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Y3 MOD soft tissue surgery > Nasal disease > Flashcards

Nasal disease Flashcards

1
Q

Name some of the main clinical signs of nasal disease

A
  • Sneezing
  • Snoring or increased respiratory noise
  • Nasal discharge
  • Epistaxis
  • Facial pain
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2
Q

What are the DDx for acute nasal disease?

A
  • Nasal foreign body
  • Viral URT infection (cats)
  • Allergic / irritant rhinitis
  • Tooth root abscess: can present as nasal disease if they rupture internally into the nasal cavity
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3
Q

What are the DDx for chronic nasal disease?

A
  • Unresolved acute disease
  • Feline Rhinotracheitis
  • Neoplasia
  • Fungal rhinitis
  • Lymphocytic/plasmacytic rhinitis
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4
Q

How should investigation of nasal disease be carried out on the clinical exam?

A
  • Inspection of the head
  • Palpation of the head
  • Retropulsion of the globe
  • Assessment of nasal airflow
  • Oral examination
  • Mandibular lymph node palpation
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5
Q

Inability to retropulse the globe indicates?

A

A space-occupying lesion in the retrobulbar space

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6
Q

Describe the use of blood tests when investigating nasal disease

A
  • Routine haematology and biochemistry screens to look for evidence of systemic disease.
  • Clotting profile if epistaxis is the only clinical sign, has been severe or there is evidence of haemorrhage elsewhere e.g. petichiae or ecchymoses.
  • Serological testing for Aspergillus fumigatus or Cryptococcus neoformans
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7
Q

What other investigations can you do for nasal disease?

A
  • Radiography
  • Rhinoscopy
  • Nasal biopsy
  • Forced nasal flush
  • FNA of lymph nodes
  • Nasal swabs for bacteriology / cytology
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8
Q

Where other than the head should be radiographed if nasal neoplasia is suspected?

A

Thorax - to look for metastasis

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9
Q

What is the causative agent of fungal rhinosinusitis in the dog?

A

Aspergillus fumigatus

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10
Q

Which animals are most likely to be affected by fungal rhinosinusitis?

A

Young to middle aged medium or large breed dogs

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11
Q

Where in anatomically damaged by fungal rhinitis?

A

Causes extensive damage and destruction of the turbinates

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12
Q

What are the clinical signs of fungal rhinitis?

A
  • Nasal discharge: usually mucopurulent. Epistaxis is a frequent finding
  • Facial pain
  • Ulceration and depigmentation of the nasal planum/nares
  • Dullness and depression
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13
Q

What are the diagnostic methods for fungal rhinitis, which is gold standard?

A
  • History and clinical signs.
  • Serology: false negatives are relatively frequent, rarely false positives will occur
  • Radiography
  • Rhinoscopy
  • Histopathy = GS!
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14
Q

What will be seen on radiographs of patients with fungal rhinitis?

A

Shows destruction of the turbinate bones with increased radiolucency and increased fluid density in the nasal cavity due to discharge

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15
Q

What will be seen on rhinoscopy of patients with fungal rhinitis?

A

Reveals turbinate destruction and possibly visible fungal plaques and allows collection of nasal biopsies

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16
Q

What is seen on the histopathy of patients with fungal rhinitis?

A

Identification of fungal hyphae in nasal biopsies is the gold standard for diagnosis of fungal rhinitis.

17
Q

How can fungal rhinitis be treated?

A

Oral antifungal drugs are largely ineffective
Topical treatment with antifungal drugs is the most successful. 2 techniques are commonly used:
• Trephination of the frontal sinuses followed by packing with clotrimazole cream
• Non-invasive clotrimazole soaking via catheters placed in the nasal cavity

18
Q

Which neoplasia’s can affect the nasal cavity?

A

A variety of mostly malignant tumours may affect the nasal cavity, including adenocarcinoma, osteosarcoma, chondrosarcoma, squamous cell carcinoma, fibrosarcoma and lymphoma

19
Q

What are the clinical signs of a nasal neoplasia?

A
  • Reduced nasal airflow.
  • Nasal discharge (frequently epistaxis).
  • Facial swelling or distortion
  • Palate swelling or distortion
  • Exopthalmos due to invasion into the retrobulbar space.
  • Neurological signs due to extension through the cribriform plate
20
Q

How is neoplasia of the nasal cavity diagnosed?

A

History and clinical signs Diagnostic imaging Rhinoscopy and biopsy

21
Q

How is neoplasia of the nasal cavity treated?

A
  • Radiation therapy: palliative rather than curative

- Chemotherapy for nasal lymphoma

22
Q

Non-infectious inflammatory rhinitis is also known as?

A

Lymphocytic/plasmacytic rhinitis

23
Q

What are the clinical signs of non-infectious inflammatory rhinitis?

A
  • Serous or mucopurulent nasal discharge, usually bilateral.

- Sneezing / snorting.

24
Q

How is non-infectious inflammatory rhinitis diagnosed?

A

History and clinical signs Diagnostic imaging

Rhinoscopy and biopsy

25
Q

What will be seen on diagnostic images for non-infectious inflammatory rhinitis?

A

Mild loss of turbinate detail and increased soft tissue density due to discharge in the nasal cavity

26
Q

What are the treatment approaches for non-infectious inflammatory rhinitis?

A
  • Environmental modification: cleaning and ventilation, humidification
  • Saline instillation / intermittent nasal flushes
  • Anti-inflammatories (NSAIDs or corticosteroids)
  • Antibacterials
  • Mucolytics
  • Allergen testing / elimination
27
Q

Name some examples of common nasal foreign bodies

A

Grass seeds, pieces of wood, grass blades (especially in cats)

28
Q

What are the clinical signs of a nasal foreign body?

A
  • Sudden onset.
  • Sneezing (often paroxysmal at first, later intermittent).
  • Distress / pawing at face.
  • Eventually may cause purulent nasal discharge (usually unilateral).
29
Q

How is a nasal foreign body diagnosed?

A
  • History and clinical signs
  • Rhinoscopy
  • Diagnostic imaging
  • Exploratory rhinotomy
30
Q

How is a nasal foreign body treated?

A
  • Nasal flushing to dislodge the foreign body. Pack the common pharynx with swabs and examine them for the foreign body post-flushing.
  • Endoscopic removal.
  • Rostral retraction of the soft palate and retrieval with forceps for grass blades in cats.
  • Rhinotomy if none of the above is successful.
31
Q

How can dental disease cause nasal disease?

A
  • If apical abscesses rupture into nasal cavity
  • Usually in older patients
  • Extract affected teeth and treat with appropriate Antibacterials
32
Q

What are some other causes of nasal discharge?

A
  • Cleft palate
  • Ciliary dyskinesia
  • Parasites
  • Dysphagia and nasopharyngeal reflux

Y3 MOD soft tissue surgery (7 decks)

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