upper airway Flashcards
general steps to work up a case
history pe
ddx
upper airway endoscopy
revise ddx
further diagnostics
what breathing noise is always considered pathologic
inspiratory noises
serous nasal discharge
viral or allergy
mucoid to purulent nasal discharge
bacterial, sinusitis
hemorrhagic nasal discharge
GP mycosis, trauma, EIPH
ethmoid hematoma
unilateral nasal discharge vs bilateral
unilateral seen in ethmoid turbinates, drainage angle or mild GP disease
what causes nasal fold collapse
large negative pressure during inspiration collapses the folds
nasal fold collapse common treatment
nasal strips decrease negative inspiratory pressure
there is a laceration to the nostrils. what do you need to remember
do not allow them to heal by second intention. it will stricture
collapse of the nostrils, nasal cavity or nostril flutter. can be unilateral or bilateral
facial nerve paralysis
what causes choanal atresia
failure of the buconasal membrane to rupture in utero
how do we treat a nasal polyp
cut off with OB wire
what is the general treatment for fungal rhinitis
sx debridement and systemic antifungals. long course
zoonotic
theres a nasal septal defect. what do you need to rule out
mass effect vs congenital
you remove a nasal foreign body. now what
find potential inciting cause for FB
what is the sinus cavity 3D image of choice
CT— but does not allow for definitive diagnosis
what sinuses normally communicate
rostral maxillary and ventral conchal bulla
frontal sinus and dorsal conchal sinus
what is the structure we rupture to allow the three sinus compartments to communicate
maxillary septal bullae
what is the most common bone flap
frontonasal bone flap
most common lication for a sinuscopy
frontochonchal
what is the most common cause of sinusitis
dental disease 08-11
what causes primary sinusitis
obstruction of the drainage angle. this causes mucus and bacteria to build up in the sinus cavities
treatment for acute sinusitis vs chronic
acute- broad spec abx
chronic- sinus lavage +- sinuostomy
facial bone deformation, +- airway obstruction +- sinusitis
sinus cyst
how to diagnose a sinus cyst
round fluid filled structure on radiographs
treatment for sinus cyst
sx removal is 80% curative
most common sinus neoplasia
SCC– need sinuostomy and biopsy to confirm
prognosis of sinus neoplasia
<6mo survival time with sx removal
young horse lump on face +- history of trauma
suture periostitis
treatment for suture periostitis
topical antiinflam, TIME, +- abx if theres a history of trauma
when do we perform bony repair surgery in a sinus fracture
only if the fracture is endented. if it is level we can treat conservatively
what steps of our PE need to be added for a sinus fracture
assess bony orbit
neuro exam
endoscopy
how do we diagnose an ethmoid hematoma PEH
endoscopy to look for mass. rads to check involvement
treatment for PEH (hematoma)
formalin injection series or laser ablation
why does PEH recur in 67% of cases
involvement with the sphenopalatine sinus. formalin could cross the cribriform
general clinical signs of a guttural pouch issue
nasal discharge +- blood
cranial nerve deficits
dyspnea
+- horners
what causes guttural pouch tympany
salpingopharyngeal ostia acts as a one way valve for air. young animals
treatment for GP tympany
stop the one way valve- catheter +- sx fenestration if recurrent
GP empyema- what causes it
URT infection that extends into the GP — or LN ruptures in the GP
what to remember about GP empyema
screen for strangles
scary amount of blood coming from the nose
GP mycosis
GP mycosis treatment
leave the blood clot alone.
SEDATE the horse
coils or nitinol plugs to affected artery
what does DDSP cause
obstruction on inspiration
what are the three pathophys to DDSP
neuromuscular junction
reduced larynx elevation
hypoglossal N dysf
most common cause of airway obstruction in racehorses
DDSP
treatments for DDSP
treat inflam
cornell collar
laryngeal tie
issue that causes respiratory distress in foals. often secondary to FPT
nasopharnygeal dysfunction
prognosis for nasopharyngeal dysfunction
good. SC and will resolve in a month
treatment for cleft palate without aspiration pneumonia
conservative therapy if minor.
treatment for more severe cleft palate.
sx repair, but high rate of recurrence. also you cant do this to the hard palate
when do we choose a dynamic endoscopy
normal standing endoscopy or abnormal standing endoscopy and we what to further eval
why would some conditions only be present in dynamic endoscopy
negative pressure created in exercise causes collapse.
what are the four effects of negative pressure on the soft tissues
vocal fold collapse, pharyngeal collapse, axial deviation of aryiepiglottic folds
DDSP
roaring
LLH
laryngeal hemiplagia
what causes L Laryngeal hemiplagia
neurogenic atrophy of the cricoarytenoid dorsalis m CAD
two goals of conservative or tie back procedures in LLH
decrease noise and improve exercise intolerance
how do we ddx laryngeal hemiplagia from arytenoid chondropathy
US looking at CAD muscles.
early vs chronic treatment for arytenoid chondropathy
early- antiinflammatories, +- resect granulomas
chronic- arytenoidectomy
what tissues are causing entrapped epiglottis
ariepiglottic folds and subepiglottic mucosa
treatment for entrapped epiglottis
axial midline incision.
excellent prognosis
how to remove a subepiglottic mass
snare off the mass via the mouth
