Nasal Disease: Surgical Approach to the Nasal Cavity Flashcards
The most frequent tumour to affect the nasal planum is the
SCC
Are dogs or cats nasal planum tumour more likely to need surgery as more invasive on presentation?
Dogs
Where do nasal planum tumours often originate in dogs?
Nasal vestibule
How to perform diagnostic biopsies of nasal planum?
- Scalpel slice
- Punch
Normal met site of SCC of the nasal planum?
LN
The prognosis for tumours that have metastasised to the lymph node?
May be guarded
If a SCC has met to the LN, what other met check needed?
Thorax (xray vs ct)
Treatment options in SCC in cats (superficial) (3)
- Photodynamic
- Strontium
- Curettage with cautery
Define deep nasal tumour?
> 5mm
Tx for deep nasal lesion?
Nasal planectomy
How to mark histo edges for the pathologist?
Indian ink
What blood test should be performed before nasal surgery?
Coagulopathy
Pre op planning with planectomies; what should be included? (3)
- Blood profiles and BMBT
- MRI scan unless very superficial lesion (most dogs require advanced imaging, cats are usually more superficial)
- Lots of owner preparation (particularly if young children in the family).
For clean surgical margins of? is usually sufficient.
a 1 cm
Nasal planectomy; nerve blocks?
infra orbital
Surgical prep in cats for nasal planectomy:
Do you leave whiskers in place?
If poss
Surgical prep in cats for nasal planectomy:
Surgically prep with what? (2)
The oral cavity prepped with a dilute povidone-iodine solution or aqueous chlorhexidine.
Surgical prep in cats for nasal planectomy:
Position?
ventral recumbency with the mouth slightly opened using a mouth gag.
Surgical prep in cats for nasal planectomy:
Surgical margins? What happens if not possible?
1cm; if this isnt poss a 0.5 cm margin will often result in clean surgical margins.
Surgical prep in cats for nasal planectomy:
For larger tumours, or those situated more ventrally, the nasal planectomy should be combined with
pre-maxillectomy.
What should be left in place during a cat nasal planectomy to aid recontruction?
A small strip of skin is left in place at the rostral lip
The lips are very vascular and haemostasis is provided by (4)
electrosurgery,
artery forceps
ligation
Ice cold saline soaked swabs
In cases where only the nasal planum has been resected, how to reconstruct?
skin can be sutured to the maxilla using simple interrupted rolling sutures or a purse string suture.
How to place an simple interrupted rolling suture?
anchoring the skin through holes made in the maxilla using K-wires
Suture material for nasal planectomy?
absorbable suture of 2M or 1.5M monofilament suture such as polydiaxanone
When the nasal planectomy has been combined with a premaxillectomy, what are used to close the defect?
unilateral or bilateral labial flaps
When the nasal planectomy has been combined with a premaxillectomy; The labio-gingival borders are incised as necessary to permit tension free advancement, aiming for a palatobuccal recess of about
1cm
When the nasal planectomy has been combined with a premaxillectomy,
What helps reduce a rostral nasal fistula?
Suturing the labial submucosa to the palatine bone using bone holes made with k-wires
How many layer closure
Suturing the labial submucosa to the palatine bone using bone holes made with k-wires
What is involved?
A three-layer closure of palatine periosteum/bone tunnels to labial submucosa followed by oral mucosa medially and skin laterally is used.
How to perform a lip flap in a dog?
remove the skin from one side and the mucosa from the other side bar the 1-2 cm distal mucocutaneous junction to create a terminal island of skin, labial mucosa and labial margin.
Post nasal planectomy; feeding?
sloppy food and continue soft food for 4-6 weeks
Other than possible feeding/tube what needs to be assisted in cats post planectomy?
Grooming
How to remove sutures after planectomy?
sedate/GA
How to prevent food debris post planectomy?
nasal aperture will initially need gentle cleaning with damp cotton buds or swabs to remove food debris
Post op complications with nasal planectomy? (5)
Dehiscence
Nasal stenosis
Recurrence
Anorexia
Sloppy eating and retrieving ability will be affected
The one-year survival rate after resection for nasal planum squamous cell carcinomas in cats is?
80% +
