Nares and Nasal Passages Flashcards
How do you approach and upper airway case in a horse?
HX and PE
Make a Differential Diagnosis List
Primary Diagnostic - upper airway endoscopy
Update Diff
Secondary diagnostics - rads, dynampic endoscopy, MRI, CT, Oral Exam, Blood Work, Biopsy
Working diagnosis and treatment
What are some HX things to ask about?
Ease of breathing, exercise tolerance, swellings, noise, eating ok, nasal discharge
What should you during your examination?
Listen for noise on inspiration and expiration, listen to airflow through the nostrils, palpation, facial deformities, auscultate trachea and lungs
Inspiratory noise is always…
pathologic
What are some inspiratory noises?
Stridor - high pitched
Stertor/Snoring - Low pitched
Roaring or whistling - low to high pitched sneezing
-Normal to have expiratory noise (canter or gallop when feet hit ground)
What structures do you examine on endoscopy?
- Larynx (make swallow)
- Trachea
- Dorsal pharyngeal recess and pharynx
- Guttural Pouch 1
- Ethmoid Turbinate’s
- Sinus Drainage Angle
- Nasal passage 1 - nasal septum, ventral chonchal bulla
- Other side
Ideally not under sedation
What are some diagnostic techniques and what do they examine in the upper airway?
Sinus/nasal passaged
Larynx/pharynx
All Regions
Sinus/Nasal passages - head rads, dental exam, head CT and Head MRI (bone)
Larynx and pharynx - watch during exercise, dynamic endoscopy/treadmill endoscopy, laryngeal ultrasound (soft tissue)
All regions - full exam and resting endoscopy
What anatomical structures should we consider in the upper airway?
Nasers, nasal passage, paranasal sinus, guttural pouch, pharynx, larynx, dynamic conditions
What does a tracheotomy do?
Provides an airway in a horse with a life-threatening URT obstruction
-Oblatory nasal breathers
When should you perform a tracheotomy?
Don’t hesitate
-Pulmonary edema
-Asphyxia
What are some complications of a tracheotomy?
Cellulitis, Emphysema, Cartilage damage, stricture
What are some types of discharge you may see from the nares?
Serous - clear - viral or allergic
Mucoid - bacterial or sinusitis
Hemorrhagic -
-Fresh: GP mycosis, trauma, lower airway (EIPH)
-Old: Ethmoid hematoma, lower airway necrotizing pneumonia
Feed contamination - choke, dysphagia due to pharyngeal disfunction
Fetid Odor - dental or chronic
What causes nasal discharge to come out both nostrils or lateralize?
Anatomy
-Rostral to nasal septum - lateral
-prior to septum - both sides
Injury in sinus drainage angle - onesided
Guttural puch - one nostril mostly, lots of blood in pharynx and everywhere
What is a cystic lesion filled with fluid, that is mostly a cosmetic problem unless it obstructs the airway (usually unilateral 3-5cm in nasal diverticulum and contains squamous and keratin debris?
Epidermal Inclusion Cyst
What is another name for an epidermal inclusion cyst?
Atheroma of false nostril
How do you remove an epidermal inclusion cyst?
Remove surgically with standing sedation with local anesthesia
-External or internal approach
-Need to remove lining or will recurred
When the mucocutaneous fold separating the false and true nostril attached to the alar cartilage collapses what is that disease? May occur more during exercise.
Alar fold collapse
What breed commonly gets alar fold collapse?
standard breeds and saddle breeds
When can sound be heard when you have an alar fold collapse?
On both inspiration and expiration
-Can reduce performance
How do you diagnose Alar fold collapse?
-Large mattress suture tied over gauze to hold alar fold open to see if noise goes away
-Rule out other causes of noise and exercise intolerance with resting or dynamic endoscopy
How do you surgically correct an alar fold collapse?
Surgically resect it under GA, standing, return to exercise 2-3 weeks
-Should have improved noise and performance
What is occuring when there is collapse of the alar fold and the nasal fold?
Nasal Fold Collapse
What is one way to treat this?
Adhesive nasal strips used on horses during intense exercise
-Reduce peak inspiratory pressure and resistance when horse is maximally exercising - pull dorsal concha fold lateral and expand dorsal meatus
What are some other common conidiations of the nares that you are likely to encounter?
Trauma - primary closure and scar can cause secondary stenosis
Facial Nerve (CNVII) paralysis - lack of tone in nostril may cause flutter or collapse of nostril, look for signs (facial dissymmetry)
