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Surgery of the Upper Airways, Thyroid, Larynx and Trachea > Nasal Disease: Recognition and Diagnosis > Flashcards

Nasal Disease: Recognition and Diagnosis Flashcards

1
Q

Common dx of canine and feline ?

A

neoplasia, 
rhinitis,
foreign bodies, 
fungal infections,
polyps

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2
Q

What are the nasal cavities separated by?

A

Nasal septum

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3
Q

What structure marks the start of the nasopahrynx?

A

Choanea

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4
Q

Nasal fossa:
A) What is it divided by?
B) Divided into? (2)

A

A) Dorsal concha; curved shelf of bone originating from the ethmoidal crest
B) Dorsal meatus and the middle meatus

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5
Q

Nasal fossae:
A) What does the ventral nasal concha extend from?
B) What does concha divide the nasal cavity into?

A

A) Conchal crest
B) middle meatus and ventral meatus before forming the alar fold rostrally

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6
Q

Ethmoturbinates:
A) Caudally; where to they extended from?
B) and to?

A

A) the midline ethmoidal plate
B) Cribiform plate

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7
Q

Ethmoturbinates:
What sinuses are they present in?

A

Presphenoid
Frontal sinus

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8
Q

How can ethmoturbinates be sub divided? (2)

A

long, medially lying endoturbinates
smaller, more superficial ectoturbinates.

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9
Q

Nasopharygeal meatus:
What is it formed by? (3)

A

The confluence of the caudal ends of the dorsal, middle and ventral meatuses

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10
Q

Where does the nasopharyngeal meastus run to?

A

Choanea

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11
Q

Nasal planum
A) Epitheliea type?

A

pigmented and consists of tough, thickened keratinized squamous epithelium.

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12
Q

The external nares are supported by (4)

A

Dorsolateral cartilage,
ventrolateral cartilage,
accessory cartilage
cartilaginous septum

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13
Q

What is the largest of the nasal cartilages and merges with the ventral nasal concha?

A

The dorsolateral cartilage

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14
Q

Where are The olfactory receptors are located mainly?

A

ethmoturbinates and thus are in the caudodorsal section of the nasal cavity.

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15
Q

Nasal mucosa:
The blood supply originates from the maxillary artery that arborises into (2,1)

A

sphenopalatine and major palatine branches before continuing as the infraorbital artery

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16
Q

What supplies the nasal conchae, and its terminal branches are known as the caudal lateral nasal arteries

A

The sphenopalatine artery

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17
Q

Lymphatic drainage of nasal mucosa? (3)

A

retropharyngeal,
parotid
submandibular lymph nodes.

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18
Q

Clinical signs of nasal disease (9)

A

sneezing,
stertor,
nasal discharge,
epiphora,
epistaxis, 
inappetence,
sleep disorders,
dyspnoea
facial swelling or distortion

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19
Q

A careful history is useful and should include: (5)

A

progression of clinical signs

response to previous treatments

outdoor exposure and environment

vaccination status

contact with other household or cattery cats.

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20
Q

What areas of CE should be focussed on with nasal dx? (6)

A
  • Teeth
  • Larynx ausc
  • Nasal airflow
  • Epiphora - fluoro
  • Assymetry
  • Nasal planum
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21
Q

Why use fluorecein dye for epiphora?

A

Assess nasolacrimal duct

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22
Q

Diagnostic tests for nasal dx after CE? (3)

A

blood profiles including coagulation profiles (and ideally FeLV/FIV status)

imaging including rhinoscopy if available

culture and histology.

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23
Q

Which biopsy techniques might commonly be required in cases of nasal disease? (4)

A

Rhinoscope
Blind biopsy
Nasal flush
Trephination though the maxillary bone

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24
Q

Rhinoscope, size for:
A) Small dog/cat
B) Dog?

A

A) 1.9
B) 2.7

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25
Q

Rhinoscope; what to do to a haemorrhaging biopsy site to take more samples?

A

flushed with cold isotonic fluid

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26
Q

How to perform a larger biopsy with rhinoscope?

A

A pair of crocodile or cup forceps can also be passed parallel to the scope

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27
Q

What should be performed before performing a blind biopsy? Why?

A

advanced imaging should ideally be used to locate the approximate area of disease

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28
Q

How to avoid cribiform plate damage when performing blind biopsies?

A

A pair of crocodile or cup forceps is measured from the nares to the medial canthus of the eye and a piece of tape placed at this level to avoid damage to the cribriform plate

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29
Q

Possible tools for blind biopsies? (3)

A
  • Crocodile
  • Stylet
  • 16-gauge catheter with an end that is cut obliquely attached to a 10 ml syringe to apply negative pressure to the sample
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30
Q

Nasal flush:
A) How?
B) Syringe size?
C) Repeat?

A

A) high pressure saline being flushed through the nares whilst the other nostril is digitally occluded
B) 20 ml syringe
C) 2-3 times

31
Q

What is the risk if the cribiform plate is damaged?

A

Cerebral damage

32
Q

If repeated nasal biopsies have failed to yield a diagnostic result, any mass lesion seen on imaging can be biopsied via?

A

trephination through the maxillary bone

33
Q

Maxillary trephination:
After making a small skin incision, the bone is perforated with a  A) (2) of large enough diameter to allow B) to be passed into the nasal cavity

A

A) Michel’s trephine or K wire

B) crocodile forceps

34
Q

Maxillary trephination is rarely necessary but can be useful for?

A

tumours originating from the maxillary sinus.

35
Q

Nasal sampling - haemorrhage is expected; what should therefore happen?

A

pharynx should be packed with a conform bandage or large swab (dog)

36
Q

Ventral approach to the nasal cavity. Pros (1)

A

Good cosmetic results

37
Q

Ventral approach to the nasal cavity. cons (1)

A

Limited access for instruments and ET tube

38
Q

Dorsal approach to the nasal cavity
Pros (1)

A

Good access

39
Q

Dorsal approach to the nasal cavity
Cons (2)

A

poor cosmetic appearance
subcutaneous emphysema.

40
Q

Pre-op prep for nasal surgery? (4)

A
  • Blood profiles and coagulation profiles or at minimum a BMBT
  • +/- Temporary carotid ligation
  • Blood available if necessary
  • Arterial blood pressure monitoring
41
Q

Ventral Rhinotomy
Position?

A

Dorsal recumbency with the head secured in a level position with tape around the maxillary canines.

42
Q

Ventral Rhinotomy
If the oral cavity is compromised by the presence of an endotracheal tube what should be placed?

A

a guarded pharyngostomy tube

43
Q

How to place a guarded pharyngostomy tube? (incision site, intrument)

A

Small skin incision caudal to hyoid apparatus onto the point of some large forceps such as Rochester-Carmalt - bring the tube into the pharynx. It is then retroflexed into the trachea.

44
Q

During a ventral rhinotomy, what happens to the pharynx?

A

Pack with a swab

45
Q

Ventral rhinotomy:
Where is the palate incision?

A

The palate is then incised over the midline from the level of the canine teeth to the fourth premolars.

46
Q

During palate incisions, electro-coagulation should be used sparingly - T or F

A

True

47
Q

Ventral rhinotomy:
- What is elevated to expose the palatine bone?

A

The mucoperiosteum

48
Q

What runs alongside the dental arcade from the carnassial tooth? (Which you need to take care to avoid in ventral rhinotomy).

A

Major palatine a.

49
Q

If a large exposure is needed with ventral rhinotomy, what can be used?

A

A hinged mucoperiosteal flap of palate is raised and retracted

50
Q

During a ventral rhinotomy, what is used to access the nasal cavity?

A

A burr is then used to gently burr through the palatine bone

51
Q

If a burr isnt available for a ventral rhinotomy how can you access?

A

Two holes can be made with K-wires and then connected with rongeurs which can then be used to enlarge the cavity.

52
Q

What is used in a ventral rhinotomy to decrease haemorrhage and increase visualisation?

A

Ice saline

53
Q

How to close a ventral rhinotomynmucoperiosteum? (material (2), number of layers, pattern)

A

Relatively long-lasting suture material e.g. polydiaxonone or glycomer 631 
single layer
simple interrupted suture.

54
Q

How many and name the layers of closure of the soft palate.

A

3
- nasal mucosa,
- palatine subcutaneous tissue + muscles
- oral mucosa

55
Q

Which animals should a ventral rhinotomy be avoided in and why?

A

skeletally immature dogs - affect the development of the muzzle

56
Q

Dorsal Rhinotomy:
Position?

A

The patient is placed in sternal recumbency, with the nose positioned level on a sandbag. The pharynx is packed with a swab or bandage.

57
Q

Dorsal Rhinotomy
Where is the initial incision?

A

A midline incision is made from the medial canthus of the eye rostrally over the nasal bone.

58
Q

Dorsal Rhinotomy:
The skin and periosteum are elevated and retracted by (2)

A

Stay sutures
Gelpi retractors

59
Q

Dorsal Rhinotomy:
How to control haemorrhage?

A
  • Bipolar electro-coagulation
  • Swab pressure
60
Q

Dorsal Rhinotomy:
How to get through the nasal bone and access nasal cavity?

A

Burr

61
Q

Dorsal Rhinotomy:
How to access nasal cavity if no burr available? (2)

A
  • Two holes can be made with K-wires and then connected with rongeurs
  • An air saw can be used to cut a rectangular flap of bone
62
Q

Use of an air saw for dorsal rhinotomy is difficult in cats; why?

A

Confined incisional area

63
Q

Best suture material for closure of the periosteum in a dorsal rhinotomy?

A

polydioxanone or glycomer 631

64
Q

What layers are closed in a dorsal rhinotomy?

A
  • Periosteum
  • Mucosa
  • Skin
65
Q

How to ensure drainage of S/C air accumulating with a dorsal rhinotomy/prevent emphysema? (3)

A
  • A small piece of sterile tube is sutured into the wound dorsally connecting the nasal cavity with the air to act as a drain
  • A small gap is left at the dorsal aspect of the incision (can occlude)
  • Tie on bandage
66
Q

Post rhinotomy; what position to recover in?

A

Head down

67
Q

Post rhinotomy; after removing throat pack, check the pharynx for..?

A

Blood clots

68
Q

Post rhinotomy; what to use if there is ongoing haemorrhage? (2)

A
  • Nasal tampons/pack nose
  • Adrenaline (vasoconstrict)
69
Q

Post rhinotomy; why are they commonly anorexic? (4)

A

temporary disruption of the normal sense of smell
stress,
discomfort
medications

70
Q

What food to offer post rhinotomy?

A

Soft + pungent

71
Q

Post rhinotomy - restrict what toys?

A

Hard/chew

72
Q

What do you need to assist cats with post rhinotomy?

A

Grooming

73
Q

If the drain becomes occluded in a dorsal rhinotomy and subcutaneous emphysema occurs this is usually self-resolving in?

A

7- 10days

74
Q

Rhinotomy complications (5)

A
  • Bleeding
  • Sneezing (can lead to epistaxis)
  • Anorexia
  • Subcut emphysema
  • Dehiscence

Surgery of the Upper Airways, Thyroid, Larynx and Trachea (10 decks)

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