Avulsion of lip in a Tom cat and its Surgical Management
A R Ninu
Department of Veterinary Surgery and Radiology
Veterinary College and Research Institute, Tirunelveli – 627 358
Tamil Nadu Veterinary and Animal Sciences University
Abstract
Repair of rostral lower lip avulsion in a cat following fight with another cat is discussed in this case report.
Keywords: bite wound, cat, lip avulsion
Introduction
Lip avulsions in cats can result from bite or automobile accidents and the most common cause was bite by animals. Bilateral rostral lower lip avulsion was more common in cats compared to dogs where bilateral rostral upper lip avulsion was most common. Most common short term complication was wound dehiscence (Saverino and Reiter, 2018). This is a case report on bilateral rostral lower lip avulsion due to cat bite in a cat.
Materials and Methods
An year old male non-descript cat was brought with a history of hanging of lower lip due to bite from another cat three days back (Fig. 1.). Locally, the cat was given antirabies vaccination. Under xylazine (@ 2mg/kg b. wt.) – ketamine (@ 10 mg/kg b. wt.) sedation, the site was debrided followed by lavaging using diluted povidone iodine solution (0.5 %). This was followed by application of simple interrupted sutures through the edges of the torn lip and the buccal gingiva at lingual suface and incorporating the crown of the canine teeth on both the sides of lower jaw using Polyglycolic acid no 2-0 suture material. There was no suture holding capacity in the symphyseal region. Post-operatively, cephalexin was given per os @ 15 mg/Kg b. wt. for 5 days after food BID and pantoprazole @ 1mg / Kg. b. wt. per os OD pre-prandial for five days. It was reported by the owner that the cat removed the sutures after six days post-operatively, but there was improvement in the condition.
Discussion
Several methods are available for the repair of the lip avulsion in cats. This varies with the extend of lip avulsion and time elapsed/the suture holding capacity of the tissues involved. Necrosis or loss of tissue may result in increased tension on the sutures applied. Suturing the subcutaneous layer of avulsed skin to the mandibular symphysis or even deeply through the mylohyoideus muscles for the caudal lip avulsion is another option in such cases. Drilling hole through the lower rostral mandible and taking bite through the lower lip mucosal edges and passing these sutures through the pre-drilled holes and tying the knot may be attempted. Even passing sutures through the skin and around the lower mandibles as in a symphyseal mandibular fracture and tying the knot outside the skin with stents to reduce the tension on the skin knots are reported. Flaps, grafts or second intension healing can also be considered (Jang et al., 2022; Saverino and Reiter, 2018).
The suture material used for the repair may be an absorbable monofilament suture material like polydioxanone 2-0 that warrants security even in delayed wound healing or absorbable suture material like polyglycolic acid 2-0. Use of non-absorbable monofilament sutures like polyamide may be used when the knots are tied on the skin of the lower lip (Debbarma et. al., 2023). Even stainless wires may be tried when the avulsed lower lip is tied to the bone of the lower mandible or when taken around the crown of the canines or the incisors of lower jaw as for interdental wiring. Tissue adhesives like n-butyl-2-cyanoacrylate also have been documented for adhering the mandibular part/caudal part of the lower lip and this reduced the duration of surgery considerably (Rathnayake et al., 2019).
Conclusion
It could be concluded that the rostral lower lip avulsion in cats can be managed by suturing the mucosa of the avulsed lip to the mucosa of the gingiva on the lingual surface if there is no self- mutilation else healing will occur under mixed intention depending on the day of suture dehiscence.
Acknowlegement
The author is thankful for the constant encouragement received from the Dean, Veterinary College and Research Institute, Tirunelveli. The authors is also thankful for the support received from the Director of Clinics, TANUVAS , Professor and Head, Department of Veterinary Surgery and Radiology and Professor and Head, VCC, Veterinary College and Research Institute, Tirunelveli- 627 358.
References
Debbarma, A., Behra, S. S., Dash, J., Mishra, S. R. and Behera, M. (2023). Lip avulsion in a cat and its surgical treatment. J. Pharma. Innov. 12(7): 208-209.
Jang, K., Chae, Y., Yang, E., Jo, H. M., Shim, K. M., Bae, C., Kang, S. S. and Kim, S. E. (2022). Successful surgical repair of severe lower lip avulsion in two cats. J. Vet. Clin. 39(5): 264- 271.
Rathnayake, S. P., Rathnayake, R. A. M. K. and de Silva, D. D. N. (2019). Reconstruction of mandibular lip avulsion in a cat using tissue adhesive and standard wound closure – a case report. S. L. Vet. J. 66(1): 31-33.
Saverino, K. M. and Reiter, A. M. (2018). Clinical presentation, causes, treatment, and outcome of lip avulsion injuries in dogs and cats: 24 cases (2001-2017). Front Vet Sci.
Fig. 1. Lip avulsion in Tom cat
