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Surgery of the Head and Neck in Small Animals
Surgery of the Head and Neck in Small Animals
T. Németh, DVM, PhDT. Németh, DVM, PhD
Surgical anatomySurgical anatomy
Surgical anatomySurgical anatomy Surgical anatomySurgical anatomy
Surgical anatomySurgical anatomy Main Surgical Diseases of the Oral Cavity
Main Surgical Diseases of the Oral Cavity
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
Main Surgical Diseases of the Oral Cavity
Main Surgical Diseases of the Oral Cavity
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
Mandibular Symphyseal SeparationMandibular Symphyseal Separation
• Incidence– cat, (dog)– „high rise syndrome” – car accident
• Diagnostics– history– salivation, eating unability– mandibular dislocation – X-ray
Mandibular Symphyseal SeparationMandibular Symphyseal Separation
• Therapy– stabilisation– short acting
narcosis– fixation (tension
band wire) – antibiotics– artificial feeding
(syringe, gastrostomy)
– implant-removal after 4 weeks
Mandibular Symphyseal SeparationMandibular Symphyseal Separation
Main Surgical Diseases of the Oral Cavity
Main Surgical Diseases of the Oral Cavity
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
Palatoschisis / Cleft palatePalatoschisis / Cleft palate
• Incidence– congenital: brachycephalic
dogs
• Incidence– congenital: brachycephalic
dogs
SoftSoft palatepalate hypoplasiahypoplasia
SoftSoft and and hardhardpalatepalate hypoplasiahypoplasia
DevelopmentDevelopment of of palatespalates
Palatoschisis / Cleft palatePalatoschisis / Cleft palate
• Incidence– acquired: cats(„high rise syndrome”)
• Incidence– acquired: cats(„high rise syndrome”)
Palatoschisis / Cleft palatePalatoschisis / Cleft palate
• Diagnostics– history (congenital or traumatic)
– oronasal reflux• nasal discharge, regurgitation, sneezing, gagging
– aspiration / pneumonia– oral inspection– endoscopy– radiology (aspiration)
• Diagnostics– history (congenital or traumatic)
– oronasal reflux• nasal discharge, regurgitation, sneezing, gagging
– aspiration / pneumonia– oral inspection– endoscopy– radiology (aspiration)
Palatoschisis / Cleft palatePalatoschisis / Cleft palate
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
Palatoschisis / Cleft palatePalatoschisis / Cleft palate
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
– “rotational flap”
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
– “rotational flap”
1.1.
2.2.
3.3.
Palatoschisis / Cleft palatePalatoschisis / Cleft palate
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
– “advancement flap”
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
– “advancement flap”
1.1. 2.2. 3.3.
Palatoschisis / Cleft palatePalatoschisis / Cleft palate
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
– “advancement flap”– antibiotics (anaerobics!)
– soft diet– stitch removal after 4
weeks
• Therapy– surgery (?)– suturing (monofil
absorbable or steel wire)
– “advancement flap”– antibiotics (anaerobics!)
– soft diet– stitch removal after 4
weeks
1.1. 2.2. 3.3.
Main Surgical Diseases of theOral Cavity
Main Surgical Diseases of theOral Cavity
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
Tumours of the oral cavityTumours of the oral cavity
• 7% of canine tumours(1. Skin tumours, 2. Mammary tumours, 3. Oral tumours)
• gingiva dental alveoli labium palate tongue
• 7% of canine tumours(1. Skin tumours, 2. Mammary tumours, 3. Oral tumours)
• gingiva dental alveoli labium palate tongue
Tumours of the oral cavityBenign neoplasia
Tumours of the oral cavityBenign neoplasia
• Periferial Odontogenetic Fibroma
• Papilloma
• Adamantinoma
• Periferial Odontogenetic Fibroma
• Papilloma
• Adamantinoma
Tumours of the oral cavityTumours of the oral cavity
• Fibroma („epulis”)– benign fibromatosus proliferation
along the gingiva– individual susceptibility– in case of growing, extension and
oral discomfort surgery (electrocautery)
– supplementory examination: cytology, histopath, X-ray (thorax)
Epulis - boxerEpulis - boxer Epulis - boxerEpulis - boxer
Tumours of the oral cavityTumours of the oral cavity
• Fibroma („epulis”)– benign fibromatous proliferation
along the gingiva– individual susceptibility– in case of growing, extension and
oral discomfort surgery (electrocautery)
– supplementory examination: cytology, histopath, X-ray (thorax)
Tumours of the oral cavityTumours of the oral cavity
• Papilloma
- viral background
- in young age ( 1 Year)
- immunosuppression (?)
- typical clinical manifestation
Tumours of the oral cavityTumours of the oral cavity
Papillomatosis
Tumours of the oral cavityTumours of the oral cavity
• Papilloma
- spontaneous healing
- elektrocautery
- immunostimulation
– general: e.g. Baypamun
– specific: autovaccination
Tumours of the oral cavityMalignant neoplasia
Tumours of the oral cavityMalignant neoplasia
• Gingival Squamous Cell Carcinoma
• Fibrosarcoma
• Malignant Melanoma
• Gingival Squamous Cell Carcinoma
• Fibrosarcoma
• Malignant Melanoma
Tumours of the oral cavity„Staging” - TNM system
Tumours of the oral cavity„Staging” - TNM system
T umour-size
N ode (lymphonode)
M etastases
Owen, WHO, 1980Owen, WHO, 1980
Tumours of the oral cavity„Staging” - TNM system
Tumours of the oral cavity„Staging” - TNM system
I. 2 cm, bone involvement , metastic disease
II. 2-4 cm, bone involvement , metastic disease
III. 4 cm, bone involvement , metastic disease or
any tumour with bone involvementor
any tumour with ipsilateral node involvement
IV. Any tumour with bilateral node involvement or
with distant metastic disease
Tumours of the oral cavity„Staging” - TNM system
Predictable survival rate at 1 Year
Tumours of the oral cavity„Staging” - TNM system
Predictable survival rate at 1 Year
I. 100 %
II. 75 %
III. 35 %
IV. 0 %
Tumours of the oral cavity
Malignant neoplasia
Tumours of the oral cavity
Malignant neoplasia
– relatively frequent (dog, cat)
– in older age (6 years )
– fibrosarcoma , melanoma malignum, squamous cell carcinoma
– X-ray (osteolysis?, lung-metastasis?)
– cytology, biopsy– scintigraphy
– (electrocauterisation)– mandibulectomy– maxillectomy– radiotherapy– (euthanasia)
Tumours of the oral cavityFibrosarcoma I.
Tumours of the oral cavityFibrosarcoma I.
Tumours of the oral cavityFibrosarcoma I.
Tumours of the oral cavityFibrosarcoma I.
Tumours of the oral cavityFibrosarcoma I.
Tumours of the oral cavityFibrosarcoma I.
Tumours of the oral cavityBilateral Rostral Body Mandibulectomy
Tumours of the oral cavityBilateral Rostral Body Mandibulectomy
VIDEO
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
• Hemimandibulectomy
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
• Hemimandibulectomy
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
• Hemimandibulectomy
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
• Hemimandibulectomy + Cheiloplasty
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
• Hemimandibulectomy + Cheiloplasty
Tumours of the oral cavityFibrosarcoma II.
Tumours of the oral cavityFibrosarcoma II.
• Hemimandibulectomy (3 months later)
Tumours of the oral cavityFibrosarcoma III.
Tumours of the oral cavityFibrosarcoma III.
• Dobermann, 7 Y, male („Zeus”)
Tumours of the oral cavityFibrosarcoma III.
Tumours of the oral cavityFibrosarcoma III.
• Hemimaxillectomy
Tumours of the oral cavityFibrosarcoma III.
Tumours of the oral cavityFibrosarcoma III.
• Hemimaxillectomy
Tumours of the oral cavityPostoperative management
Tumours of the oral cavityPostoperative management
• Mashy diet
• Antibiotics
• Analgesics (NSAID)
• Check-up– physical– scintigraphy– X-ray
• Mashy diet
• Antibiotics
• Analgesics (NSAID)
• Check-up– physical– scintigraphy– X-ray
Main Surgical Diseases of the Oral Cavity
Main Surgical Diseases of the Oral Cavity
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
• Mandibular symphyseal separation• Palatoschisis / Cleft palate• Tumours of the oral cavity• Surgery of the tongue• Surgery of tonsils• Salivary mucocele
Surgical Diseases of the Tongue
Surgical Diseases of the Tongue
• Injuries of the tongue– biten, stab, lacerated wounds– checking the frenulum and the tone of the
tongue– general wound management – suture: monofilament, absorbable
(PDS, Monacryl, Maxon) – antibiotics (metronidazol)
Injuries of the TongueBiten wound
Injuries of the TongueBiten wound
Injuries of the TongueContusion wound
Injuries of the TongueLacerated wound
Surgical Diseases of the Tongue
Surgical Diseases of the Tongue
• Neoplasia of the tongue– rare
– papilloma, squamos cell carcinoma
– partial resection (apex linguae)
– PDS, Monacryl, Maxon
– antibiotics (metronidazol)
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the TongueSquamous Cell Carcinoma
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueMelanoma malignum
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Neoplasia of the tongueCarcinoma – partial amputation
Main Surgical Diseases of the Oral Cavity
Main Surgical Diseases of the Oral Cavity
• Mandibular symphysiolysis• Palatoschisis / Cleft palate• Gingival tumors• Surgical diseases of the tongue• Surgery of tonsils• Salivary mucocele
• Mandibular symphysiolysis• Palatoschisis / Cleft palate• Gingival tumors• Surgical diseases of the tongue• Surgery of tonsils• Salivary mucocele
TonsilectomyTonsilectomy
• Indication– Chronic tonsilitis (poodle, spaniel)– Tonsil-tumour
• carcinoma planocell.: retropharingeal and lung-metastasis
• lymphosarcoma: usually bilateral as the part of the generalised form
Chronic tonsillitis Chronic tonsillitis TonsilectomyTonsilectomy
• Indication– Chronic tonsilitis (poodle, spaniel)– Tonsil-tumour
• carcinoma planocell.: retropharingeal and lung-metastasis
• lymphosarcoma: usually bilateral as the part of the generalised form
Tonsil carcinoma Tonsil carcinoma Tonsilectomy
Tonsilectomy• Surgery
– Precise indication– General anesthesia– Intratracheal intubation!!!– Epinephrine-infiltration topically– Simple excision ( electrocautery)– Extubation with insufflated cuff– antibiotics, mashy diet
Main Surgical Diseases of the Oral Cavity
Main Surgical Diseases of the Oral Cavity
• Mandibular symphysiolysis• Palatoschisis / Cleft palate• Gingival tumors• Surgical diseases of the tongue• Surgery of tonsils• Salivary mucocele
• Mandibular symphysiolysis• Palatoschisis / Cleft palate• Gingival tumors• Surgical diseases of the tongue• Surgery of tonsils• Salivary mucocele
Cysta salivalis Cysta salivalis Surgical anatomy
– gl. parotis, mandibularis, sublingualis, zygomat.Surgical anatomy
– gl. parotis, mandibularis, sublingualis, zygomat.
Salivary MucoceleSalivary Mucocele• Anatomy
– parotid, mandibular, sublingual, zygomatic, (molar, cat!) gl.
– maxillary a., v., linguofacial a., v.
• Anatomy– parotid, mandibular, sublingual, zygomatic,
(molar, cat!) gl. – maxillary a., v., linguofacial a., v.
Salivary MucoceleSalivary Mucocele• Anatomy
– parotid, mandibular, sublingual, zygomatic, (molar, cat!) gl.
– maxillary a., v.– linguofacial a., v.
• Anatomy– parotid, mandibular, sublingual, zygomatic,
(molar, cat!) gl. – maxillary a., v.– linguofacial a., v.
Salivary MucoceleSalivary Mucocele• Anatomy
– parotid, mandibular, sublingual, zygomatic gl.(molar, cat!) gl.
• Anatomy– parotid, mandibular, sublingual, zygomatic gl.
(molar, cat!) gl.
Salivary MucoceleSalivary Mucocele
• Incidence– mainly in young dogs (German shepherd, poodle)
– as a consequence of salivary gland injury or inflammation
– forms: cervical, pharyngeal, ranula
Salivary MucoceleSalivary Mucocele• Diagnostics
– typical localisation– fluctuant lump, not
painful – puncture:
consistent, viscous bloody brownish fluid
– possibility of abscessation
Cervical mucoceleCervical mucocele
Salivary MucoceleSalivary Mucocele• Diagnostics
– typical localisation– fluctuant lump, not
painful – puncture:
consistent, viscous bloody brownish fluid
– possibility of abscessation
RanulaRanulaRanulaRanula
Salivary MucoceleSalivary Mucocele• Diagnostics
– typical localisation– fluctuant lump, not
painful – puncture:
consistent, viscous bloody brownish fluid
– possibility of abscessation
PharyngealPharyngeal cystcystPharyngealPharyngeal cystcyst
Salivary MucoceleSalivary Mucocele• Diagnostics
– typical localisation– fluctuant lump, not
painful – puncture:
consistent, viscous bloody brownish fluid
– possibility of abscessation
Salivary MucoceleSalivary Mucocele
• Therapy– antibiotics (metronidazol)– resection (gland, duct, mucocele)– drainage– marsupialisation (ranula)– (atropine)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection)
Salivary mucocele(Resection) Salivary MucoceleSalivary Mucocele
• Therapy– antibiotics (metronidazol)– resection (gland, duct, mucocele)– drainage– marsupialisation (ranula)– (atropine)
Salivary MucoceleSurgery
Salivary MucoceleSurgery
Surgery of the Ear in Small Animals
Surgery of the Ear in Small Animals
T. Németh, DVM, PhD
Surgical Diseases of the Pinna
Surgical Diseases of the Pinna
• Aural haematoma
• Injuries of the ear
• Neoplasia of the pinna
• Aural haematoma
• Injuries of the ear
• Neoplasia of the pinna
Aural HaematomaAural Haematoma
• Incidence– relatively frequent (dog, cat)– primary or secondary
• History– trauma of the pinna – contemporary external otitis
Aural HaematomaAural Haematoma
• Diagnostics– typical enlargement on the internal
surface of the pinna (fluctuent)– puncture– „maturation process”
Aural HaematomaAural Haematoma• Therapy
– “waiting time”!– antibiotics– surgery: drainage (different techniques)
Aural HaematomaSurgery
Aural HaematomaSurgery
Aural HaematomaSurgery
Injuries of the PinnaInjuries of the Pinna• Incidence
– frequent, sharp traumas (biten, lacerated wounds)
• Diagnostics– depend on the types of wound– continuous bleeding– usually the edge is affected– penetrating wounds– septic consequences, necrosis of cartilage
Injuries of the PinnaInjuries of the Pinna
• Therapy – primary wound management
– secondary wound management– cover (compression) bandage– Elisabethian collar
– antibiotics
Neoplasia of the PinnaNeoplasia of the Pinna• Incidence
– dog (cat)– papilloma, mastocytoma, carcinoma
• Diagnostics– depend on the type of neoplasia– usually close to the edge of the pinna– rapid ulceration
• Therapy– excision– partial or total resection of the pinna
Surgical Aspects of External Otitis
Surgical Aspects of External Otitis
• Incidence– frequent (mostly in dogs)– seasonal feature, breed-disposition– recurrence
• Predisposing causes
• Primary causes
• Perpetuating causes
• Predisposing causes
• Primary causes
• Perpetuating causes
EtiologyEtiologyPredisposing causesPredisposing causes
anatomiccongenitalacquired
functionalincreased aural discharge
anatomiccongenitalacquired
functionalincreased aural discharge
Primary causesPrimary causes• parasites
OtodectesDemodex Sarcoptes
• foreign bodies grass awnsanddust hair
• dermatosesatopy seborrhoea autoimmune
Perpetuating causesPerpetuating causes
• bacteria – Staph., Pseudom., Proteus, Bacteroides
• fungi– Malassezia, Candida, Aspergillus
• bacteria – Staph., Pseudom., Proteus, Bacteroides
• fungi– Malassezia, Candida, Aspergillus
Anatomy, PathogenesisAnatomy, Pathogenesis Anatomy, PathogenesisAnatomy, Pathogenesis
DiagnosticsDiagnostics
• History• Physical examination• Supplementory examination
– instrumental– laboratory– X-ray– CT– hematology– allergology
• History• Physical examination• Supplementory examination
– instrumental– laboratory– X-ray– CT– hematology– allergology
OtoscopyOtoscopy
OtoscopyOtoscopy OtoscopyOtoscopy
OtoscopyOtoscopy OtoscopyOtoscopy
OtoscopyOtoscopy OtoscopyOtoscopy
TherapyTherapy• Precise causative diagnosis
• Conservative way– topical and systemic treatment– ear canal irrigation (warm saline,
chlorhexidine, povidone iodine)• Surgery (ultimaration)
– Lateral Wall Resection (Zepp)– Total Ear Canal Ablation + Lateral Bulla
Osteotomy (TECA + LBO)
• Precise causative diagnosis
• Conservative way– topical and systemic treatment– ear canal irrigation (warm saline,
chlorhexidine, povidone iodine)• Surgery (ultimaration)
– Lateral Wall Resection (Zepp)– Total Ear Canal Ablation + Lateral Bulla
Osteotomy (TECA + LBO)
Lateral Wall Resection (Zepp)Lateral Wall Resection (Zepp)
Lateral Wall Resection (Zepp)Lateral Wall Resection (Zepp) Lateral Wall Resection (Zepp)Lateral Wall Resection (Zepp)
Lateral Wall Resection (Zepp)Lateral Wall Resection (Zepp) TherapyTherapy• Precise causative diagnosis
• Conservative way– topical and systemic treatment– ear canal irrigation (warm saline,
chlorhexidine, povidone iodine)• Surgery (ultimaration)
– Lateral Wall Resection (Zepp) – Total Ear Canal Ablation + Lateral Bulla
Osteotomy (TECA + LBO)
• Precise causative diagnosis
• Conservative way– topical and systemic treatment– ear canal irrigation (warm saline,
chlorhexidine, povidone iodine)• Surgery (ultimaration)
– Lateral Wall Resection (Zepp) – Total Ear Canal Ablation + Lateral Bulla
Osteotomy (TECA + LBO)
TECA + LBOTECA + LBO TECA + LBOTECA + LBO
TECA + LBOTECA + LBOTECA + LBOTECA + LBOTECA + LBOTECA + LBO
TECA+LBOTECA+LBO Surgical Aspects of Otitis Media and Interna
Surgical Aspects of Otitis Media and Interna
• Incidence– rare– primary or secondary– mostly unilateral
• Diagnostics– head tilt, restlessness– vestibular ataxia, desorientation, nystagmus– consistent external otitis – otoscopy (tympanic membrane), Rtg, CT
• Incidence– rare– primary or secondary– mostly unilateral
• Diagnostics– head tilt, restlessness– vestibular ataxia, desorientation, nystagmus– consistent external otitis – otoscopy (tympanic membrane), Rtg, CT
X-rayX-ray
• Anesthesia !!!• Precise projection• Bulla tympani
• Anesthesia !!!• Precise projection• Bulla tympani
X-rayX-ray
X-rayX-ray
negativenegative positivepositive
CTCT
• Anesthesia !!!• Bulla tympani !!!• Anesthesia !!!• Bulla tympani !!!
CTCT
negativenegative
CTCT
Otitis mediaOtitis media
CTCT
Otitis mediaOtitis media
CTCT
Otitis media vs tumourOtitis media vs tumour
Surgical Aspects of Otitis Media and Interna
Surgical Aspects of Otitis Media and Interna
• Therapy– Conservative
• topical: treatment of external otitis , middle ear lavage
• systemic: antibiotics, corticosteroids, B1, B12 vitamine
– Surgery• Ventral Bulla Osteotomy (cat)• TECA + LBO (dog)
• Therapy– Conservative
• topical: treatment of external otitis , middle ear lavage
• systemic: antibiotics, corticosteroids, B1, B12 vitamine
– Surgery• Ventral Bulla Osteotomy (cat)• TECA + LBO (dog)
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Atlas der KleintierchirurgieAtlas der Kleintierchirurgie
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Atlas der KleintierchirurgieAtlas der Kleintierchirurgie
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