Core

"Embryology can sometimes be perceived as somewhat opaque. In my experience this stemmed from my time in the first year of university. Perhaps it was that I couldn't perceive the benefit of the fundamental knowledge my professors were struggling to convey or it could have been that the lectures were immediately after lunch, I guess we'll never know!

As a general practitioner I never really thought too much about embryology. On beginning my development to specialism I soon realised that that fundamental knowledge was actually pretty useful.

As a specialist I am often presented with cases where the diagnosis may be in shadow. It is these cases I now find myself returning to first principles to begin to navigate the puzzle and hopefully find proverbial illumination.

Embryology is unquestionably a fundamental pillar of any advanced practitioners knowledge. This lecture will seek to refresh memories regarding the embryologic development of the tooth.

If you're not sure who Malassez and Serres are, or you think Hertwig might be a character from ""the prisoner of Azkaban"" this lecture might just be for you.

With a focus on clinical relevance we'll explore the (honestly) fascinating development of the tooth from initiation, via bud, cap and bell all the way to maturation.

Once finished, the tooth germ will hold no fear for you (hopefully), and you will be able to boldly proclaim that that deciduous tooth is molarised but not a molar!"

Cleft palate is one of the most common developmental malformations in dogs. It is an abnormal communication between the oral and nasal cavities due to the failure of fusion of the processes, bones and soft tissues responsible for forming the palate. Early diagnosis of oral clefts is essential, and usually straightforward during a physical examination following birth.
Primary cleft palates usually have limited clinical consequences, and surgical repair is often elective in the absence of clinical signs. In contrast, secondary clefts due to the large oro-nasal communication predispose affected puppies to malnutrition, aspiration pneumonia, and early mortality without supportive care and eventual surgery. Definitive surgical repair is typically performed after the eruption of adult teeth and before eight months of age.
Understanding the embryological process of palate formation provides important context for the clinical differences between cleft types. It helps decision-making and setting client expectations regarding potential outcomes, as well as guiding treatment.
This lecture will review the embryological development of the palate in dogs, classify cleft palate types, and highlight their clinical implications with emphasis on prognosis, surgical timing, and management strategies.

This lecture is focused toward those beginning their journey in oral surgery. Surgery has the potential to be highly stressful, often associated with the unplanned presence of blood in the surgical field!

A clear understanding of the vascular anatomy can provide confidence to the clinician and mitigate unwanted blood loss.

The lecture will explore the course of the vessels of the head from their origin, the common carotid, with specific focus on vessels with clinical importance, such as the angularis oris.

This lecture will also consider methods of haemostasis and what to do if the worst happens.

This presentation focuses on the clinical relevance of anatomy through selected cases, highlighting common complications and principles of flap reconstruction. It emphasizes the importance of anatomical precision in surgical planning and outcome optimization.

Advanced oromaxillofacial surgeries in dogs and cats present unique challenges in anesthetizing the patient, particularly regarding airway management and intubation. Traditional (routine, orthograde, or normograde) endotracheal intubation techniques may not always be feasible or optimal due to anatomical constraints and limiting surgical access. In such cases, alternative intubation techniques have emerged as valuable alternatives, offering improved access, reduced risk of complications, and enhanced surgical outcomes.

The first aim in maxillofacial trauma repair is to restore the pre-trauma occlusion, allowing patients to comfortably resume masticatory functions(1). Routine intubation typically impairs the evaluation of occlusion intra-operatively. In addition, temporary maxillomandibular fixation (MMF) has become the standard of care when patients undergo open reduction and internal fixation (ORIF) for trauma that resulted in a malocclusion(1). In addition, temporary MMF allows the surgeon to proceed with ORIF without the need to intermittently assess occlusion. A normograde intubation followed by a pharyngotomy or transmylohyoid intubation overcomes these challenges that exist with temporary MMF and bypasses the oral cavity optimizing surgical outcome(2,3). The decision to use a transmylohyoid over a pharyngotomy intubation is operator preference. The latter has a more hostile surgical work environment due to the close proximity of the maxillary and linguofacial veins, external carotid artery, vagosymphatetic trunk, and the recurrent laryngeal nerve. These techniques can also be used for patients that undergo reconstruction of the mandible after oncologic surgery with a staged or immediate reconstruction. In these reconstructive cases, as well as patients that have bilateral mandibular fractures a pharyngotomy intubation may be preferred as the transmylohyoid intubation technique may limit the surgical field.

On the contrary, pathologies that result in a restricted range of motion of the TMJ possess a different set of challenges when normograde intubation is not feasible. Restricted range of motion of the TMJ could be the result of pathologies directly related to the TMJ such as TMJ ankylosis or pseudoankylosis. Other differentials include oral foreign body, retrobulbar disease, neoplasia, zygomatic sialocele, and masticatory muscle myositis (MMM). Masticatory muscle myositis, an immune mediated condition that attacks type 2M muscle fibers, is known to cause inflammation of the masticatory muscles in the acute stage and atrophy with fibrosis of these muscles in the chronic stage, both of which result in reduced range of motion or in severe cases even total inability to open the mouth. For these patients an endoscopy guided intubation or retrograde intubation may circumvent these difficulties(4,5).

Lastly, a temporary tracheostomy should be reserved for patients where all other options have been exhausted due to the significant morbidity and relatively high complication rate associated with this technique(6,7).

REFERENCES

1. Boudrieau RJ, Verstraete FJM: Principles of maxillofacial trauma repair, in FJM Verstraete, MJ Lommer (eds): Oral and maxillofacial surgery in dogs and cats. London, UK, Saunders Elsevier, 2012, pp 233–242
2. Soukup JW, Snyder CJ. Transmylohyoid Orotracheal Intubation in Surgical Management of Canine Maxillofacial Fractures: An Alternative to Pharyngotomy Endotracheal Intubation. Veterinary Surgery (2015) 44:432–436. doi: 10.1111/J.1532-950X.2014.12138.X
3. Lantz GC. Pharyngotomy and pharyngostomy. in FJM Verstraete, MJ Lommer (eds): Oral and maxillofacial surgery in dogs and cats. London, UK, Saunders Elsevier, 2012, pp 543–546
4. Vieitez V, Ezquerra LJ, López Rámis V, Santella M, Álvarez Gómez de Segura I. Retrograde intubation in a dog with severe temporomandibular joint ankylosis: Case report. BMC Vet Res (2018) 14:1–6. doi: 10.1186/S12917-018-1439-7/FIGURES/1
5. Abdoon ASS, Soliman AA, Fathalla SI, Gadallah S, Kandil OM, Shaalan AH. Cheap and easy use of a video laryngoscope as a guide for endotracheal intubation in dogs. Bull Natl Res Cent (2019) 43: doi: 10.1186/S42269-019-0178-7
6. Guenther-Yenke CL, Rozanski EA. Tracheostomy in cats: 23 cases (1998–2006). J Feline Med Surg (2007) 9:451–457. doi: 10.1016/J.JFMS.2007.06.002
7. Nicholson I, Baines S. Complications associated with temporary tracheostomy tubes in 42 dogs (1998 to 2007). Journal of Small Animal Practice (2012) 53:108–114. doi: 10.1111/J.1748-5827.2011.01167.X

Mandibular injuries are a common occurrence in cats that are presented for maxillofacial trauma.
A retrospective study was performed on a population of 109 cats that were presented for evaluation and treatment of mandibular trauma. Medical records and diagnostic imaging were reviewed to determine mandibular fracture location, morphology, and treatment. Follow-up data were obtained from repeat clinical examination and diagnostic imaging.
The most commonly injured anatomical locations were the mandibular symphysis (55.0%), the condylar process of the mandible (49.5%) and mid ramus (48.6%). More severe pre-operative fracture displacement was associated with a poor healing outcome in the mid ramus and coronoid process regions. The group of cats treated with open reduction and internal fixation (ORIF) had a significantly higher percentage of cats showing adequate healing (P = 0.0247) compared to the group of cats treated with maxillomandibular fixation (MMF). Cats treated with ORIF also had lower prevalence of persistent malocclusion (9.1%) when compared to cats treated with MMF (53.9%) (P = 0.0138, respectively). Patient survival was high at 94.5% indicating cats that were diagnosed and treated for mandibular trauma often have a good prognosis. Pre-operative fracture displacement may influence healing in select regions of the mandible. Fractures treated with ORIF had a higher rate of adequate bone healing when compared with fractures treated with MMF.

Surgical techniques for mandibular fracture repair should provide for fracture stability, however rigid internal fixation may not be necessary since the mandible is a non-weightbearing bone. Further, application of internal fixation techniques may disrupt vascular supply to bony fragments which has already been compromised secondary to the traumatic event. Non-invasive osteosynthesis can provide for occlusal maintenance and bone healing while maintaining optimal oral and dental health. Strength in bending was determined for interdental apparatuses applied to canine cadaver hemimandibles osteotomized between the mandibular third and fourth premolar teeth.The bending strength of stainless steel wire applied using a Stout loop interdental wire technique and Erich arch bar anchored to teeth using individual interdental wires was increased by acrylic reinforcement. Although acrylic does not adhere well to metal, it conforms to crown shape and interdigitates with gross metal architecture and deformation (wire twists). The ability of non-invasive methods to provide mandibular fracture stabilization in dogs while avoiding iatrogenic complications inherent with other more conventional fixation methods makes them particularly desirable.The low cost of materials, relative ease of application, and frequency of mandibular/maxillary fracture in dogs contribute to their potential uses in veterinary medicine. In fact, there use is an economically viable alternative to muzzle coaptation since the outcome with these techniques is more likely to restore occlusion while avoiding the potential complications associated with tape muzzles. Interdental wire fixation methods for human maxillofacial fracture stabilization include Ivy loop, Stout loop, Risdon, and Essig wiring techniques. Application techniques and outcomes for these non-invasive techniques will be presented including complications associated with coronally applied devices.

Content: A practical session on the emergency management and definitive repair of oral trauma. Topics will include the stabilization of jaw fractures, treatment of tooth luxations and avulsions,
and soft tissue laceration repair. Techniques for internal fixation and the use of composite materials will be discussed.

Relevance: Oral trauma is a common presentation in the emergency setting. This lecture will provide veterinarians with the critical knowledge and skills to effectively manage these cases, from initial stabilization to long-term reconstruction, ensuring optimal functional and aesthetic outcomes for the patient.

Management of Dentoalveolar Trauma: Classification and Clinical Decision-Making

The 2025 WSAVA dental guidelines provide an update on the previous edtion. This document can help you improve your practices quality, but also gain more client complience. There is more information on pathologies including juvinile conditions as well as up to date refrences. New chapters on dental radiograph interpretation and utilization of support staff will further your practice growth. There is also astep by step information on extractions and dental prophylaxis. This lecture will improve your bottom lines in many ways.