Head and neck disease (Yr3)

Question 1

where can unilateral nasal discharge be localised to?

Answer 1

sinus or nasal passage

Question 2

where can bilateral nasal discharge be localised to?

Answer 2

guttural pouch, larynx, pharynx, lower respiratory tract

Question 3

what innervates the motor control of the nares?

Answer 3

facial nerve

Question 4

what are the typical causes of facial nerve paresis/paralysis?

Answer 4

recumbency where there is pressure on nerve (GA) or iatrogenic (surgery)

Question 5

what is another name for a nasal atheroma?

Answer 5

epidermal inclusion cyst

Question 6

what anatomical region do epidermal inclusion cysts (nasal atheroma) form?

Answer 6

nasal diverticulum

Question 7

what is the clinical signs associated with epidermal inclusion cysts (nasal atheroma)?

Answer 7

non-painful swelling at nasoincisive notch

Question 8

how can epidermal inclusion cysts (nasal atheroma) be treated?

Answer 8

surgical removal (often carries a good prognosis)

Question 9

what are the signs associated with alar fold collapse?

Answer 9

respiratory noise at exercise (fluttering) and poor performance

Question 10

how is collapse of the alar folds treated?

Answer 10

resection

Question 11

what is a progressive ethmoid haematoma?

Answer 11

encapsulated non-neoplastic locally invasive mass that grows in the nasal passage and paranasal sinuses

Question 12

how are progressive ethmoid haematomas treated?

Answer 12

nasal passage - intralesional formalin or laser excision
sinuses - sinus flap surgery

Question 13

what are the clinical signs of fungal rhinitis?

Answer 13

unilateral purulent/haemorrhagic nasal discharge
malodorous smell
nasal stertor

Question 14

how is fungal rhinitis treated?

Answer 14

removal of plaques and necrotic bone
topical enilconazole lavage

Question 15

how many paranasal sinuses are there?

Answer 15

7 pairs (2 functional groups - rostral and caudal)

Question 16

what are the rostral paranasal sinuses?

Answer 16

rostral maxillary
ventral conchal

Question 17

what are the caudal paranasal sinuses?

Answer 17

caudal maxillary
frontal
dorsal conchal
sphenopalatine
ethmoid sinus

Question 18

what are the main two clinical signs associated with paranasal sinus disease?

Answer 18

nasal discharge
facial swelling

Question 19

how should primary sinusitis be treated?

Answer 19

TMPS for 7-14 days
phenylbutazone
feed from ground, dust free environment, turn out

Question 20

what is the one cause of primary sinusitis that shouldn’t be treated with antimicrobials?

Answer 20

strangles (Streptococcus equi var equi)

Question 21

what is the most common cause of secondary sinusitis?

Answer 21

dental disease

Question 22

what is responsible for abduction of the arytenoids to open the glottis?

Answer 22

cricoarytenoideus dorsalis (CAD) muscle

Question 23

what innervates the cricoarytenoideus dorsalis (CAD) muscle?

Answer 23

recurrent laryngeal nerve

Question 24

what are the two types of dorsal displacement of the soft palate?

Answer 24

intermittent
persistent

Question 25

when does intermittent dorsal displacement of the soft palate occur?

Answer 25

during intense exercise only

Question 26

when will the soft palate return to normal after intermittent dorsal displacement of the soft palate?

Answer 26

when the horse swallows

Question 27

what are the signs seen with intermittent dorsal displacement of the soft palate?

Answer 27

expiratory obstruction causing gurgling/vibrating noise, possibly causing the horse to pull up

Question 28

what disease states can often lead to persistent dorsal displacement of the soft palate?

Answer 28

epiglottic entrapment sub-epiglottic ulcers sub-epiglottic cysts

Question 29

what is needed to diagnose intermittent dorsal displacement of the soft palate?

Answer 29

exercising endoscopy (will only occur with strenuous exercise)

Question 30

what conservative treatments are available for intermittent dorsal displacement of the soft palate?

Answer 30

often resolves with age get horse fitter (stronger respiratory muscles) change tack tongue tie (prevent caudal movement)

Question 31

what surgical techniques are available for managing dorsal displacement of the soft palate?

Answer 31

tie forward (best) palatoplasty

Question 32

how is a tie forward procedure done?

Answer 32

sutures placed between basihyoid bone and thyroid cartilage to position the larynx more rostrally and caudally

Question 33

how does palatoplasty work to treat dorsal displacement of the soft palate?

Answer 33

uses thermal/laser cautery to stiffen the soft palate (poor evidence of efficacy)

Question 34

when would pharyngeal lymphoid hyperplasia be of clinical significance?

Answer 34

when associated with dorsal displacement of the soft palate

Question 35

when is treatment of pharyngeal lymphoid hyperplasia indicated?

Answer 35

when associated with intermittent dorsal displacement of the soft palate treat with anti-inflammatories

Question 36

when is dynamic pharyngeal collapse seen?

Answer 36

yearling (2 year olds) sports horses (neck flexion)

Question 37

what is the typical clinical sign of a cleft palate?

Answer 37

milk coming from nostrils

Question 38

which is the most common side for recurrent laryngeal neuropathy?

Answer 38

left (unilateral paralysis of arytenoid cartilage)

Question 39

what is the typical signalment of recurrent laryngeal neuropathy?

Answer 39

large horses (genetic predisposition)

Question 40

what is the classic clinical signs of recurrent laryngeal neuropathy?

Answer 40

abnormal inspiratory noise (roaring) at exercise poor performance

Question 41

how can resting laryngeal function be graded?

Answer 41

1. normal 2. can fully abduct but asynchronous 3. can't fully abduct 4. complete paralysis

Question 42

what is the treatment options for recurrent laryngeal neuropathy?

Answer 42

prosthetic laryngoplasty (tie-back) ventriculocordectomy (hobday) laryngeal re-innervation

Question 43

how is tie-back (prosthetic laryngoplasy carried out for recurrent laryngeal neuropathy?

Answer 43

sutures placed from cricoid cartilage to muscular process of left arytenoid cartilage to permanently abduct the left arytenoid

Question 44

what complications can be seen with prosthetic laryngoplasty (tie-back)?

Answer 44

coughing seroma formation infection of implant dysphagia chondritis

Question 45

what is a hobday procedure?

Answer 45

ventriculocordectomy - laryngeal ventricles (saccules) removed to reduce vibration and noise associated with recurrent laryngeal neuropathy

Question 46

what can cause unilateral laryngeal paralysis?

Answer 46

4th brachial arch defect laryngeal dysplasia guttural pouch mycosis previous surgery

Question 47

what can cause bilateral laryngeal paralysis?

Answer 47

hepatic disease toxicity (organophosphate, lead...) post anaesthetic complication

Question 48

what causes congenital laryngeal dysplasia?

Answer 48

abnormal laryngeal cartilage development due to 4th brachial arch deformity (right side effected)

Question 49

what laryngeal dysfunctions are seen due to laryngeal dysplasia?

Answer 49

limited abduction of right arytenoid cartilage rostral displacement of palatopharyngeal arch

Question 50

what is the typical clinical sign seen with vocal cord collapse?

Answer 50

inspiratory whistle at exercise

Question 51

how is vocal cord collapse treated?

Answer 51

vocalcordectomy

Question 52

what is the typical sign of medial deviation of the aryepiglottic folds?

Answer 52

thick inspiratory noise (seen in juveniles)

Question 53

how is medial deviation of the aryepiglottic folds treated?

Answer 53

laser removal of aryepiglottic folds

Question 54

what clinical signs are seen with epiglottic entrapment?

Answer 54

respiratory noise cough when eating poor performance

Question 55

what horses is sub epiglottic cysts seen most commonly in?

Answer 55

young horses (congenital)

Question 56

how is arytenoid chondrites treated?

Answer 56

antibiotics (topical and systemic) partial arytenoid resection (guarded prognosis)

Question 57

what clinical signs are associated with guttural pouch disease?

Answer 57

epistaxis dysphagia (nasal discharge) dyspnoea external swelling neurological (ataxia, head tilt, facial paralysis...)

Question 58

what is the main clinical sign of guttural pouch mycosis?

Answer 58

severe epistaxis nasal discharge nerve dysfunction (dysphagia, horners, laryngeal paralysis)

Question 59

how should guttural pouch mycosis be treated?

Answer 59

keep horse calm and prevent further bleeding referral needed if associated with epistaxis

Question 60

how do guttural pouch chondroids form?

Answer 60

chronic infection (guttural pouch empyema) results in inspissated purulent material developing

Question 61

what is guttural pouch tympany?

Answer 61

air trapanned by in guttural pouch in foals up to a year old due to a congenital defect

Question 62

what are the clinical signs of guttural pouch tympany?

Answer 62

marked retropharyngeal swelling respiratory stridor dysphagia