Equine upper resp tract soft tissue disease and surgery Flashcards
Which meatus do we use to place scope/stomach tube and why
Ventral because it is the largest and least likely to hit the ethmoturbinates and cause a bleed
Where should we look for pus in suspected sinusitis
EThmoturinates because this is where the sinuses drain to
Signs and aetiolofy of equine nasal paralysis
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
What must we remember when dealing with nostril wounds
Need careful apposition and must be stitched shut
This is to avoid healing with stenosis or loose flaps that could obstruct the airway
What is a false nostril atheroma
Epidermal cyst that can develop beneath mucosa of false nostril
Full of sterile, cheesy material
Can grow to obstruct airflow
Treating false nostril atheroma
Local nerve block and local anaesthsia then remove
Don’t go for needle drainage as often end up with recurrence and infectino
What is the most common cause of non-exercising epistaxis
Ethmoidal haematoma
What is an ethmoidal haematoma
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
Diagnosis of ethmoidal haematoma
Use endoscopy; visualise dark red mass with yellow/green pigment
If ethmoid haematoma is in the sinus what might we see instead
Stream of blood from sinus drainage angle
Treatment of ethmoidal haematoma
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
Ddx for epistaxis at rest
Guttural pouch mycosis; rare but life threatening
Ethmoidal haematoma common
Trama
Tumours/infection
How much bloo dmight we lose from traumatic epistaxis
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
What is a rare traumatic cause of epistaxis which causes bleeding into guttural pouch
Rectus capitus avulsion/tear; related to hyperextension of the neck during fall backwards
Prognosis for nasal neoplasia
poor
Aeriology of nasal mycosis
Secondary to sinusitis/sinonasal surgery
Presentation and treatment of nasal mycosis
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 )
What topical antifungal can we use with nasal mycosis
Immaverol
Which horses can apical infection of rostral maxillary teeth be a cause of unilteral nasal discahrge
Young horses
What is wry nose
Congenital deformity of neonates with deformity of nasal septum and facial bone
Maxillary sinnus anatomy
Large caudal maxillary comparmnet
Smaller rostral maxillary compartment
- These are separatted by maxillary sinus septum
What must we do when treating disease affecting both the rostral and caudal maxillary sinuses
Break through the maxillary sinus septum; do this dorsally as thinnest here
Allows medication of both compartments
Causes of facial swellings in horses
Most common sinonasal neoplasia, sinus cyst, dental disease, primary issue
What radiographic views can be used to evaluate the head
Lateral view for looking at fluid lines/soft tissue in sinuses
30* dorsolateral-lateral oblique view good for looking at tooth roots e.g to check for periapical infection
DV for midline septum, ventral concal sinus
How does primary sinusitis develop
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
What empirical antibiotic choice would we make with primary sinusitis if using
Penicillin or doxycyline
When are antibiotics likely to be unefficaceous in suspected sinusitis
Where there is facial swelling; suggests infection very longstanding
Chronic duration
Inspissated pus; very hard and all stuck in sinuses
Why do we not go for antibiotics when we see epistaxis
Because it is probably trauma or haematoma NOT infection
Why should we never do more than 2 courses of antibiotics for sinusitis
Can get development of a resistant population; this iwll be a major issue if then going for surgery
Surgical treatment options for sinusitis
Trephine and lavage sinuses (low pressure or high pressure under endoscopic guidance to remove inspissated pus)
Sinus osteotomy (flap)
INdications for sinus osteotomy
No response to trephine and lavage
Poor drainage from nostil when lavaging due to blocked ostium
Inspissated bus
Ventral conchal sinus involvement
How common are wound issues in sinus flap surgery
30% due to being direty surgery with infected materal
What are sinus cysts
Spae occupying lesions growing from respiratory mucosa
Contain bright yellow fluid
Can cause facial distortion via hormonal secretion and effects on thin overlying bone
Treatment of sinus cyst
Surgical removal via flap
What is the most common type of sinus neoplasia and what must we remember if we suspect it
SCC
These always start in the oral cavity so should look in the mouth; can biopsy from there easier
Treatment of sinus mycosis
Debride + put topical antifungal e.g natamycin, immaverol
Which blood vessel bleeds during guttural pouch mycosis epistaxis
Internal carotid artery
Clinical signs of guttural pouch mycosis
Epistaxis; generally a couple small bleeds before fatal haemorrhage
High heart rate
Male MMs
Weak ataxic
Often neuro signs; dysphagia related to pharyngeal paralysis
Treatment of guttural pouch mycosis
Occlusion of affected artery e.g with balloon catheter
Topical antifungals
Supportive treatment ofr dysphagia
Antibiotics if pneumonia
What is guttural pouch empyema and what is it usually associated with
Accumulation of pus in the guttural pouch
Usually associated with strangles (strep equi var equi)
What is guttural pouch tympany
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
What secondary effects can we get from guttural pouch tympany
Empyema is common due to secretions in pouch being unable to drain
Can get nasopharyngeal collapse causing dyspnoea/dysphagia
Treatment of guttual pouch tympany
LAser to enlarge ostium
Or make new hole
