Surgical conditions of the nasal passages and sinuses

Question 1

What is laminar flow

Answer 1

the absolute flow in linearity through a body/structure

Question 2

where is the majority of resistance to airflow?

Answer 2

in the upper airway

Question 3

If you change airflow, what do you change?

Answer 3

gas exchange-and thus performance

Question 4

What are the features of the nares?

Answer 4

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

Question 5

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

Answer 5

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

Question 6

What is an issue with redundant alar folds?

Answer 6

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

Question 7

What is a ddx for reduandant alar folds?

Answer 7

dorsal displacement of the palate

Question 8

How do you confirm diagnosis of redundant alar folds?

Answer 8

temporary suture to side of nostril–does noise go away

Question 9

What is a problem with excising the false nostril?

Answer 9

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

Question 10

What are atheromas?

Answer 10

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

Question 11

How are atheromas diagnosed?

Answer 11

clinical appearance????look up

Question 12

What is a ddx for atheroma?

Answer 12

1. neoplasia
2. foreign body
3. abscess

Question 13

How do you treat atheromas?

Answer 13

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

Question 14

What does the nasal septum do?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

Why do you have to pack nasal septum removal?

Answer 16

bleeds a lot. Give it a tracheostomy in surgery

Question 17

What are the features of nasal septum resection

Answer 17

presents due to noise/exercise intolerance

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

Question 18

How is nasal septum issues diagnosed?

Answer 18

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

Question 19

What is the treatment for nasal septum issues?

Answer 19

removal

Question 20

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

Answer 20

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

Question 21

What are the paranasal sinuses?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

What is the problem with sinuses?

Answer 23

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

Question 24

What is the history with sinusitis?

Answer 24

nasal discharge (foal?) resp tract infection

Question 25

What is seen on clinical exam?

Answer 25

``` 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) ```

Question 26

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

Answer 26

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

Question 27

What does clear nasal discharge possibly with ocular discharge mean?

Answer 27

likely due to viral dz

Question 28

How can you perform percussion in good way?

Answer 28

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

Question 29

How is sinusitis diagnosed?

Answer 29

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

Question 30

Which mandible will appear larger than the other on radiograph?

Answer 30

the one farther away from the plate?

Question 31

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

Answer 31

soft tissue density that forms a straight line

Question 32

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

Answer 32

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

Question 33

What should you do after flushing pus from the sinus?

Answer 33

take radiographs again

Question 34

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

Answer 34

because can get facial nerve paralysis (temoporary) with block

Question 35

Is primary sinusitis common or rare?

Answer 35

rare

Question 36

Who does primary sinusitis occur in?

Answer 36

young horses

Question 37

What is primary sinusitis associated with?

Answer 37

URT infection (usually viral)???

Question 38

How is primary sinusitis treated?

Answer 38

lavage and antibiotics

Question 39

What is primary sinusitis usually caused by?

Answer 39

virus

Question 40

What are the causes of secondary sinusitis?

Answer 40

sinus cyst neoplasia infected teeth ethmoid hematoma

Question 41

What are progressive ethmoid hematomas?

Answer 41

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

Question 42

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

Answer 42

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

Question 43

Why should you radiograph progressive ethmoid hematomas?

Answer 43

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

Question 44

What are clinical signs of progressive ethmoid hematoma?

Answer 44

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

Question 45

How is progressive ethmoid hematomas dx?

Answer 45

endoscopy (hist), bilateral

Question 46

Tx for progressive ethmoid hematoma

Answer 46

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

Question 47

What is ddx for progressive ethmoid hematoma

Answer 47

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