Nasal planum and nasal cavity

Question 1

What technique for treatment of stenotic nares was described by Dickerson 2020 in Vet Surg?

Answer 1

Dorsal offset rhinoplasty

Question 2

In a study by Clarke 2022 in Vet Surg, did surgical correction of BOAS improve the reduction in dorsoventral diameter of the nasopharynx during respiration?

Answer 2

No - surgery did not improve the reduction in dorsoventral diameter of the nasopharynx. May suggest inadequate upper airway dilator muscle function.

Question 3

According to Gleason 2022 in Vet Surg, list 4 respiratory and 3 gastrointestinal abnormalities that are more common in brachycephalic cats.

Answer 3

Increased dyspnea, sneezing, coughing, nasal discharge, respiratory noise, decreased activity.

Increased halitosis, difficulty chewing and hypersalivation.

Compare to Gleason 2023 in Vet Surg, with improvements in these parameters observed following ala vestibuloplasty - specifically improved pulmonary blood flow (decreased pulmonary transit time), decreased snoring, open mouth breathing, sneezing, dyspnoea, nasal discharge, increased activity.

Question 4

According to Franklin 2024 in Vet Surg, which of the following rhinoplasty techniques resulted in the greatest increase in the cross sectional area of the nares and nasal vestibuli?
1) Vertical wedge resection
2) Modified horizontal wedge resection
3) Ala-vestibuloplasty

Answer 4

Ala-vestibuloplasty resulted in greatest increase (74%, as compared to 26% for vertical wedge, and 15% for modified horizontal wedge).

Ala-vestibulopasty also extended further caudally (to the level of the caudal nasal vestibule).

Question 5

In a study by Bouyssou 2021 in JFMIS, what CT findings were characteristic of non-lymphomatous nasal neoplasia?

Answer 5

More likely to be unilateral, extend into the frontal sinus, and show areas of mineralization. Regional lymphadenomegaly was more common in lymphoma.

Overlap between CT findings of neoplastic and inflammatory conditions, but bony changes to the nasal cavity boundaries less likely with inflammatory lesions.

Question 6

In a study by Yoshikawa 2023 in JVIM, what was the MST for sinonasal tumours undergoing stereotactic radiotherapy? What complications were reported (2)?

Answer 6

MST 441 days.

Oro-nasal or naso-cutaneous fistula (7%), and chronic rhinitis (61%).

Question 7

Describe the cartilages of the nose.

Answer 7

Question 8

Name the nasal conchae of the nasal cavity.

Answer 8

Ventral, dorsal, ethmoidal. Ventral is larger than the dorsal conchae and the rostral extension forms the alar fold.

Question 9

Name the nasal meatuses of the nasal cavity.

Answer 9

Ventral, middle, dorsal and common.

Question 10

What is the rostral extent of the nasopharynx?

Answer 10

The choanae.

Question 11

What are the three paranasal sinuses?

Answer 11

Maxillary recess, sphenoidal sinus, frontal sinus.

The anatomy of the frontal and sphenoidal sinuses vary, and they may be absent in some patients.

Question 12

What are the major differential diagnoses for dogs or cats with nasal disease?

Answer 12

Neoplasia (adenocarcinoma, SCC, lymphoma, other), inflammatory polyp, fungal infection, viral infection, bacterial infection, foreign body, dental disease, idiopathic rhinosinusitis, nasal mites, ciliary dyskinesia.

Question 13

What imaging techniques can be used for the work-up of nasal/nasopharyngeal disease?

Answer 13

Radiography: bone lysis associated with the presence of neoplastic disease.

CT/MRI: allow more detailed information than radiography, and may be better able to differentiate neoplasia from rhinitis.

Rhinoscopy/nasopharyngoscopy: allows for simultaneous exploration and sample collection. Samples can be collected by swab, flush or biopsy. Severity of mucosal abnormalities are not necessarily predictive of histopathologic abnormalities.

Question 14

What is the CT appearance of nasopharyngeal polyps?

Answer 14

Isoattenuating to the surrounding muscle, and hypoattenuating to the adjacent soft tissue. Contrast rim enhancement is common.

Question 15

What test might be useful in diagnosing cryptococcus infection in cats?

Answer 15

Serum antigen testing. May eliminate the need for invasive testing.

Question 16

What test can be used to detect Mycoplasma and Bartonella bacterial species as possible causes of rhinitis?

Answer 16

PCR testing. Routine culture swabs of the nasal passages are rarely informative.

Question 17

What is the most common neoplasm of the nasal planum?

Answer 17

SCC (cats more commonly affected than dogs).

White cats at increased risk for development.

Question 18

What is the MST for dogs undergoing surgical excision of nasal planum SCC?

Answer 18

12.5 weeks (with surgery alone). 26 weeks was reported with the use of radiotherapy alone.

Question 19

What is the cause of stenotic nares in brachycephalic dogs?

Answer 19

Axial deviation of the dorsolateral nasal cartilage.

Abnormal conchal development is also common, with frequent extension into the nasopharynx.

Question 20

What is the most common nasal neoplasm in the cat?

Answer 20

Lymphoma (MST 98 days with chemotherapy).

Question 21

What is the most common nasal neoplasm in the dog?

Answer 21

Adenocarcinoma. Medium to large breed dogs are overrepresented.

Question 22

What is the treatment of choice for intranasal neoplasia in dogs?

Answer 22

Radiation (surgery has not been shown to improve survival). MST 8-19 months. Dogs with invasion of the cribiform plate have shorter survival times.

Question 23

What are the most common fungal diseases of the nose in dogs and cats?

Answer 23

Dogs: aspergillus fumigatus, blastomyces dermatidis, pythium.

Cats: cryptococcus.

Question 24

What dogs are typically affected by fungal nasal disease?

Answer 24

Young, large breed dogs. Causes a destructive rhinitis that is difficult to distinguish from nasal neoplasia.

Question 25

What are treatment options for fungal rhinosinusitis?

Answer 25

1. Trephination and infusion of low dose enilconazole daily for 7-10 days, or single high dose of clotrimazole. 2. Noninvasive foley catheter technique. Proposed to provide better distribution of infusate (with trephination medications often don't reach the rostral frontal sinus if the septum between the rostral and lateral portions of the sinus are intact). 3. Open rhinotomy and use of povidine iodine packing or enilconazole lavage. Typically reserved for refractory cases.

Question 26

What percentage of dogs are cured with surgical or non-invasive infusion catheter treatment of fungal infections?

Answer 26

65% with a single treatment, 87% with up to four infusions.

Question 27

What are some differentials for dogs/cats with nasopharyngeal disease?

Answer 27

Neoplasia, foreign bodies, inflammatory polyps, fungal granulomas, cysts, choanal atresia or nasopharyngeal stenosis.

Question 28

What are nasopharyngeal polyps?

Answer 28

Benign lesions arising from the mucosa of the auditory tube, middle ear, or nasopharynx. More common in cats.

Question 29

What is the cause of nasopharyngeal polyps?

Answer 29

Unknown - congenital and infectious (calicivirus, herpesvirus) have been postulated.

Question 30

What are treatment options for nasopharyngeal polyps?

Answer 30

Traction avulsion +/- glucocorticoids, removal via VBO. Traction avulsion may result in Horner's syndrome or vestibular signs.

Question 31

How is choanal atresia diagnosed?

Answer 31

Endoscopy, positive contrast rhinography, CT/MRI. Can be complete obstruction or partial (membranous or osseous).

Question 32

What is the treatment of choanal atresia?

Answer 32

Balloon dilatation or open excision and choanal reconstruction.

Question 33

What are some causes of nasopharyngeal stenosis?

Answer 33

Most often acquired rather than congenital. Secondary to surgery, trauma, or upper airway infection.

Question 34

What are treatment options for nasopharyngeal stenosis?

Answer 34

1. Balloon dilatation. 2. Surgical excision (requires accurate mucosal apposition to prevent recurrence). 3. Stenting.

Question 35

What arteries will be encountered during nasal planectomy?

Answer 35

Dorsal and lateral nasal arteries, and major palatine arteries.

Question 36

Which bones are transected during nasal planectomy?

Answer 36

Incisive bones, rostral aspect of the maxilla and nasal bones.

Question 37

What is the Trader's technique for stenotic nare correction?

Answer 37

Amputation of the ventral portion of the dorsolateral nasal cartilage and its associated epithelium.

Question 38

What types of wedge resection can be performed for correction of stenotic nares?

Answer 38

Vertical, horizontal, lateral. Wedges are removed from the dorsolateral nasal cartilage.

Question 39

What is an alarpexy procedure?

Answer 39

Permanent fixation of the wing of the nostril to the adjacent skin, resulting in abaxial displacement of the wing of the nostril. More invasive than other described techniques and usually reserved from revision surgeries.

Question 40

What treatment technique can be used for management of aberrant nasal conchae?

Answer 40

Laser assisted turbinectomy (LATE) using a diode laser. A reduction in intranasal airway resistance of 50% has been observed in dogs following this approach, but regrowth the turbinates has been observed.

Question 41

Why should bilateral carotid artery occlusion be avoided in cats?

Answer 41

Less robust cerebral blood supply and lack of an internal carotid artery increase the risk of brain ischemic damage.

Question 42

What are the surgical approaches that can be used to access the nasal cavity?

Answer 42

Dorsal: nasal cavity and sinuses. Ventral: ventral nasal cavity, nasopharynx, ethmoid turbinates. Lateral: unilateral exposure. Rostral/alveolar mucosal: rostral aspect of the nasal cavity.

Question 43

Why should ventral approaches to the nasal cavity be performed in caution in cats?

Answer 43

Prolonged maximal opening of the mouth can result in maxillary artery compression and subsequent cerebral and retinal ischemia.

Question 44

Describe the dorsal approach to the nasal cavity.

Answer 44

Note: If the bone flap is diseased, previously irradiated, or unstable after fixation it can be removed instead of replaced.

Question 45

What is nasal extirpation or extenteration?

Answer 45

Complete removal of the intranasal structures. The ethmoid turbinates are generally not removed due to concerns of hemorrhage and accidental intracranial penetration.

Question 46

Describe the ventral approach to the nasopharynx.

Answer 46

Incision through the oral mucosa, palatinus muscle and nasopharyngeal mucosa. Caudal margin of the soft palate is left intact. Layers closed separately in 3 layers.

Question 47

Describe the ventral approach to the nasal cavity.

Answer 47

Question 48

What are the potential advantages of a ventral rather than dorsal approach to the nasal cavity?

Answer 48

Improved cosmesis, lower risk of subcutaneous emphysema, less postoperative pain, more rapid recovery. Potential disadvantage is the risk of oronasal fistula formation.

Question 49

Why should ventral rhinotomy be performed with caution in young animals?

Answer 49

Damage to the vomer bone can cause altered muzzle growth in dogs, and can retard transverse palatal length in cats.

Question 50

What are some potential complications following rhinotomy?

Answer 50

Aspiration, hemorrhage (can be reduced by packing the nasal cavity with umbilical tape or gauze and removing 24 hours after surgery), subcutaneous emphysema, chronic serous nasal discharge following removal of the turbinates, postoperative infection (uncommon).

Question 51

How can subcutaneous emphysema be minimized following rhinotomy?

Answer 51

Minimizing subcutaneous dissection, establishing a secure periosteal closure, leaving a gap at the caudal aspect of the incision, adequate post-operative analgesia and sedation to prevent vocalization and excessive movement.

Question 52

How should the ideal location for sinusotomy be determined?

Answer 52

Based off preoperative imaging, as the location and size of the sinuses might vary based on sex, breed and ongoing pathology. Generally performed in conjunction with a dorsal rhinotomy.