1.Pet Information
Name: Ball
Variety: Pomeranian
Age: 4 years old
Weight: 5kg
Gender: female
No sterilization
2.Pre-operative Examination
2.1 Basic inspection
According to the BCS (Body Condition Scoring) body condition score of 4 points, overweight. Static observation of the dog breathing well, 26 times per minute, deeper, faintly heard the voice of the throat. Body temperature was at 38.5 C. Heart rate was 186 beats per minute. In a good mental state. Oral mucosa was pink with a capillary refill time of less than 1 second.
2.2 Laboratory examination
●The blood routine results were not significantly abnormal.
●Abnormal indicators of biochemical results may be related to starvation, protein loss of intestinal disease.
●The coagulation function results were not abnormal.
●Cardiac ultrasound results: no abnormal flexion of the ventricular wall. No abnormal structural defects were observed. There is no obvious abnormality in cardiac structural function, so regular examination is recommended.
Color Doppler show: no regurgitation in left heart, no abnormal turbulence in pulmonary artery and aortic valve.
Doppler Spectrum show: AVmax:1.03m/s PVmax:0.84m/s MV E wave: 0.61 m/s MV A wave: 0.53 m/s E / A: 1.14
●The ECG results showed no significant abnormalities.
●X-ray of the throat needed to be dated. The sedative used was propofol, 8mg / kg. With an indwelling needle, preabsorb oxygen 3 minutes before sedation, and prepare 4.5,4,3.5 cannula.
Slow through the indwelling needle to push intravenous propofol, the dog after 1 minute tongue color purple, throat sound, endotracheal cannula after oxygen and positive pressure ventilation support, after 20s the dog tongue color back to normal is pink, observe the soft palate will cover the epiglottic cartilage, the throat swelling, laryngeal cyst.
The dog was breathing steadily for laryngeal X-ray shooting, and the laryngeal bone results were normal, no obvious abnormalities in the trachea, and skin folds caused by obesity.
3.Diagnostic Results
After examination and analysis, we determined that breathing problems caused by excessive soft palate. Explain the situation to the owner, and communicate the surgical plan, decided to use laser knife to remove the long soft palate, the advantages include high cutting accuracy, small tissue damage, no bleeding and so on.
4.Operation Procedures
4.1 Preoperative medication
The operation was performed on the evening of April 7,2022, and the anti-inflammatory drug cefazolin, 25mg / kg, was used before surgery. The painkiller meloxicam, 0.2mg / kg. The sedative was 1mg / kg. The induction anesthetic propofol, 6mg / kg, repellent dexamethasone 0.5mg / kg.
4.2 Operating room preparation
The operating room turned on the ultraviolet lamp 30min in advance. During the operation, the laminar ventilation and filtration system was opened, and the basic instrument package and laser machine were prepared and converted into a laser knife.
4.3 Anesthesia
Give preoperative anti-inflammatory drugs in the central disposal area, and wait for 10min after subcutaneous injection of meloxicam. The dog achieved the sedation effect, cannula after pre-oxygenation, connected to the gas anesthesia machine. After stabilization, he was moved to the operating room to continue the anesthesia with the gas anesthesia machine.
4.4 Surgical operation
The animal lay supine, opened the mouth with gauze strips, pulled the tongue to the ventral side, and adjusted the shadowless lamp to expose the throat. Use two thin lines to determine the soft palate needed to cut, pay attention to the position of the cutting, cutting too much will cause the animal to drink water and choke water, cut too little to achieve the effect.
Pull the thin lines on both sides, expose the cutting area as shown in the figure below, and cut a small wet gauze pad below the cutting area to prevent penetration into other tissues during the laser cutting process.
Cut using a custom protocol-with a cutting power of 4W.
After cutting, infiltrate the open site with gauze soaked with lidocaine, the main purpose is to stop asthma and cough, cough will further damage the tissue, increase the probability of local swelling, such as swelling will lead to compression of the trachea, resulting in a high risk of suffocation death, which should be noted.
Infiltration time should not be too long, more than ten minutes is appropriate, too long can lead to paralysis can not swallow. Finally, wipe the mouth with wet gauze, absorb oxygen and wait for the animal to wake up. During the awakening process, we must pay attention to the situation of the animal until it is fully awake. Wear a head cover to protect the throat to prevent the animal from scratching the throat due to discomfort.
Postoperative oxygen inhalation is performed waiting for awakening.
5.Postoperative care
After surgery, the larynx was closely observed, and laser physiotherapy was used for swelling, and attention to avoid thyroid during operation. Cefazoline for 5 days, 25mg / kg twice a day.3 days of meloxicam, 0.1mg / kg, once a day.3 days of dexamethasone, 0.5mg / kg, once a day.
6.Prognosis
The prognosis is good. There was no swelling at the cutting site, no dyspnea, or sleeping snoring.
The operation time is too close, no condition tracking.
7.Conclusion
The laser knife gathers the laser energy to form a very fine light beam. The irradiation of biological tissue can be transformed into heat energy to be absorbed by the tissue, producing biological effects such as solidification, carbonization and vaporization, so as to achieve the effect of cutting.
Using a laser knife for surgery has the following advantages:
1). Smaller wound
Fine cutting of local tissue, the wound is small, small scar, no tissue contraction, easier to recover.
2). Less bleeding
During the process of laser cutting, proteins in the blood denatured and solidify after heating, which in hemostasis.
3). Avoid infection
Laser has the effect of directly killing bacteria and other microorganisms, so the postoperative infection rate is significantly reduced, and the surgical cutting effect of the infected wound surface is also good.
4). Less pain sensation
After laser surgery, there is less inflammatory response and less pain, which helps patients to improve the postoperative quality of life and accelerate healing.
5). can be used in a variety of treatments
Electric knives should not be used close to metals (such as silver mercury, metal restorations, or implants), and laser surgery is safe for metals.
8.Discussion
Soft palate is too long generally occurs in the flat nose dogs and cats, common method, brother, Pomeranian dog is relatively rare. A long soft palate carries a risk of suffocation and seriously affects the quality of life, but local swelling after surgery leads to a high risk of surgery, which is why many veterinarians fear, but the surgery itself is not complicated.
The overall effect of the laser surgery performed by the laser knife is satisfactory. The laser knife is simple to operate and causes no damage to the surrounding tissues while grasping the accuracy, which is not comparable to other surgical tools.
Before using high frequency electric knife to remove the soft palate, it is easier to accidentally injure the surrounding tissues, laser knife increases the confidence of surgery and reduces the risk of surgery.