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EBCM Lecture > Nares and Nasal Passages > Flashcards

Nares and Nasal Passages Flashcards

1
Q

How do you approach and upper airway case in a horse?

A

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

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2
Q

What are some HX things to ask about?

A

Ease of breathing, exercise tolerance, swellings, noise, eating ok, nasal discharge

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3
Q

What should you during your examination?

A

Listen for noise on inspiration and expiration, listen to airflow through the nostrils, palpation, facial deformities, auscultate trachea and lungs

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4
Q

Inspiratory noise is always…

A

pathologic

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5
Q

What are some inspiratory noises?

A

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)

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6
Q

What structures do you examine on endoscopy?

A
  1. Larynx (make swallow)
  2. Trachea
  3. Dorsal pharyngeal recess and pharynx
  4. Guttural Pouch 1
  5. Ethmoid Turbinate’s
  6. Sinus Drainage Angle
  7. Nasal passage 1 - nasal septum, ventral chonchal bulla
  8. Other side
    Ideally not under sedation
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7
Q

What are some diagnostic techniques and what do they examine in the upper airway?

Sinus/nasal passaged
Larynx/pharynx
All Regions

A

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

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8
Q

What anatomical structures should we consider in the upper airway?

A

Nasers, nasal passage, paranasal sinus, guttural pouch, pharynx, larynx, dynamic conditions

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9
Q

What does a tracheotomy do?

A

Provides an airway in a horse with a life-threatening URT obstruction
-Oblatory nasal breathers

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10
Q

When should you perform a tracheotomy?

A

Don’t hesitate
-Pulmonary edema
-Asphyxia

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11
Q

What are some complications of a tracheotomy?

A

Cellulitis, Emphysema, Cartilage damage, stricture

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12
Q

What are some types of discharge you may see from the nares?

A

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

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13
Q

What causes nasal discharge to come out both nostrils or lateralize?

A

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

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14
Q

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?

A

Epidermal Inclusion Cyst

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15
Q

What is another name for an epidermal inclusion cyst?

A

Atheroma of false nostril

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16
Q

How do you remove an epidermal inclusion cyst?

A

Remove surgically with standing sedation with local anesthesia
-External or internal approach
-Need to remove lining or will recurred

17
Q

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.

A

Alar fold collapse

18
Q

What breed commonly gets alar fold collapse?

A

standard breeds and saddle breeds

19
Q

When can sound be heard when you have an alar fold collapse?

A

On both inspiration and expiration
-Can reduce performance

20
Q

How do you diagnose Alar fold collapse?

A

-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

21
Q

How do you surgically correct an alar fold collapse?

A

Surgically resect it under GA, standing, return to exercise 2-3 weeks
-Should have improved noise and performance

22
Q

What is occuring when there is collapse of the alar fold and the nasal fold?

A

Nasal Fold Collapse

23
Q

What is one way to treat this?

A

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

24
Q

What are some other common conidiations of the nares that you are likely to encounter?

A

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)

25
Q

What is a differential list of issues with the nares?

A

Inclusion Cyst
Alar Fold Collapse
Nasal Fold Collapse
Trauma
Facial Nerve Paralysis

26
Q

What are the parts of the nasal cavity?

A

Dorsal, middle and ventral meatus

Dorsal concha and ventral concha

27
Q

Where should you pass your endoscope through?

A

Ventral meatus

28
Q

How do you know you are looking at the middle meatus?

A

Looks like Mercades sign

29
Q

What is a disease that can be a cause of epistaxis. Collection of blood vessels (nasal varicosities), may bleed during turbulent airflow. Inflammation make it bleed.

A

Nasal Mucosa Hemorrhage

30
Q

What disease can usually be seen as a deformation from the outside, is diagnosed on a DV radiograph, the maxillary incisors may fail to occlude with mandibular incisors. Mild cases are most common. (Severe - dyspnea, issues nursing, not very athletic)

A

Wry Nose (Campylorrhinus Lateralis)

31
Q

What disease is:
-Failure of the buconasal membrane rupture in early gestation
-Usually bilateral - fatal at birth if no tracheatomy
-Unilateral = exercise intolerance

A

Choanal Atresia

32
Q

What disease is:
Nasa passages much narrower than normal, exercise intolerance in foal and palliative care is needed?

A

Choanal Stenosis

33
Q

What disease is:
-Attached in the caudal nasopharynx/sinus
-soft, painless, benign growth
-unilateral due to chronic inflammation

A

Nasal Polyp

34
Q

How do you treat a nasal polyp?

A

Amputate by snaring with OB wire through protective tube
-Rule out sinus cyst or involvement of dorsal or ventral nasal conchae first (Cyst more common) - rads and endoscopy

35
Q

What are some fungal pathogens that commonly cause primary infections of the nasal passages?

A

Cryptococcosis, rhinosporidosis, phycomycosis, coccidiomycosis

36
Q

What are signs of a fungal infection of the nasal passages?

A

Bloody and mucopurulent nasal discharge

37
Q

How do you treat fungal infection of nasal passages?

A

Surgical debulk and systemic anti-fungal - fluconazole or voriconazole
-Zoonotic potential
-Aspergillus common after surgery

38
Q

What are some other nasal passage disorders?

A

Nasal foreign body - rule out sinus related cause
Nasal Septum Defect - small normal, significant = problem (rule out mass or developmental)

39
Q

What are your differentials for nasal passage disease?

A

Nasal Mucosal Hemorrhage
Wry Nose (Campylorrhinus Lateralis)
Choanal Atresia/Stenosis
Nasal Polyp
Fungal Rhinitis
Nasal Foreign Body
Nasal Septum Defect

EBCM Lecture (24 decks)

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