were diagnosed. Surgical correction with excision of subdermal fat and redundant skin was performed to address both issues. Surgery restored vision and resolved ocular irritation. More than 1 year following surgical therapy the pig is visual and comfortable with no evidence of recurrent fat deposition or entropion.     

Entropion correction by fornix-based suture placement: use of the Quickert-Rathbun technique in ten dogs

The objective of this study was to evaluate fornix-based suture placement as a method for entropion correction in the dog. Lower eyelid entropion with resultant trichiasis was corrected in 10 dogs using fornix-based suture placement similar to that employed in the Quickert-Rathbun technique used in man. A double-ended suture was placed originating at the deepest extent of the fornix and exiting the lid 1-2 mm from the eyelid margin. Degree of correction was assessed visually immediately after surgery and at re-examination with a follow-up period of up to 6 months. Fornix-based suture placement led to immediate eversion of the eyelid in each case and thus amelioration of the trichiasis in all dogs. In two cases eyelid eversion initially appeared over-corrected and in two cases exposure of conjunctival tissue was evident initially at the palpebral margin. In all cases, however, such complications were transient with long-term results giving an acceptable apposition between ocular surface and eyelid margin in all adult dogs. In three juvenile dogs on which the technique was used, further surgical treatment was required as the puppies grew. Fornix-based suture placement is a novel approach to entropion correction in the dog which yields acceptable results in the majority of suitable cases without recourse to incisional surgery.     

Cutaneous mucinous vesiculation in a dog with hypothyroidism

Hypothyroidism was documented in an overweight dog with bilateral entropion, blepharoptosis, and multiple, non-inflammatory papular and vesicular lesions on the head. Histologic evaluation of skin biopsy specimens confirmed the diagnosis of mucinous vesiculation. All skin and eyelid abnormalities resolved in response to thyroid hormone supplementation.     

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.     

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.     

Episioplasty for the treatment of perivulvar dermatitis or recurrent urinary tract infections in dogs with excessive perivulvar skin folds: 31 cases (1983-2000).

OBJECTIVE: To evaluate the effectiveness of episioplasty for the treatment of perivulvar dermatitis or chronic or recurrent urinary tract infections (UTI) believed to be secondary to excessive perivulvar skin folds in dogs and to document whether a causal relationship exists between the presence of chronic or recurrent UTI and excessive perivulvar skin folds in female dogs. DESIGN: Retrospective study. ANIMALS: 31 female dogs. PROCEDURE: Medical records of dogs with vulvar dermatitis (group 1; n = 15) or UTI (group 2; 16) were reviewed for history, signalment, physical examination findings, hematologic findings, results of urine or vaginal bacteriologic culture, and results of additional diagnostic procedures. RESULTS: 14 of 15 dogs in group 1 had complete resolution of perivulvar dermatitis and associated clinical signs following episioplasty. One dog had a relapse of clinical signs and vulvar dermatitis 2 years after surgery in association with a 9-kg (1 9.8-1b) weight gain. Sixteen of 16 dogs in group 2 had complete resolution of clinical signs of UTI following episioplasty. Urine samples were obtained via cystocentesis no earlier than 1 month after surgery to confirm resolution of UTI in 13 of 16 of dogs in group 2. Mild-to-moderate incisional swelling was the only surgical complication reported for either group, with the exception of 1 dog in group 2 that had wound dehiscence. All owners were satisfied with surgical outcomes. CONCLUSIONS AND CLINICAL RELEVANCE: All owners reported complete resolution of clinical signs for both groups of dogs. Episioplasty is an effective low morbidity treatment for perivulvar dermatitis and chronic UTI associated with excessive perivulvar skin folds.     

Technique of lateral canthoplasty for the correction of macropalpebral fissure in the dog

The various clinical anomalies associated with macropalpebral fissure in the dog can be relatively successfully addressed by a reduction in functional eyelid length and stabilisation of the lateral canthus. In this new technique the basic principles of the Kuhnt-Szymanowski lateral canthoplasty have been extended to include an additional shortening of the upper eyelid obtained by a triangular split thickness resection. Results in a series of 22 patients have demonstrated significant clinical improvement throughout, with optimum positioning of the modified palpebral fissures being achieved in five of these patients by the additional and subsequent resection of redundant forehead skin.     

Reconstruction of the eyelids of a dog using grafts of oral mucosa.

A five-month-old English cocker spaniel with distichiasis had been treated four times surgically by a tarsomeibomian resection technique. As a result, three-quarters of the margins of its upper eyelids had been eliminated and the lower eyelids had become considerably thinner. The dog had developed upper entropion and upper eyelid trichiasis, and keratoconjunctivitis sicca. It was treated medically and grafts of oral mucosa were used to reconstruct its upper eyelids. A year after surgery, the new palpebral margin was completely functional and cosmetically acceptable. The dog's eyes appear normal and only require treatment with artificial tears.     

Prolonged survival after craniectomy with skull reconstruction and adjuvant definitive radiation therapy in three dogs with multilobular osteochondrosarcoma

Multilobular osteochondrosarcoma is an uncommon canine tumor but presents a treatment challenge when arising on the skull. This retrospective case series study aimed to describe outcome of a multimodality treatment approach involving aggressive surgical resection and adjuvant definitive radiation therapy in a group of dogs with multilobular osteochondrosarcoma of the calvarium. Clinical, imaging, treatment, and outcome data were collected from retrospective review of medical records. Three dogs met inclusion criteria. The presenting clinical complaint was the presence of a mass effect of the skull in all three dogs and concurrent neurologic abnormalities in one dog. Advanced imaging revealed aggressive lytic and proliferative tumors arising from the calvarium in all three dogs. All dogs were treated surgically with a modified craniectomy, repaired with a titanium mesh—polymethyl methacrylate bone cement implant or a low prolife titanium mesh plate and followed by adjuvant definitive radiation therapy with 2.5 Gy per fraction for 22 daily fractions. There were no major immediate surgical complications and radiation was well tolerated overall. Neurologic improvement was seen in the patient that presented with neurologic disease. Survival times from surgery were 387, 422, and 730 days and from the time of radiation were 358, 397, and 677 days. Findings in this sample of three dogs supported the use of aggressive therapy with a combination of surgical craniectomy and cranioplasty utilizing a titanium mesh implant and high dose definitive radiation therapy for local control and prolonged survival times in dogs with multilobular osteochondrosarcoma of the skull.     

Severe carpal and tarsal shearing injuries treated with an immediate arthrodesis in seven dogs

The medical records of seven dogs with severe, grade 3, open shearing wounds of the carpus or tarsus that were treated with an immediate arthrodesis were reviewed. Six dogs were managed with a transarticular external skeletal fixator (ESF), and one dog was treated with plate fixation. The soft tissues were managed simultaneously along with the definitive joint stabilization in all cases. Minor complications occurred in four dogs: one dog that required a skin graft, one dog in which a skin graft was recommended but not performed, one dog in which a secondary skin closure was performed, and one dog in which a delayed cancellous bone graft was placed. Major complications occurred in three dogs: two dogs that required restabilization of the arthrodesis and one dog that required implant (i.e., plate) removal due to infection. All dogs healed with acceptable functional and cosmetic results. Further long-term evaluation of five dogs revealed that all but one dog had either excellent or good functional outcomes, and the remaining dog had a fair outcome. Similarly, five dogs had either excellent or good cosmetic outcomes, with the remaining dog having a fair outcome. All owners were very satisfied with the overall results. This clinical study demonstrated that an immediate, definitive management technique, in which bone fusion and wound management are undertaken as simultaneous objectives, is a viable technique of managing severe periarticular shearing injuries. Transarticular stabilization with an ESF is the technique recommended.     

Feline entropion: a case series of 50 affected animals (2003–2008)

Aim  To evaluate the signalment, clinical signs, and etiopathogenesis of entropion in 50 cats.
Methods  Signalment and history of 50 cases of entropion in cats presented to a referral ophthalmology clinic. Animals were examined with direct and indirect ophthalmoscopy and slit-lamp biomicroscopy. Animals were treated surgically with a Hotz-Celsus procedure and results of surgery were evaluated between 4 and 22 weeks.
Results  Sixteen cats were young (mean age 4.1 ± 3.6 years) with pre-existing irritative ocular surface conditions such as conjunctivitis, corneal ulceration or sequestrum. Twenty-six cats were relatively older (mean age 11.3 ± 2.2 years) with involutional entropion with or without enophthalmos, presumed to result from a reduction in orbital tissue. Five cats were Persians with entropion associated with brachycephalic facial anatomy, whereas three were entire young adult male Maine Coones with in-turning associated with excessive facial 'jowl' tissue. Surgical treatment was curative in the majority of cases after one surgery although an increased amount of eyelid tissue was required to be removed for correction compared with similar surgery in the dog.
Discussion  This study has shown that entropion in cats may be caused in young animals as a result of continued blepharospasm related to irritative causes such as conjunctivitis or corneal ulceration or in older animals with lid laxity or globe enophthalmos. Lid in-turning was also seen in Persian and Maine Coone breeds.     

Adenocarcinoma of the gland of the third eyelid in seven dogs

Adenocarcinoma of the gland of the third eyelid developed as a smooth, pink nodule on the bulbar aspect of the third eyelid of seven 10- to 16-year-old dogs. Tumors recurred in 4 dogs. One dog, which initially had the most infiltrative-appearing tumor among those studied, was euthanatized 7 months after the first excision, because of extensive local recurrence and suspected metastasis. Tumors did not recur after removal of the entire third eyelid as the initial or follow-up procedure. We recommend removal of the entire third eyelid to prevent local recurrence of the tumor.     

192iridium brachytherapy, using an intracavitary afterload device, for treatment of intranasal neoplasms in dogs.

After surgical removal of a primary intranasal neoplasm, an implant device, designed to deliver 192iridium (192Ir) brachytherapy, was positioned in the nasal cavity of 8 dogs. Ribbons containing 192Ir seeds were placed in the device, using an afterloading technique. Dosimetry, to a dose of 7,000 to 10,000 centiGray (cGy), was calculated to encompass the site previously occupied by the tumor and a 1-cm margin of surrounding normal tissue. The quantity of 192Ir implanted varied between 16.69 and 100.80 mg of radium equivalent. The duration of implantation ranged from 90 to 168 hours. All dogs tolerated the implant well, but had a mucoid nasal discharge after radiotherapy. The implant device allowed rapid application and removal of the radioactive ribbons. Mean (+/- SD) radiation exposure to each radiotherapist during seed loading and unloading was 14.4 (+/- 5.3) and 4.5 (+/- 0.9) mrem, respectively. A uniform dose distribution around the intranasal implant device was achieved; however, dogs that received doses in excess of 9,400 cGy at the dorsolateral surface of the nose and/or hard palate had bone and soft tissue necrosis between 70 and 120 days after treatment. One dog was euthanatized 50 days after treatment because of metastatic disease, and 2 dogs were euthanatized because of local tumor recurrence at 125 and 212 days. Death, considered unrelated to treatment, occurred in 1 dog that was euthanatized 27 days after treatment and in 3 dogs that died 30, 93, and 456 days after treatment. Necropsy was performed on 3 of these dogs and evidence of intranasal neoplasia was not observed. One dog remained disease-free at 587 days after treatment.     

Repair of radial fractures in toy breed dogs with self-reinforced biodegradable bone plates, metal screws, and light-weight external coaptation

OBJECTIVE: To describe a surgical technique for, and outcome after, treatment of radial fractures with biodegradable self-reinforced polylactide plates and metal screws, and external coaptation. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Eleven Toy breed dogs. METHODS: Radial fractures were repaired by application of a single or 2 stacked biodegradable self-reinforced polylactide plates (poly-L/D, L-lactide, stereocopolymer [LL-and DL-lactide ratio 70/30]; SR-PLA (70/30) implants) secured with metal screws, and light-weight external coaptation. Healing was evaluated clinically and by radiography at 2, 4, 6, 8, 9, 12, 24-26 weeks, and at 1 and 2 years. Owners were interviewed 3 years after surgery. RESULTS: Radial fracture lines disappeared within 4-14 weeks in 10 dogs; an implant failed in 1 dog. Ambulation was excellent for healed fractures. Excessive skin tension led to removal of implants in 1 dog and suture repair in another dog. No foreign body reaction from implant degradation was observed and the plate was usually no longer palpable at 2 years. One dog had a fracture through a screw hole at 1 year. CONCLUSION: Healing and complication rates after repair of radial fractures with SR-PLA (70/30) plates were considered similar or better than reported after repair with metallic plates or external fixation in Toy breed dogs. No radiographic signs of osteopenia were identified under the plate during follow-up. CLINICAL RELEVANCE: Biodegradable polylactide plates could be considered as an alternative to metal plates for radial fracture repair in Toy breed dogs, however available plates are likely not strong enough when used as a single plate. Implant removal is usually not needed.     

Full-thickness Thoracic and Abdominal Wall Reconstruction in Dogs Using Carbon/Polycaprolactone Composite

Square 9 × 9 cm full-thickness defects were created in the thoracic wall of five dogs and the abdominal wall of five dogs. The skin was retained. Ten centimeter squares of carbon fabric with a thin polycaprolactone (PCL) lining were sutured into the defects with the PCL lining facing the viscera. The dogs were observed for 5 months. The surgical technique was simple and fast. All implants were well tolerated. Cosmetic results were excellent in nine dogs. One dog (abdominal implant) developed an infection and draining tract, and a second dog (thoracic implant) had a subclinical infection. Thoracic implants caused brief serosanguinous pleural transudate. Mild paradoxical respiratory motion disappeared by 8 weeks. Lungs were radiographically normal. At necropsy, fibrous tissue was present but lacked orientation. Loose adhesions covered 20 to 80% of implant linings. There was no significant difference in ultimate tensile strength of implant/fibrous tissue compared to control abdominal wall. No carbon fragments were observed in lymph nodes. Increased numbers of secondary follicles, plasma cells, eosinophils, and sinus histiocytes in lymph nodes suggested immunologic stimulation of undetermined significance.     

Modified Kuhnt–Szymanowski surgical procedure for secondary cicatricial ectropion in a horse

A 1‐year‐old Dutch Warmblood gelding was presented to the University of Florida’s Large Animal Hospital (UF‐LAH) for correction of ectropion of the right lower eyelid. The ectropion was the result of a lower eyelid laceration. A primary repair was performed by the referring veterinarian; however, the horse prematurely removed the sutures and the wound healed with inversion of the eyelid margin. Surgical correction of the entropion, with removal of tissue from the lower eyelid, resulted in cicatricial ectropion. During the initial evaluation at UF‐LAH, a corneal ulcer was noted in the right eye because of exposure from the anatomically nonfunctional lower eyelid. A modified Kuhnt–Szymanowski procedure was performed to correct the ectropion and repair the eyelid margin. The surgical site healed appropriately with an acceptable cosmetic and functional result. No recurrences of corneal ulcers in the right eye were reported in the 18 months following surgical correction of the ectropion.     

小型犬尺桡骨,股骨远端骨折的钢板植入及取出手术

本文对小型犬尺桡骨和股骨远端骨折实施了钢板植入和愈合后钢板的取出手术。由于小型犬骨骼细,找不到合适的钢板。我们利用现有的材料根据骨折的具体情况,进行了钢板植入手术的尝试均取得了成功。     

A case of lipogranulomatous conjunctivitis in a horse

Objective

To describe a case of lipogranulomatous conjunctivitis in a horse.

Animal Studied

A client-owned 12-year-old Standardbred gelding presenting with chronic conjunctivitis and palpebral masses.

Methods

Complete ophthalmic examination, surgical excision, histopathology, and bacterial culture of biopsy samples were performed.

Results

Upper and lower eyelids of both eyes were affected, with multiple yellow-to-white nodules on the palpebral conjunctiva, adjacent to the eyelid margin. Nodule removal was achieved via partial tarsal plate excision. Histopathological examination revealed granulomatous inflammation and large droplets of presumed free lipid in the conjunctival lamina propria. The animal was diagnosed with lipogranulomatous conjunctivitis. No postoperative ocular discomfort was observed for months; however, 3 years later, new conjunctival nodules were noticed, requiring a second surgical procedure on three of the eyelids. Transient entropion in the left lower eyelid was observed 2 months after the second surgery, and no recurrence of conjunctival nodules was observed after 18 months of follow-up.

Conclusion

To our knowledge, this is the first report of lipogranulomatous conjunctivitis in horses.