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Y3 MOD Dentistry > Disease of the equine head and neck 3 > Flashcards

Disease of the equine head and neck 3 Flashcards

1
Q

Describe the anatomy and innervations of the nares/nostrils

A
  • Alar folds
  • Supported by alar cartilages
  • Facial nerve innervation
  • Nasal diverticulum (false nostril)
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2
Q

Name some nasal disorders

A
  • Trauma: lacerations
  • Facial nerve paresis /
    paralysis
  • Nasal atheroma
  • Alar fold collapse
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3
Q

When can Facial nerve paresis/paralysis occur?

A

Uncommon

  • General anaesthesia / recumbency where pressure over facial nerve
  • Iatrogenic e.g. surgery of the face
  • Most often temporary paresis, will resolve with time
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4
Q

What are the clinical signs of Facial nerve paresis/paralysis?

A
  • Facial swelling
  • Asymmetry
  • Reduced airflow
  • Nasal stertor
    +/- facial distortion
  • Poor performance
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5
Q

How is facial nerve paralysis/paresis diagnosed?

A

Observation

Palpation

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6
Q

How should acute lacerations be treated and managed?

A
  • Full thickness defects: precise anatomical repair
    important to preserve ability to dilate fully
  • Minimal debridement: good blood supply, preserve the tissues
  • 2 or 3 layer closure: appropriate suture materials
    and size
  • Monitor for rubbing of sutures (+/- stent over the site)
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7
Q

What are the considerations of chronic scarring following a facial laceration?

A
  • Performance limiting: reduced nasal airflow
  • Cosmetics may be important
  • Reconstructive surgery possible
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8
Q

An epidermal inclusion cyst is also known as?

A

A nasal artheroma

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9
Q

Where is an epidermal inclusion cyst located?

A

Cyst within nasal diverticulum (false nostril)

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10
Q

What is the clinical sign of an epidermal inclusion cyst?

A

Non-painful swelling at Nasoincisive notch

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11
Q

How are epidermal inclusion cysts diagnosed?

A

History, visual appearance, histopathology

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12
Q

Describe the treatment and prognosis of an epidermal inclusion cyst

A
  • Surgical removal (usually under local anaesthesia +
    standing sedation)
  • Formalin treatment reported but risk of necrosis (not recommended)
  • Excellent prognosis with surgical removal; likely to recur with simple drainage.
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13
Q

Describe the features and signs of alar fold collapse

A

Flaccid or redundant alar folds:
- Respiratory tract noise at exercise – fluttery sound
- Exercise intolerance in performance horses
Pathogenesis = Unknown

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14
Q

How is alar fold collapse diagnosed and treated?

A
  • Fluttering sound at exercise (DDx laryngeal /soft palate disorders)
  • Temporary sutures
  • Resection of the alar folds
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15
Q

Which structures separate the L and R nasal passaged?

A

Nasal septum and vomer bone

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16
Q

Describe the dorsal and ventral conchae (turbinates)

A
  • Thin scrolls of cartilage & bone
  • Divide the nasal passages into 3 meati: dorsal, middle, ventral
  • Form the conchal sinuses caudally
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17
Q

Describe the sinus drainage angle

A
  • Narrow passageway where paranasal sinuses drain into the nasal passages
  • Usually 2-3mm diameter – cannot directly access the paranasal sinuses in normal horses using nasal endoscopy
  • Horses present with a unilateral nasal discharge as drainage occurs rostrally to the nasal septum
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18
Q

What are the 2 key anatomical features of the nasal passages?

A
  • Sinus drainage angle

- Ethmoidal turbinates

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19
Q

Name 2 congenital disorders of the nasal passages

A
  • Wry nose (nasal septum deviation)

- Choanal atresia (rare)

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20
Q

Name 4 acquired disorders of the nasal passages

A
  • Trauma (iatrogenic common)
  • Progressive ethmoid haematoma (PEH)
  • Fungal rhinitis
  • Foreign bodies (rare)
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21
Q

Clinical Signs Of nasal passage disease that may be seen include:

A
  • Nasal Discharge
  • Abnormal Respiratory Noise
  • Dyspnoea
  • Malodorous smell
  • Facial / nasal Distortion
  • Head Shaking
  • Snorting / rubbing nose
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22
Q

What are the features of nasal trauma?

A
  • Epistaxis
  • Kick / blunt trauma
  • Iatrogenic: trauma during nasogastric intubation / endoscopy (common)
  • Haemorrhage usually stops within 5-10 minutes
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23
Q

How can iatrogenic trauma be avoided when tubing?

A
  • Ensure tube placement in the VENTRAL meatus not middle meatus (more likely to traumatise ethmoturbinates)
  • Use a smooth tube
  • Lubricant on the end of the tube
  • Do not force the tube when you meet resistance
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24
Q

Describe the features of a progressive ethmoid haematoma

A
  • Encapsulated non-neoplastic mass
  • Unknown aetiology
  • Locally invasive (doesn’t
    metastasise)
  • Grows into the nasal passages / paranasal sinuses
  • Removal to be curative
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25
Q

What are the clinical signs of a progressive ethmoid haematoma?

A

• Epistaxis (nasal passages / sinuses)
- Usually intermittent
- Often slightly brown / red colour
• +/- Facial swelling (sinuses)

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26
Q

How are nasal progressive ethmoid haematomas diagnosed?

A
  • Endoscopy: characteristic yellow / green lesion on ethmoid

+/- computed tomography

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27
Q

How are sinus progressive ethmoid haematomas diagnosed?

A
  • Radiography
  • Sinoscopy
  • Computed Tomography: assess cribriform plate
    • Possible intracranial extension
    • Formalin contraindicated for treatment
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28
Q

How would you treat a progressive ethmoid haematoma in the nasal passages?

A 
Intra-lesional formalin:
• ***CT first***
• Assess cribiform plate
• Multiple formalin injections
- +/- Laser excision/ablation:
• If small
• Post formalin treatment
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29
Q

How would you treat a progressive ethmoid haematoma in the sinuses?

A

Sinus flap surgery

  • Treat sinusitis
  • Remove lesions +/- laser
30
Q

What is the other name for fungal rhinitis?

A

Nasal aspergillosis

31
Q

What are the clinical signs of fungal rhinitis?

A
  • Unilateral purulent / haemorrhagic nasal discharge
  • +/- Malodorous smell
  • Occasionally nasal stertor
32
Q

How is fungal rhinitis diagnosed?

A

Endoscopy

Fungal culture

33
Q

How is fungal rhinitis treated?

A
  • Removal of fungal plaques & necrotic bone
  • Topical antifungal treatment
    Enilconazole lavage (‘Imaverol’)
34
Q

How main pairs/groups of paranasal sinuses are there?

A

7 pairs of paranasal sinuses

2 functional groups - rostral and caudal

35
Q

What is the key point of information to know about the paranasal sinus groups?

A

No communication between groups!!!
Sinuses within each group share drainage
into the nasal passages

36
Q

Name the paranasal sinuses in the rostral group

A 
Rostral maxillary (RMS)
Ventral conchal (VCS)
37
Q

Name the paranasal sinuses in the caudal group

A 
Caudal maxillary (CMS)
Frontal (FS)
Dorsal conchal (DCS)
Sphenopalatine (SP)
Ethmoid sinus (ES)
38
Q

What structure separates the rostral and caudal groups of sinuses?

A

Oblique bony septum

39
Q

Describe conchal bullae

A

Separated from the paranasal sinuses

Air filled regions that sit rostral to these but they can become infected

40
Q

Name the 2 most common paranasal sinus diseases

A

Primary sinusitis

Secondary sinusitis

41
Q

Name 4 less common paranasal sinus diseases

A
  • Sinus cysts
  • Sinus progressive ethmoid haematoma
  • Neoplasia
  • Trauma
42
Q

What are the 2 most common presentations with paranasal sinus disease?

A
  • Nasal discharge

- Facial swelling

43
Q

What are the clinical signs of paranasal sinus disease

A 
• Predominantly UNILATERAL nasal discharge (may be bilateral if bilateral sinus disease)
• Nature of discharge may assist diagnosis:
- Serous
- Purulent
- Mucopurulent
- Haemorrhagic
• +/- Facial swelling
• +/- Facial deformity
• +/- Decreased nasal airflow
44
Q

Describe external examination of the head for signs of paranasal sinus disease

A
  • Lymph nodes e.g. submandibular
  • Facial symmetry
  • Nasal airflow
  • +/- Percussion of sinuses (dull sound if there is fluid or a mass)
45
Q

What are the diagnostic methods for paranasal sinus disease

A
  • Endoscopy: Sinus drainage angle
  • Radiography: Laterolateral, Dorsoventral
  • Computed Tomography
  • Sinoscopy: endoscope directly into the sinuses
46
Q

What is the most common cause of primary sinusitis?

A

Previous URT infection

Streptococcus spp.

47
Q

What are the 5 most common causes of secondary sinusitis?

A
  • Dental disease
  • Sinus cyst
  • Progressive Ethmoid Haematoma
  • Neoplasia
  • Fungal sinusitis (rare)
48
Q

What are the diagnostic methods for sinusitis, which is the gold standard?

A
  • Endoscopy
  • Radiography
  • Computed tomography (GS)
49
Q

Which diagnostic method allows visualisation of purulent material coming from the sinus drainage angle?

A

Endoscopy

50
Q

What can be used for the initial treatment of primary sinusitis?

A

Antimicrobials

51
Q

What are the considerations surrounding antimicrobial use?

A
  • +/- Culture and sensitivity testing - Only to rule out Strep. Equi var equi infection (Strangles)
  • One course of antibiotics ONLY: Trimethoprim sulphonamides for 7-14 days.
    Poor response/recurrence indicates further
    investigation required
52
Q

Why should different antimicrobials not be tried?

A
  • Promotes antimicrobial resistance (AMR)
  • Will not resolve chronic infection with inspissated pus present or where there is a secondary cause of infection
  • Adds unnecessary costs to clients bill (and may prevent them being able
    to afford further diagnostics / treatment)
53
Q

What are some other treatment methods for primary sinusitis?

A
  • NSAID’s: e.g. phenylbutazone
  • Feed from the ground: encourage drainage
  • Dust free management: reduce URT inflammation
  • Turn out as much as possible: drainage / reduced inflammation
54
Q

Secondary sinusitis is most frequently due to…?

A

Dental disease

Approximately 60% of secondary sinusitis cases

55
Q

Which teeth most commonly affect the rostral maxillary sinus?

A

Upper 08 / 09’s

56
Q

Which teeth most commonly affect the caudal maxillary sinus?

A

Upper 10 / 11’s

57
Q

Why can diagnosis of secondary sinusitis be difficult?

A
  • Radiography insensitive (difficult to interpret radiographs in many cases)
  • Computed Tomography is the gold standard (and may be more cost effective)
58
Q

How can secondary sinusitis be treated?

A
  • Removal of infected tooth

- Management of sinusitis

59
Q

Describe paranasal sinus cysts and their effects/signs

A
  • Young horses most common but can be seen in all ages
  • Aetiology unknown
  • Filled with yellow, viscous fluid
  • Causes erosion and distortion as it expands -> Nasal passage deformity and facial swellings
60
Q

What are the clinical signs of paranasal sinus cysts?

A
  • Facial swelling
  • Reduced nasal airflow (can be subtle to detect)
  • Nasal discharge
  • Nasal stertor
61
Q

How are paranasal sinus cysts diagnosed?

A

Radiography
Sinoscopy
Computed tomography

62
Q

How are paranasal sinus cysts treated?

A

Surgical removal via trephine portals / sinus flap

63
Q

Describe diagnosis/signs of sinus neoplasia

A 
• May not be detected until extensive growth of the mass has already occurred
- Facial swelling
- +/- nasal discharge, head shaking
• Radiography / sinoscopy
• Computed tomography
64
Q

What are the 4 common types of sinus neoplasia

A
  • SCC
  • Adenocarcinoma
  • Fibro-osseous tumors
  • Myxoma
65
Q

How are sinus neoplasia treated?

A

Usually too extensive to treat

Debulking and radiotherapy uncommonly performed (costs / facilities)

66
Q

How is sinus trauma diagnosed and treated?

A
  • Clinical signs
  • Radiography
  • +/- Ultrasound
  • +/- Computed Tomography
    • Removal / stabilisation of bone fragments
    • Flushing of sinuses to remove any blood/purulent material
67
Q

Where is the trephine site to access the frontal sinus?

A

60% from midline to medial canthus
0.5cm caudal to medial canthus
Can then access CMS, DCS, SP
Can access RMS/VCS if remove maxillary septal bulla

68
Q

Where is the trephine site to access the caudal maxillary sinus?

A

2cm rostral and 2cm ventral to medial canthus

69
Q

Describe sinus surgery to perform sinus flaps

A
  • May need increased access into the sinuses for removal of masses/other treatment
  • Often performed under standing sedation
  • Rectangular / circular bony flap created
70
Q

What are some of the potential complications when performing sinus surgery?

A
  • Haemorrhage
  • Infection of the trephine portal/sinus flap
  • Bone sequestrum formation
  • Poor cosmesis
  • Recurrence of sinusitis
71
Q

What is empyaema of the conchal bullae?

A

Chronic infection of the dorsal or ventral conchal bulla

72
Q

What is suturitis and its signs?

A
  • Periostitis of the suture lines
  • Most common- frontonasal suture
  • Can occur after sinus surgery
  • Bilateral, firm, swellings in the nasofrontal region
  • Usually regress

Y3 MOD Dentistry (11 decks)

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