Indo-Am. J. Agric. & Vet. Sci., 2014 ISSN Rambabu 2321 9602 Kalaka www.iajavs.com et al., 2014 Vol. 2, No. 3, September 2014 2014 Meghana Publications. All Rights Reserved Case Report LOWER EYELID RECONSTRUCTIVE SURGERY AFTER SEBACEOUS GLAND ADENOMA RESECTION IN A GERMAN SHEPHERD DOG: A CASE REPORT C Ramani 1, Rambabu Kalaka 1 *, L Nagarajan 1, M Thangapandiyan 2 and B Justin William 1 *Corresponding Author: Rambabu Kalaka kalakarambabu@gmail.com A 7 year-old female German shepherd dog was presented to small animal ophthalmology unit, Department of Veterinary Surgery and Radiology, Madras Veterinary College, Teaching Hospital, Chennai with a mass in the right lower eyelid. Complete excision of the tumor was performed under general anaesthesia. The extent of skin loss in the lower eyelid required reconstruction, so the sliding skin flap or H blepharoplasty technique was performed. Successful treatment of lower eyelid mass was achieved by surgical removal and no recurrence was noticed during the subsequent months. The mass was histologically diagnosed as a sebaceous gland adenoma. A "H blepharoplasty" resulted in satisfactory functional and cosmetic outcome. Keywords: Lower Eyelid; Sebaceous gland Adenoma; H Blepharoplasty; Sliding skin flap: dog INTRODUCTION The eyelid is a common site for neoplastic diseases in dogs (Brightman, 1993; Bedford, 1998). Among the most common eyelid tumors in dogs, the ones that stand out are adenoma of the sebaceous gland (Khehbiel e Langham, 1975) Whether eyelid tumors are malignant or benign, the importance of an appropriate therapy should be considered, in view of the ocular discomfort that it causes and because of its potential to impair vision (Miller e Dubielzig, 1996; Willis e Wilkie, 2001). Reconstructive blepharoplasty is indicated in any dog in which trauma or surgical excision has removed more than one third of the eyelid margin. It should be remembered that although the eyelid skin is pliable, the surrounding facial skin is relatively inelastic and may not stretch readily to provide donor skin. If the eyelid mass involves less than about one third of the eyelid margin, removal can be performed in a routine fashion. If the mass involves more than one third of the eyelid margin, reconstruction of the eyelid will be necessary. This may require more complicated procedures, and sometimes more than one surgery will be needed to fully reconstruct the eyelid (Rizk Awad, 2012). The case report describes reconstructive surgery of the lower eyelid with a sliding H blepharoplasty technique after surgical excision 1 Department of Veterinary Surgery & Radiology, MVC,Chennai. 2 Department of Veterinary Pathology, MVC, Chennai 77
Indo-Am. J. Agric. & Vet. Sci., 2014 Rambabu Kalaka et al., 2014 of a sebaceous gland adenoma in a German shepherd dog. Figure 2: Excised Tumor Mass CASE REPORT A 7 year-old female German shepherd dog was presented to small animal ophthalmology unit, Department of Veterinary Surgery and Radiology, Madras Veterinary College, Teaching Hospital, Chennai with a right lower eyelid mass. The mass had been present for approximately 2 months but had recently increased in size. The dog was in good physical condition. Ophthalmic examination and hematologic test appeared normal except the mass of the lower eyelid (Figure 1). Figure 1: Lower Eyelid Mass demanded a surgical technique for reconstruction of the lower eyelid (H blepharoplasty). The incisions were extended vertically for twice the height of the excised portion. Triangular pieces of skin were excised at the end of each incision. These triangles facilitated closure without skin folds and helped to distribute tension slightly diverging incisions also allowed for wound contracture. The sides of the triangle was approximately the height of the excised portion. Surrounding skin was undermined with scissors to provide skin mobility. Skin closure was begun at the eyelid Figure 3: HP showing Sebaceous Gland Adenoma Irregular Lobules of Several Layers of Germinative Sebocytes The dog was prepared for aseptic surgery, premedication with Atropine and Xylazine @ 0.04 mg/kg and 1 mg/kg body weight intramuscularly. Analgesia was maintained with Tramadol @ 4 mg/kg of body weight intravenously followed by Diazepam and Propofol anaesthetic induction @ 0.3 mg/kg and 5 mg/kg of body weight intravenously and Isoflurane @ 2% for maintenance of general anesthesia. Complete excision of the tumour was carried out. (Figure 2). Since the excision of the mass involved a significant loss of tissue the procedure 78
Indo-Am. J. Agric. & Vet. Sci., 2014 Rambabu Kalaka et al., 2014 margin using a 3-0 polyglycolic acid (PGA). The flap was sutured to the underlying conjunctiva along the eyelid margin with 3-0 PGA in a simple continuous pattern. Postoperatively the dog was given to Tab.Cefalexin 500 mg @ 22 mg/kg b.wt b.i.d and Tab. Prednisolone 2 mg/kg b.wt for five days. On histopathology examination tumor mass diagnosed as Sebaceous gland adenoma showing irregular lobules of several layers of germinative sebocytes (Figure 3). RESULTS The wound healed by first intention and the sutures were removed on 10 th postoperative day. The dog completely recovered and no recurrence or complication was observed. Reconstruction of the lower eyelid by H blepharoplasty resulted in satisfactory functional and cosmetic outcome. DISCUSSION Successful treatment of lower eyelid sebaceous gland adenoma can be achieved by H blepharoplasty surgical removal (Slatter, 2008). Figure 4: Post Operative Picture In this case, reconstruction of the lower eyelid by sliding skin flap H blepharoplasty resulted in satisfactory functional tear well and cosmetic outcome (Figure 4). ACKNOWLEDGMENT The Authors grateful to the Director of Clinics, Tamil Nadu Veterinary and Animal Sciences University and the Dean, Madras Veterinary College for the facilities provided for the study. REFERENCES 1. Bedford P G C (1999), Diseases and Surgery of the canine eyelid, In Gelatt K N, Veterinary Ophthalmology, 3 rd Edition, Philadelphia: Lippincott Williams & Wilkins, chapter 14, pp. 535-568. 2. Brigthman A L (1993), Eyelids, In: Slatter D, Textbook of Small Animal Surgery, 2 nd ed., Philadelphia: W.B. Saunders, Vol. 2, ch. 82. p. 1157-1177. 3. Krehbiel J D and Langham R F (1975), Eyelid neoplasms of dogs, Am J Vet Res, Vol. 36, No. 1, pp. 115-119. 4. Miller P E and Dubielzig R R (1996), Ocular tumors, In: Withrow S J, Macewen E G, Small Animal Clinical Oncology, 2 nd ed., London: W B Saunders., ch. 27, pp. 420-431. 5. Rizk Awad (2012), Lower Eyelid Reconstructive Surgery after Melanoma Resection in a Horse, Vol. 1, pp. 514. 6. Slatter D (2008), Fundamental Veterinary Ophthalmology, 4 th ed., Philadelphia, PA, Saunders, pp. 123-126. 7. Willis A M and Wilkie D A (2001), Ocular Oncology, Clin Tech Small Anim Pract, Vol. 16, No. 1, pp. 77-85. 79