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Horse Medicine > Surgical conditions of the nasal passages and sinuses > Flashcards

Surgical conditions of the nasal passages and sinuses Flashcards

1
Q

What is laminar flow

A

the absolute flow in linearity through a body/structure

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2
Q

where is the majority of resistance to airflow?

A

in the upper airway

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3
Q

If you change airflow, what do you change?

A

gas exchange-and thus performance

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4
Q

What are the features of the nares?

A
  1. cartilaginous support over nasoincisive notch
  2. muscles innervated by facial nerve
  3. major site of upper airway resistance
  4. fake nostril/alar folds
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5
Q

What can affect the facial nerve? what is a consequence?

A

gutteral pouch dz. cannot flare nostrils–cannot open up when exercising

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6
Q

What is an issue with redundant alar folds?

A

uncommon
cause expiratory flutter
no abnormalities on clin exam
Dx: rule out DDSP–dorsal displacement of the palate

Dx. temporary suture–suture to side of nostril to confirm diagnosis
Tx. excision
beware of referred noise–just b.c hear in trachea, doesn’t mean in trachea

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7
Q

What is a ddx for reduandant alar folds?

A

dorsal displacement of the palate

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8
Q

How do you confirm diagnosis of redundant alar folds?

A

temporary suture to side of nostril–does noise go away

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9
Q

What is a problem with excising the false nostril?

A

if not careful can enter the rostral maxillary sinus when remove
can bleed profusely

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10
Q

What are atheromas?

A

in false nostrils
uncommon
floctuant circular mass in nasal diverticulum
not painful or warm

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11
Q

How are atheromas diagnosed?

A

clinical appearance????look up

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12
Q

What is a ddx for atheroma?

A
  1. neoplasia
  2. foreign body
  3. abscess
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13
Q

How do you treat atheromas?

A
  1. remove the entire thing! including the entire secretory lining
  2. inject formalin (first)
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14
Q

What does the nasal septum do?

A

supports nasal bone
separates the nostrils
important in prolongation of maxilla during development

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15
Q

What is the implication of the fact that the nasal septum is important in prolonging maxilla during development?

A

cannot remove it in a foal with nasal septum issues because need maxilla to continue to grow. also if remove the nostrils can collapse

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16
Q

Why do you have to pack nasal septum removal?

A

bleeds a lot. Give it a tracheostomy in surgery

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17
Q

What are the features of nasal septum resection

A

presents due to noise/exercise intolerance

clin exam: resp noise at resep, palpable lesions, nasal bone deformation

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18
Q

How is nasal septum issues diagnosed?

A
  1. exam/history
  2. endoscopy NEED
  3. DV radiographs
  4. CT (usually don’t need)
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19
Q

What is the treatment for nasal septum issues?

A

removal

20
Q

How can you tell a head radiograph shot is a true DV?

A

only see a thin line of gas where three meatuses are lined up on both sides and see upper cheek teeth because maxilla wider

21
Q

What are the paranasal sinuses?

A 
frontal (1)
--dorsal conchal (6)
rostral maxillary (2) (lateral)
--ventral conchal (7) (medial)
caudal maxillary (3)
sphenopalatine (4)
ethmoidal (5) (part blood, part air)
22
Q

How does the ventarl contral sinus fluid get into the nose?

A

it has to first go into rostral maxillary sinus and through a dorsal hole into the nose
This is why the majority of nasty exudate comes from the ventral conchal sinus b/c difficulty draining

23
Q

What is the problem with sinuses?

A

they are always in communication with airway so they get infected easily

24
Q

What is the history with sinusitis?

A

nasal discharge (foal?) resp tract infection

25
Q

What is seen on clinical exam?

A 
facial deformity (trapped fluid), pain on palpation, dull resonance
As soon as get changing in bone, get change in nasolacrimal duct and get epiphora (overflow of tears onto face)
26
Q

Why might a horse get a small red lesion that looks like ulcer?

A

Nasal discharge! may or may not be bilateral. May be only indication of nasal discharge

27
Q

What does clear nasal discharge possibly with ocular discharge mean?

A

likely due to viral dz

28
Q

How can you perform percussion in good way?

A

put fist in mouth–open mouth allows resonance, can tell difference between left and right

29
Q

How is sinusitis diagnosed?

A
  1. exam
  2. endoscopy-nasomaxillary aperture–where sinuses drain, gutteral pouches–harbor infectious agents
  3. multiple radiographs
  4. sinocentesis (kral tap)
  5. sinoscopy
  6. CT
30
Q

Which mandible will appear larger than the other on radiograph?

A

the one farther away from the plate?

31
Q

What is the appearance of fluid on radiograph? (sinusitis)

A

soft tissue density that forms a straight line

32
Q

When are you going to run into issues when doing trephination in horse?

A

when you hit the enternal endosteum (cannot block it)–makes horse flick head

33
Q

What should you do after flushing pus from the sinus?

A

take radiographs again

34
Q

Why should you do a thorough physical exam and what should you warn clients about when blocking for sinocentesis?

A

because can get facial nerve paralysis (temoporary) with block

35
Q

Is primary sinusitis common or rare?

A

rare

36
Q

Who does primary sinusitis occur in?

A

young horses

37
Q

What is primary sinusitis associated with?

A

URT infection (usually viral)???

38
Q

How is primary sinusitis treated?

A

lavage and antibiotics

39
Q

What is primary sinusitis usually caused by?

A

virus

40
Q

What are the causes of secondary sinusitis?

A

sinus cyst
neoplasia
infected teeth
ethmoid hematoma

41
Q

What are progressive ethmoid hematomas?

A

expanding mass originating from the mucosa of the ethmoid OR paranasal sinuses (not on ethmoid!)
progressive expansion from hemorrahge

42
Q

What will you see with scope with a progressive ethmoid hematoma?

A

may see mass

may only see discharge!!! may not see mass! May be hidden away

43
Q

Why should you radiograph progressive ethmoid hematomas?

A

because may not see the mass or all the mass by endoscope but may deform the bone where you cannot see–e.g. in the sinus

44
Q

What are clinical signs of progressive ethmoid hematoma?

A
  1. epistaxis=-not much
  2. respiratory stridor–can occlude airway or swings around and blocks
  3. facial deformity
45
Q

How is progressive ethmoid hematomas dx?

A

endoscopy (hist), bilateral

46
Q

Tx for progressive ethmoid hematoma

A 
surgical excision (bleeds a lot)
chemical ablation--preferred--but don't pickle brain if has eroded through ethmoid conchae
47
Q

What is ddx for progressive ethmoid hematoma

A
  1. fungal granuloma (rare!)
  2. neoplasia (SSC)
  3. nasal polyps (don’t tend to be there)

Horse Medicine (14 decks)

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