Oropharynx Flashcards
What are 3 signs that point to oral dz?
Halitosis
Ptyalism (sometimes with blood)
Prehension difficulty
If you suspect oral dz, but none is seen what should you consider next?
Neuromuscular dz
What is CUPS?
Canine ulcerative periodontal stomatitis
What is FOPS?
Feline orofacial pain syndrome, similar to trigeminal neuralgia in humans
What are two drugs that might be used to help alleviate the pain from FOPS?
Gabapentin
Phenobarb
NOTE: NSAIDs not very helpful
What is tonsillitis/pharyngitis?
Inflammation of the tonsils of pharynx
Whata re two major presenting signs you see with tonsillitis/pharyngitis?
Anorexia
Odynophagia (pain swallowing food)
What is odynophagia?
Pain when swallowing food
What is crucial when considering the signs of tonsillitis/pharyngitis?
Vaccination hx, thinking rabies
What are two clinical findings associated with tonsillitis/pharyngitis?
Enlarged tonsils
FB
When examining oropharynx for tonsillitis/pharyngitis, what samples should you take?
Cytology or biopsy of tonsils, especially if bleeding or ulcerated
What is tonsillitis/pharyngitis most commonly secondary to?
Respiratory dz
What are 3 common etiologies of tonsillitis/pharyngitis?
Viral (most common)
Bacterial (rare and secondary)
Nasopharyngeal polyps
What 5 things would you do to gain a dx of tonsillitis/pharyngitis?
Viral isolation (Idexx PCR) **for sure do in cats
Imaging (CT specifically)
Endoscopy (can use to look above soft palate)
Cytology
Biopsy
What are 4 steps to treating tonsillitis/pharyngitis?
Find and treat underlying cause
Remove FB
Abx
Symptomatic (analgesia, soft foods)
What nasopharyngeal dz might you see?
Stenosis/tumors
What are 2 diagnostic approaches to nasopharyngeal dz?
CT
Felxible endoscopy
What can you do to intervene in cases of nasopharyngeal stents/tumors?
Interventions- stents
What age of cat typically gets nasopharyngeal polyps?
Young cats, 1-6yoa
What a re the clinical signs of nasopharyngeal polyps?
Upper respiratory signs and dysphagia
What is dysphagia?
Difficult or painful swallowing
What are the 4 phases of swallowing?
Oral
Pharyngeal
Cricopharyngeal
Oesophageal
What is the normal oral phase of swallowing?
Grabbing food, bolus formation, bolus passed in aboral direction and pushed into oropharynx.
What are 5 signs of abnormal oral phase of swallowing?
Tilting or throwing the head back to swallow Difficult prehending Food/water drops Salivation Food is held in the cheeks
What is the goal of the pharyngeal phase of swallowing?
To prevent aspiration while moving food into the esophagus.
What is the normal pharyngeal phase of swallowing?
Contractions propel bolus from the oropharynx to the laryngopharynx, the soft palate is elevated and the larynx is elevated against the epiglottis
What two phases of swallowing are difficult to distinguish from one another?
The pharyngeal phase and the cricopharyngeal phase
If a patient develops laryngeal paralysis, what do they become predisposed to?
Aspiration
What are 4 signs of abnormal pharyngeal phase of swallowing?
Coughing
Retching
Gagging
Food goes back into the mouth
NOTE: Worse while drinking
NOTE: Nasal discharge is actually reflux of food into the nasopharynx
What is the normal cricopharyngeal phase?
Cricopharyngeal muscle relaxes and the pharyngeoesophageal sphincter opens
What are 4 signs of abnormal cricopharyngeal phase?
Repeated efforts to swallow
Coughing
Retching
Gagging
What happens in the esophageal phase of swallowing?
Peristaltic wave is generated in the pharynx and propagated through the esophagus to carry bolus to the stomach
What is the conformation of the oropharyngeal structures to allow airflow?
Soft palate is down
Epiglottis is open
Pharyngeal muscles relax
Pharyngeosophageal sphincter is closed
When diagnosing dysphagia, what 3 things are you looking for in your history?
Vaccine status (rabies)
Trauma, weakness of concurrent dz
Differentiate oral from pharyngeal/cricopharyngeal dysphagia
When performing a clinical exam on a dysphagic animal, what is one thing you might do that can help you differentiate anorexia from dysphagia?
See for yourself by offering water and different food items
On top of your general physical exam, what are 4 other things you would perform to help diagnose dysphagia?
Palpate masticatory muscles
Neuro exam (gag reflex)
Mouth inspection (sedate/GA)
Videofluoroscopy
What is the diagnostic approach for dysphagia?
If cannot eat or prehend/eats with pain = Oral dysphagia
If tries to eat/no pain/difficult drinking/respoiratory signs = Pharyngeal/cricopharyngeal dysphagia
What are 3 Ddxs for dysphagia?
Infection
Myopathy/myositis
Neuropathy
What 3 things would you do to rule out infection?
CBC
Culture (rarely beneficial)
Viral isolation/serology
What screening test would you run to rule out myopathy/myositis?
CK
What 2 endocrine dzs would you screen for if you suspect a neuropathy?
HypoT
Addison’s (typical and atypical)
What are 3 diagnostics you can do to determine cause of oral dysphagia?
RADs - FB, fxs
FNA - Abscess
FNA, biopsy - Neoplasias
What diagnostics would you use to determine a cricopharyngeal achalasia?
Fluoroscopy (barium swallow)
What is a cricopharyngeal achalasia?
A bar of muscle tissue which causes a physical restriction
What diagnostics would you use to determine a mass or FB?
Pharyngeal endoscopy
What 3 diagnostics would you use to determine a retropharyngeal neoplasia/abscess/lymphadenopathy?
US
FNA
Biopsy
What diagnostics would you use to rule out secondary pneumonia?
Thoracic RADs
NOTE: Should do this whenever you have stridor or respiratory issues
What diagnostics would you use to determine myasthenia gravis?
Screening test is ACTH Ab titer
NOTE: Corticosteroids can interfere with this test, wean off a couple weeks ahead of test
How do you treat dysphagia?
Usually symptomatic treatment
Specifically identify and treat underlying cause
NOTE: Cricopharyngeal achalasia tx is myotomy, only thing with a specific treatment
What are 5 common differentials for a cervical mass?
Pharyngeal stick injury Sialocoele Thyroid carcinoma Lymphadenopathy Insect sting/bite
What are 4 infrequent causes for a cervical mass?
Salivary gland neoplasia (usually in severe pain and odynophagia)
Hematoma
Calcinosis circumscripta
Sialadenitis/salivary gland necrosis
What are 4 things you would investigate in your patient’s history with a cervical mass?
Duration
Owner description
Change over time
Location
If the cervical mass increases and decreases in size, what 2 things should be at the top of your ddx?
Sialocoel
Salivary gland hyperplasia
If the cervical mass is painful, what 2 things should be on your ddx?
Neoplasia
Salivary gland necrosis
If you have a lymphadenopathy, what might you want to be looking for?
Oral neoplasia
What is the typical signalment of e pharyngeal stick injury?
A young playful puppy
What are 5 clinical signs do you expect to see with a pharyngeal stick injury?
Dull Bloody saliva Terrible halitosis Pain opening mouth Anorexia
With a pharyngeal stick injury, what do you typically see on RADs?
Emphysema around the cervical area
NOTE: Can also track into mediastinum and also go under the skin
How do you manage a pharyngeal stick injury?
Explore all tracts
Establish drainage
Don’t rely on abx
What do you need to be early on in your treatment of a pharyngeal stick injury?
Fairly aggressive to make sure you don’t manifest complications later
Where can rostral pharyngeal FBs migrate to?
Retrobulbar (can cause abcesses)
Temporal/masseteric (facial sinus)
Why are wooden FBs difficult to spot of RADs?
They’re usually radiolucent
What is surprising about sewing needles?
They’re inert, and COULD be left alone, but the thread is irritating. Also, needles can migrate if in muscles.
If you have a lateral pharyngeal FB, whay do you need multiple views?
Because difficult to localize where the exact location is.
What 3 things might you see on a RAD of a cervial FB patient that suggest esophageal involvement?
SQ emphysema
Dyspnoea
Pneumomediastinum
What is a sialocele?
A soft painless swelling
What causes a sialocele?
A defect in the polystomatic sublingual gland
What should you be careful of when sampling or draining a sialocele?
Easy to contaminate and it becomes an abscess
What is the quality of the fluid drained from a sialocele?
“tenacious” honey coloured fluid
How do you confirm a sialocele?
“Drip test”
Why would you juts go in surgically instead of continuing diagnostics with a sialocele?
Because they can easily become infected
Where would you palpate if you suspected a thyroid carcinoma?
Mid-cervical with deep palpation
What would you palpate if you suspected a thyroid carcinoma?
A firm mass ventrolateral to the larynx
What are 2 clinical signs you would see with a thyroid carcinoma?
Coughing/respiratory signs
Regurgitation
What imaging is most helpful with a thyroid carcinoma?
CT contrast
What do you need to remember when taking a biopsy of a thyroid carcinoma?
They will bleed a lot so make sure you have blood on hand
What is the signalment for a patient with idiopathic sialadenitis?
Young terriers (JRT)
What 3 things would you see with idiopathic sialadenitis?
Extreme pain
Tortoise movement (sign of odynophagia)
Hypersalivation (more severe at night)
Why is idiopathic sialadenitis phenobarbitone responsive?
One clinical sign may be temporal lobe epilepsy
What can salivary gland hyperplasia or metaplasia progress to?
Salivary gland necrosis
What is the underlying etiology of salivary gland hyper-/metaplasia?
Esophageal dz (vagal nerve abnormality)
How do you treat salivary gland hyper-/metaplasia?
Multimodal analgesia
