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Module 15 > Approach to Horses with Facial Swelling & Nasal Discharge > Flashcards

Approach to Horses with Facial Swelling & Nasal Discharge Flashcards

1
Q

What are the nasal conchae

A

thin, scrolled shaped bony structures

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2
Q

what is the function of nasal conchae

A

increases surface area of the nasal cavity

provides rapid warmings and humidification of air as it passes into lungs

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3
Q

what are the nasal conchae divided into

A

dorsal

middle

ventral

common meatuses

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4
Q

what do the dorsal and ventral conchae enclose

A

a recess and a bulla

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5
Q

what are the structures of the nasal conchae

A

caudal to the dorsal and ventral conchae are the dorsal conchal sinus and ventral conchal sinus

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6
Q

what can cause infections of the bullae

A

cause chronic unilateral nasal discharge with and without concurrent paranasal sinusitis

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7
Q

how many paranasal sinuses are there

A

7

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8
Q

what are the paranasal sinuses

A
  1. dorsal (endoturbinate I) conchal sinus
  2. middle (endoturbinate II; ethmoid) conchal sinus
  3. ventral conchal sinus
  4. sphenopalatine sinus
  5. frontal sinus
  6. rostral maxillary sinus
  7. caudal maxillary sinus
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9
Q

name the paranasal sinuses

A
  1. rostral maxillary sinus (RMS)
  2. caudal maxillary sinus (CMS)
  3. ventral conchal sinus (VCS)
  4. sphenopalatine sinus (SPS)
  5. frontal sinus (FS)
  6. ethmoid (E)
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10
Q

name the paranasal sinus anatomy

A
  1. frontomaxillary opening
  2. dorsal conchal sinus (DCS)
  3. infraorbital canal
  4. septum between RMS and CMS
  5. caudal bulla of VCS
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11
Q

name the paranasal sinus anatomy

A
  1. rostral maxillary sinus
  2. caudal maxillary sinus
  3. sphenopalatine sinus
  4. frontal sinus
  5. dorsal conchal sinus
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12
Q

how do the sinuses relate to dentition

A

tooth roots of the caudal four maxillary cheek teeth are closely associated with maxillary sinuses

triadan 08 and 09: associated with rostral maxillary sinus

triadan 10 and 11: associated with caudal maxillary sinus

triadan 07 may be associated with rostral sinus

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13
Q

how do the sinuses related to dentition in young horses

A

alveoli of large cheek teeth reserve crowns occupy much of these maxillary sinuses

with age, alveoli remodel and retract, resulting in increased sinus cavity volume

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14
Q

which cheeck teeth can result in secondary sinusitis

A

periapical infection of the caudal maxillary cheek teeth

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15
Q

how do the paranasal sinuses communicate

A

directly: maxillary sinuses communicate with the middle nasal meatus through nasomaxillary aperture
indirectly: dorsal, middle, and ventral conchal sinuses, the frontal sinus and the sphenopalatine sinus communicate indirectly with the middle nasal meatus through the caudal maxillary sinus

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16
Q

what are the most common clinical signs of paranasal sinus disease

A

persistent, purulent unilateral nasal discharge

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17
Q

what are the less common clinical signs of paranasal sinus disease (8)

A
  1. facial swelling
  2. focal or diffuse and progressive or static as well a reduced airflow through a nostril(s)
  3. external draining tracts
  4. halitosis (malodorous breath)
  5. epiphora (excessive tearing from eyes)
  6. respiratory stertor (abnormal respiratory noise)
  7. enlarged submandibular lymph nodes
  8. head tilting
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18
Q

what does the clnical exam of a horse with unilateral, malodorous purulent nasal discharge

A

make sure to thoroughly palpate the patient’s face/skull

facial symmetry

any abnormalities including lumps or depressions, submandibular lymph node swelling or evidence of external draining tracts

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19
Q

what abnormalities can be seen on upper airway endoscopy

A

exudate coming from nasomaxillary aperture, ethmoid hematomas and/or distortion of the nasal septum or conchae

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20
Q

why is a dental exam important

A

dnetal disease is the most common cause of paranasal sinusitis in horses

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21
Q

what should an oral exam entail

A

use a dental mirror and evaluate the dental arcades thoroughly

assess one Triadan row at a time, looking at the occlusal surface and interdental space of every cheek tooth

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22
Q

what are the radiographic views used to assess the sinuses

A
  1. latero-lateral
  2. dorsoventral
  3. dorso30lateral-ventrolateral oblique views for maxillary arcades
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23
Q

what view is this

A

latero-lateral

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24
Q

what view is this

A

oblique views

dorso30lateral-ventrolateral oblique

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25
Q

what view is this

A

dorsal-ventral

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26
Q

how are radiographs labelled

A

the image should always be labelled as the side adjacent to plate

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27
Q

what are the landmarks for radiographic positioning

A
  1. lateral canthus
  2. midline of face
  3. facial crest
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28
Q

what does the latero-lateral view assess

A

paranasal sinuses

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29
Q

how is a latero-lateral view taken

A

centre the x-ray beam just dorsal to the facial crest and collimate to dorsal midline and the lateral canthus of the eye

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30
Q

what abnormalities can be seen on latero-lateral view

A

fluid lines

intra-sinus soft tissue opacities

fractures

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31
Q

what view is this and what are the structures

A

normal latero-lateral

blue: frontal sinus
green: dorsal conchal sinus
red: rostral maxillary sinus
purple: caudal maxillary sinus
yellow: sphenopalatine sinus

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32
Q

what view is this and structures

A

normal latero-lateral view

blue: dorsal conchae
green: ventral conchae

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33
Q

what is shown here

A
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34
Q

what are fluid lines

A

represent a collection of fluid (most likely purulent exudate in cases of sinusitis) within the paranasal sinuses

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35
Q

what is shown here and what view is this

A

latero-lateral

soft tissue opacity in the dorsal conchal sinus

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36
Q

what is shown here and what view

A

latero-lateral view

horse with chronic bilateral purulent nasal discharge

fracture of the maxillar

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37
Q

what are the dorso30lateral-ventrolateral oblique views used to assess

A

apices of the maxillary cheek theeth to help rule out dental disease as a cause of paranasal sinus disease

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38
Q

how is a dorso30lateral-ventrolateral view taken

A

beam should be centred 1cm dorsal to the rostral aspect of the facial crest and aimed roughly 30 degrees ventrally

the window for collimation is the same as a latero-lateral view

39
Q

what are radiographic anatomy of significance with regards to teeth on oblique views (3)

A
  1. enamel
  2. periodontal ligament
  3. lamina dura: radiographic representation of cortical alveolar bone, which lines the alveolus in permanent teeth
40
Q

what are radiographic abnormalities that can be seen on oblique views (5)

A
  1. periapical sclerosis and halo formation
  2. periodontal ligament widening
  3. loss of the lamina dura
  4. clubbing of tooth apices
  5. hypercemetosis
41
Q

what are the structures shown here

A
42
Q

what abnormality is shown here

A

periapical infection

43
Q

what is shown here and what is the abnormality

A

periapical infection

44
Q

what abnormality is shown

A
45
Q

what abnormality is shown here

A

periapical clubbing

periapical infection

46
Q

what is shown here

A

hypercementosis

periapical infection

47
Q

what does the dorso-ventral view used to assess

A

nasal caivty and axial compartments of the paranasal sinuses

48
Q

how is the dorsal-ventral view taken

A

x-ray plate is placed under the mandible and the beam is centred between facial crests

49
Q

what abnormalities can be identified on dorso-ventral views

A

ventral conchal sinusitis and space occupying lesions

50
Q

what are the normal structures of the dorso-ventral views

A

caudal maxillary sinus

rostral maxillary sinus

ventral conchal sinus

51
Q

what is shown here

A

ventral conchal sinusitis

52
Q

what are the disadvantages of radiographs

A

2D image of a complex 3D structure

identifying diseases can be difficult esp those that are subtle

53
Q

whehn is CT indicated (3)

A
  1. when radiographic findings are equivocal or normal in the face of disease
  2. when medical and/or surgical treatment is unsuccessful
  3. evidence of multifocal or extensive disease or the extent of the disease is unknown
54
Q

what are the two types of sinus surgeries

A
  1. sinus trephination: making a small hole into the sinus
  2. sinusotomy: making a large window into the sinus
55
Q

where is sinus trephination done

A

into the frontal sinus

56
Q

what does sinus trephination allow and when is it useful

A

evaluation of all paranasal sinuses compared to protals made into the maxillary sinuses

useful in young horses whose cheek teeth occupy much of the maxillary sinuses

57
Q

what are the landmarks for sinus trephination into the frontal sinus

A

usually made 0.5cm cadual to an imaginary line drawn between the left and right medial canthi and halfway between midline and the ipsilateral medial canthus

58
Q

what is sinuscopy

A

direct endoscopy of the paranasal sinuses following trephination

all sinuses can be evaluated if using a frontal trephination portal once the maxillary septal bulla is broken down surgically

59
Q

what is the maxillary septal bulla

A

anatomical division between rostral paranasal sinuses (rostral maxillary and ventral conchal sinuses) and caudal paranasal sinuses (dorsal conchal sinus and caudal maxillary sinus)

60
Q

what is sinusotomy

A

makes a large window into the paranasal sinuses for direct visualization via a three sided flap

61
Q

when is sinusotomy indicated

A

if removal of a large mass or a significant amount of inspissated material is required

62
Q

what are the causes of primary sinusitis

A

bacteria sinusitis

fungal sinusitis

63
Q

what are secondary sinusitis

A

dental disease

paranasal sinus cysts

ethmoidal hematomas

trauma

neoplasia

64
Q

what does primary sinusitis most commonly occur after

A

a transient upper resp viral infection

65
Q

how does purulent exudate accumulate witihn the paranasal sinuses during primary sinusitis

A

increased mucous production, mucosal inflammation, impaired drainage from nasomaxillary aperture and impaired mucociliary clearance

this is due to a upper resp viral infection

66
Q

what is the most common bacterial isolate in primary sinusitis

A

Streptococcus zooepidemicus

67
Q

how is acute primary sinusitis treated

A

most spont resolve

but may also require 2 week course of antimicrobials (Strep. zooepidemicus is responsive to penicillin or trimethoprim/sulfamethoxazole) and anti-inflammatories (NSAIDs such as phenylbutazone)

plus feeding from the floor to facilitate drainage from the sinuses

68
Q

how are chronic cases of primary sinusitis treated

A

it’s important to rule out secondary sinusitis as a cause (dental disease) if the c/s have been present for more than 2 months

where there is gross thickening of sinus mucosa (impedes drainage) a foley catheter may be placed to drain + irrigate to remove any purulent exudate present

69
Q

how is sinus irrigation done

A

best performed through a trephination site made into the frontal sinus

foley catheter and irrigated using warm plain isotonic saline or isotonic saline with 0.01% povidine iodine

should drain freely through the nose after it comes through the nasomaxillary aperture

70
Q

what is primary fungal sinusitis

A

fungal infection of paranasal sinuses

71
Q

what can primary fungal sinustis cause as a clinical sign

A

head shaking where fungal plaques have been identified on the infraorbital canal within the paranasal sinuses

72
Q

how is primary fungal sinusitis treated

A

surgical debridement via trephination or a bone flap followed by topical antifungal therapy

73
Q

what is the most common cause of secondary sinusitis

A

dental disease most often due to apical infection of the caudal 07s to 11s of the maxillary arcades

74
Q

how is secondary sinusitis treated due to dental disease

A

removal of affected tooth/teeth, followed by sinus irrigation through a foley catheter placed via a trephine opening into the frontal sinus

  1. perioperative antimicrobials (penicillin +/- metronidazole) and anti-inflammatories (NSAIDs such as phenylbutazone)
75
Q

what is a paranasal sinus cyst

A

expansive, fluid filled, space occupying mass which usually originates in the maxillary sinus but can extend into all paranasal sinuses

can impair normal drainage from nasomaxillary aperture

76
Q

what are the common clinical signs of paranasal sinus cysts (5)

A
  1. mucopurulent nasal discharge
  2. progressive distortion of the frontal, maxillary and/or conchal bones
  3. reduced nasal airflow
  4. epiphora (excessive tearing from eye)
  5. exophthalmos (bulging of eye)
77
Q

what are the diagnostic findings in paranasal sinus cyst

A

distortion of nasal conchae may be observed on upper airway endoscopy

rounded, soft tissue opacity lesions may be identified within the frontal or maxillary sinuses on radiography

78
Q

what is shown here

A

space occupying mass of soft tissue opacity

79
Q

how are paranasal sinsu cysts treated

A

surgical removal either through bone flap or trephine followed by lavage of the sinus

distortion of nasal cavities and septum remodel rapidly after surgery and facial distortion eventually resolves

80
Q

do paranasal sinus cysts recurr normally

A

no its rare

81
Q

what are progressive ethmoid hematomas

A

slow-expanding, non-neoplastic masses that originates in or around the ethmoid larnyrinth or occasionally the paranasal sinuses

82
Q

what are the casues of progressive ethmoid hematomas

A

unknown but theorized that hemorrhage occurs into the submucosa of an endoturbinate, causing mucosa to stretch and thicken, forming the capsule of a hematoma

over time they enlarge by repeated hemorrhage into the submucosa

83
Q

are progressive ethmoid hematomas usually unilateral or bilateral

A

unilateral

84
Q

what are common clinical signs of progressive ethmoid hematomas

A
  1. intermittent unilateral serosanguinous nasal discharge
  2. respiratory stritor
  3. halitosis
85
Q

what are less comon clinical signs of progressive ethmoid hematomas

A
  1. head shaking
  2. dyspnea
  3. facial deformaties
  4. presence of a mass at the level of the nares
86
Q

how are ethmoid hematomas diagnosed

A

history + clinical exam + upper airway endoscopy + radiography

a tan/brown/red mass may be visualized coming from the ethmiod labyrinth or nasomaxillary aperture

87
Q

how are progressive ethmoid hematomas treated

A

surgical removal or ablation

surgical removal typically for large masses

smaller can be ablated through transendoscopic injection of 4% formaldehyde

88
Q

is it common for progressive ethmoid hematomas to recurr

A

yes after surgical removal approx 43% will recurr

89
Q

what is the most common neoplasia involving the paranasal sinuses

A

squamous cell carcinoma

90
Q

what are the clinical signs of neoplasia in the paranasal sinuses

A

unilateral nasal discharge

respiratory stritor

facial swelling

epiphora

halitosis

91
Q

what will be seen on oral exam with paranasal neoplasia

A

loose maxillary cheek teeth or abnormal tissue along the hard palate

92
Q

how is paranasal neoplasia treated

A

pallitive through surgical removal of as much mass as possible –> successful removal of the entire mass is usually not possible due to invasivness

93
Q

what is the prognosis of paranasal neoplasia

A

long term prognosis is poor

Module 15 (27 decks)

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