Equine upper resp tract soft tissue disease and surgery

Question 1

Which meatus do we use to place scope/stomach tube and why

Answer 1

Ventral because it is the largest and least likely to hit the ethmoturbinates and cause a bleed

Question 2

Where should we look for pus in suspected sinusitis

Answer 2

EThmoturinates because this is where the sinuses drain to

Question 3

Signs and aetiolofy of equine nasal paralysis

Answer 3

Due to facial nerve damage e.g trauma, lateral recumbency in GU

Signs = muzzle deviated towards normal side, drooping ear and eye

Can slowly regross at 1cm/month if not transected completely

Question 4

What must we remember when dealing with nostril wounds

Answer 4

Need careful apposition and must be stitched shut
This is to avoid healing with stenosis or loose flaps that could obstruct the airway

Question 5

What is a false nostril atheroma

Answer 5

Epidermal cyst that can develop beneath mucosa of false nostril
Full of sterile, cheesy material
Can grow to obstruct airflow

Question 6

Treating false nostril atheroma

Answer 6

Local nerve block and local anaesthsia then remove
Don’t go for needle drainage as often end up with recurrence and infectino

Question 7

What is the most common cause of non-exercising epistaxis

Answer 7

Ethmoidal haematoma

Question 8

What is an ethmoidal haematoma

Answer 8

Non-neoplastic haemorrhagic polyp which grows from ethmoturbinate surfase and expands down nasal cavity

Presents with small leakages of blood every few days not assocaited with exercise

Question 9

Diagnosis of ethmoidal haematoma

Answer 9

Use endoscopy; visualise dark red mass with yellow/green pigment

Question 10

If ethmoid haematoma is in the sinus what might we see instead

Answer 10

Stream of blood from sinus drainage angle

Question 11

Treatment of ethmoidal haematoma

Answer 11

If small can inject formalin every 2-3 weeks until it regresses
Cannot do this for large lesions due to risk of large volumes leaking out and causing mucosa sloughing

If large in nose or in sinus, do surgical removal using flap

Question 12

Ddx for epistaxis at rest

Answer 12

Guttural pouch mycosis; rare but life threatening
Ethmoidal haematoma common
Trama
Tumours/infection

Question 13

How much bloo dmight we lose from traumatic epistaxis

Answer 13

Almost always self-limiting
Up to 5-10 litres
Should keep head elevated; once 10 L lost start to place catheter and think about next steps

Question 14

What is a rare traumatic cause of epistaxis which causes bleeding into guttural pouch

Answer 14

Rectus capitus avulsion/tear; related to hyperextension of the neck during fall backwards

Question 15

Prognosis for nasal neoplasia

Answer 15

poor

Question 16

Aeriology of nasal mycosis

Answer 16

Secondary to sinusitis/sinonasal surgery

Question 17

Presentation and treatment of nasal mycosis

Answer 17

Very smelly nasal discharge
On endoscopy see furry plaques in nasal cavit
Treat via trans-endoscopic debridement of plaques, spraying of topical antifungals,
(may need flap surgery )

Question 18

What topical antifungal can we use with nasal mycosis

Answer 18

Immaverol

Question 19

Which horses can apical infection of rostral maxillary teeth be a cause of unilteral nasal discahrge

Answer 19

Young horses

Question 20

What is wry nose

Answer 20

Congenital deformity of neonates with deformity of nasal septum and facial bone

Question 21

Maxillary sinnus anatomy

Answer 21

Large caudal maxillary comparmnet
Smaller rostral maxillary compartment
- These are separatted by maxillary sinus septum

Question 22

What must we do when treating disease affecting both the rostral and caudal maxillary sinuses

Answer 22

Break through the maxillary sinus septum; do this dorsally as thinnest here
Allows medication of both compartments

Question 23

Causes of facial swellings in horses

Answer 23

Most common sinonasal neoplasia, sinus cyst, dental disease, primary issue

Question 24

What radiographic views can be used to evaluate the head

Answer 24

Lateral view for looking at fluid lines/soft tissue in sinuses

30* dorsolateral-latearl oblique view good for looking at tooth roots e.g to check for periapical infection

DV for midline septum, ventral concal sinus

Question 25

How does primary sinusitis develop

Answer 25

There are bacteria normally in the cavity
Where there is mucosal oedema, this blocks the outflow of normal secretions so these accumulate and allow growth of bacteria

Question 26

What empirical antibiotic choice would we make with primary sinusitis if using

Answer 26

Penicillin or doxycyline

Question 27

When are antibiotics likely to be unefficaceous in suspected sinusitis

Answer 27

Where there is facial swelling; suggests infection very longstanding
Chronic duration
Inspissated pus; very hard and all stuck in sinuses

Question 28

Why do we not go for antibiotics when we see epistaxis

Answer 28

Because it is probably trauma or haematoma NOT infection

Question 29

Why should we never do more than 2 courses of antibiotics for sinusitis

Answer 29

Can get development of a resistant population; this iwll be a major issue if then going for surgery

Question 30

Surgical treatment options for sinusitis

Answer 30

Trephine and lavage sinuses (low pressure or high pressure under endoscopic guidance to remove inspissated pus)

Sinus osteotomy (flap)

Question 31

INdications for sinus osteotomy

Answer 31

No response to trephine and lavage
Poor drainage from nostil when lavaging due to blocked ostium
Inspissated bus
Ventral conchal sinus involvement

Question 32

How common are wound issues in sinus flap surgery

Answer 32

30% due to being direty surgery with infected materal

Question 33

What are sinus cysts

Answer 33

Spae occupying lesions growing from respiratory mucosa
Contain bright yellow fluid
Can cause facial distortion via hormonal secretion and effects on thin overlying bone

Question 34

Treatment of sinus cyst

Answer 34

Surgical removal via flap

Question 35

What is the most common type of sinus neoplasia and what must we remember if we suspect it

Answer 35

SCC
These always start in the oral cavity so should look in the mouth; can biopsy from there easier

Question 36

Treatment of sinus mycosis

Answer 36

Debride + put topical antifungal e.g natamycin, immaverol

Question 37

Which blood vessel bleeds during guttural pouch mycosis epistaxis

Answer 37

Internal carotid artery

Question 38

Clinical signs of guttural pouch mycosis

Answer 38

Epistaxis; generally a couple small bleeds before fatal haemorrhage
High heart rate
Male MMs
Weak ataxic
Often neuro signs; dysphagia related to pharyngeal paralysis

Question 39

Treatment of guttural pouch mycosis

Answer 39

Occlusion of affected artery e.g with balloon catheter
Topical antifungals
Supportive treatment ofr dysphagia
Antibiotics if pneumonia

Question 40

What is guttural pouch empyema and what is it usually associated with

Answer 40

Accumulation of pus in the guttural pouch
Usually associated with strangles (strep equi var equi)

Question 41

What is guttural pouch tympany

Answer 41

Where guttural puch fills with air due to dysfunction of eustacian tube such that it acts as a one way valve
Seen in young foals <6 weeks; mostly fillies

Question 42

What secondary effects can we get from guttural pouch tympany

Answer 42

Empyema is common due to secretions in pouch being unable to drain
Can get nasopharyngeal collapse causing dyspnoea/dysphagia

Question 43

Treatment of guttual pouch tympany

Answer 43

LAser to enlarge ostium
Or make new hole