Surgical conditions of the nasal passages and sinuses Flashcards
What is laminar flow
the absolute flow in linearity through a body/structure
where is the majority of resistance to airflow?
in the upper airway
If you change airflow, what do you change?
gas exchange-and thus performance
What are the features of the nares?
- cartilaginous support over nasoincisive notch
- muscles innervated by facial nerve
- major site of upper airway resistance
- fake nostril/alar folds
What can affect the facial nerve? what is a consequence?
gutteral pouch dz. cannot flare nostrils–cannot open up when exercising
What is an issue with redundant alar folds?
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
What is a ddx for reduandant alar folds?
dorsal displacement of the palate
How do you confirm diagnosis of redundant alar folds?
temporary suture to side of nostril–does noise go away
What is a problem with excising the false nostril?
if not careful can enter the rostral maxillary sinus when remove
can bleed profusely
What are atheromas?
in false nostrils
uncommon
floctuant circular mass in nasal diverticulum
not painful or warm
How are atheromas diagnosed?
clinical appearance????look up
What is a ddx for atheroma?
- neoplasia
- foreign body
- abscess
How do you treat atheromas?
- remove the entire thing! including the entire secretory lining
- inject formalin (first)
What does the nasal septum do?
supports nasal bone
separates the nostrils
important in prolongation of maxilla during development
What is the implication of the fact that the nasal septum is important in prolonging maxilla during development?
cannot remove it in a foal with nasal septum issues because need maxilla to continue to grow. also if remove the nostrils can collapse
Why do you have to pack nasal septum removal?
bleeds a lot. Give it a tracheostomy in surgery
What are the features of nasal septum resection
presents due to noise/exercise intolerance
clin exam: resp noise at resep, palpable lesions, nasal bone deformation
How is nasal septum issues diagnosed?
- exam/history
- endoscopy NEED
- DV radiographs
- CT (usually don’t need)
What is the treatment for nasal septum issues?
removal
How can you tell a head radiograph shot is a true DV?
only see a thin line of gas where three meatuses are lined up on both sides and see upper cheek teeth because maxilla wider
What are the paranasal sinuses?
frontal (1) --dorsal conchal (6) rostral maxillary (2) (lateral) --ventral conchal (7) (medial) caudal maxillary (3) sphenopalatine (4) ethmoidal (5) (part blood, part air)
How does the ventarl contral sinus fluid get into the nose?
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
What is the problem with sinuses?
they are always in communication with airway so they get infected easily
What is the history with sinusitis?
nasal discharge (foal?) resp tract infection
What is seen on clinical exam?
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)
Why might a horse get a small red lesion that looks like ulcer?
Nasal discharge! may or may not be bilateral. May be only indication of nasal discharge
What does clear nasal discharge possibly with ocular discharge mean?
likely due to viral dz
How can you perform percussion in good way?
put fist in mouth–open mouth allows resonance, can tell difference between left and right
How is sinusitis diagnosed?
- exam
- endoscopy-nasomaxillary aperture–where sinuses drain, gutteral pouches–harbor infectious agents
- multiple radiographs
- sinocentesis (kral tap)
- sinoscopy
- CT
Which mandible will appear larger than the other on radiograph?
the one farther away from the plate?
What is the appearance of fluid on radiograph? (sinusitis)
soft tissue density that forms a straight line
When are you going to run into issues when doing trephination in horse?
when you hit the enternal endosteum (cannot block it)–makes horse flick head
What should you do after flushing pus from the sinus?
take radiographs again
Why should you do a thorough physical exam and what should you warn clients about when blocking for sinocentesis?
because can get facial nerve paralysis (temoporary) with block
Is primary sinusitis common or rare?
rare
Who does primary sinusitis occur in?
young horses
What is primary sinusitis associated with?
URT infection (usually viral)???
How is primary sinusitis treated?
lavage and antibiotics
What is primary sinusitis usually caused by?
virus
What are the causes of secondary sinusitis?
sinus cyst
neoplasia
infected teeth
ethmoid hematoma
What are progressive ethmoid hematomas?
expanding mass originating from the mucosa of the ethmoid OR paranasal sinuses (not on ethmoid!)
progressive expansion from hemorrahge
What will you see with scope with a progressive ethmoid hematoma?
may see mass
may only see discharge!!! may not see mass! May be hidden away
Why should you radiograph progressive ethmoid hematomas?
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
What are clinical signs of progressive ethmoid hematoma?
- epistaxis=-not much
- respiratory stridor–can occlude airway or swings around and blocks
- facial deformity
How is progressive ethmoid hematomas dx?
endoscopy (hist), bilateral
Tx for progressive ethmoid hematoma
surgical excision (bleeds a lot) chemical ablation--preferred--but don't pickle brain if has eroded through ethmoid conchae
What is ddx for progressive ethmoid hematoma
- fungal granuloma (rare!)
- neoplasia (SSC)
- nasal polyps (don’t tend to be there)
