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RUSVM Small Animal Surgery 1 > Upper Airway > Flashcards

Upper Airway Flashcards

1
Q

History/ clinical signs associated with nasal dz?

A 
Nasal discharge 
Sneezing 
Reverse sneezing 
Stertor 
Epistaxis 
Facial deformation 
Ocular discharge
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2
Q

T/F: rhinoscopy and nasopharngoscopy should be performed prior to imaging

A

False

AFTER

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3
Q

What is the most common indication for nasal planum resection?

A

Neoplasia

  • SCC
  • Lymphoma, maligant histiocytosis, maligant melanoma, basal cell carconoma, mast cell tumor , HAS
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4
Q

What type of surgery would you do to gain access to the nasal cavity and sinuses?

A

Rhinotomy (dorsal)

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5
Q

What type of surgery would you do to access the ventral nasal cavity and choanae?

A

Rhinotomy (ventral)

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6
Q

You have a dog with a sinusitis and you want to drain and infiltrate drugs into the cavity. What type of surgery would you do?

A

Sinusotomy

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7
Q

What are the major risks and complications of nasal surgery?

A

Hemorrhage —> dorsal, lateral, and major palatine arteries

Flap necrosis

Oronasal fistula (surgically made passage between the oral and nasal cavity)

Dehiscence

Stenosis of the airway

Incomplete resection or recurrence (neoplasia)

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8
Q

Brachycephalic breeds have a local chrondrodysplasia that results due to early ankylosis of what bones?

A

Basioccipital

Basisphenoid

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9
Q

What are the brachycephalic dog breeds?

A 
English and French bulldog 
Pug
Shih Tzu 
Pekingese 
Boston Terrier 
Boxer 
Chihuahua 
Cavalier King Charles spaniel 
Maltese 
Chow chow 
Yorkshire terrier 
Miniature pinscher 
Shar pei
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10
Q

What are the primary disease components of brachycephalic airway syndrome?

A

Stenotic nares

Elongated soft palate most important

Everted laryngeal saccules/stage I laryngeal collapse

Hypoplasia trachea

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11
Q

What are some contributing problems to brachycephalic airway syndrome?

A 
Nasopharyngeal turbinates 
Stage 2/3 laryngeal collapse 
Tonsillar eversion 
Tracheal collapse 
Secondary edema 
Macroglossia
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12
Q

What is the pathophysiology of upper airway obstructive disease?

A

Higher neg pressures to overcome obstruction —> secondary soft tissue changes (edema/hyperplasia/collapse) —> decreased air flow with increased obstruction

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13
Q

Normally, the epiglottis should overlap the soft palate by how much?

A

1-2mm at midline

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14
Q

Elongated soft palate causes what respiratory sound/sign??

A

Inspiratory dyspnea (Stertor)

Exentsion of the soft palate into the rima glottis causes obstruction and causes loss of protective laryngeal function

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15
Q

Stage the laryngeal collapse..

Collapse of the cuneiform cartilage

A

Stage 2

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16
Q

Stage the laryngeal collapse..

Everted laryngeal saccules

A

Stage 1

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17
Q

Stage the laryngeal collapse ..

Collapse of the coriculate cartilage

A

Stage 3

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18
Q

Collapse of the larynx results in what respiratory sound?

A

Stridor

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19
Q

What is a hypoplasic trachea?

A

Irregular, thick/firm cartilage rings

Overlap of rings

Increased airflow resistance

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20
Q

T/F: Hypoplastic trachea can be treated by placing a tracheal stent

A

False

No treatment

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21
Q

What gastrointestinal comorbidities are seen with BAS?

A 
Regurgitation 
Vomiting 
Hiatal hernia 
Pyloric hypertrophy 
Ulceration

Risk factor for aspiration pneumonia

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22
Q

Signalment associated with BAS?

A

Brachycephalic
2-3yrs
M>F

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23
Q

What is your DDX for chow chow that presents as..

Exercise intolerance
Increased noise, “snoring”, or “snuffling”
Gastrointestinal signs

A

Brachycephalic airway syndrome

Space occupying mass of the upper airway

  • neoplasia
  • abscess
  • granuloma
  • foreign body
  • epiglottic retroversion
24
Q

What would you look for on radiographs on a dog with BAS?

A

Right heart enlargement

Assess for hypoplastic trachea (tracheal lumen:thoracic inlet ratio)

Non-cardiogenic pulmonary edema

Aspiration pneumonia

Hiatal hernia

Megaesophagus (may be associated with reflex of esophagitis)

25
How should you perform an upper airway exam for BAS ?
Avoid drugs that affect laryngeal function (Eg ketamine, diazepam, large dose pure u, or acepromazine) Propofol, then can give sedative/opioid after exam Doxapram improve respiration (general CNS stimulant ) Tonsil -> soft palate -> nasopharynx -> arytenoid cartilages -> nares
26
When is surgery necessary for BAS?
When there is presence of any of the components | -early surgical intervention is important to prevent secondary changes
27
You just did surgery on a BAS patient.. what should you do post op?
GU protectants and promotility agents (eg famotidine, pantoprazole, metoclopramide) Anti-inflammatories for soft palate reaction and saccule excision Anti-emetic at time of pre-med (maripotant) Preoxygenation
28
What are techniques that can be used in a staphylectomy?
Sharp dissection (freehand/ “cut and sew”) CO2 laser excision Bipolar sealing device excision
29
What are the advantages to doing a staphylectomy with a laser?
Rapid | Very little blood loss
30
What technique is useful for soft palate surgery when the palate is very thick?
Folded flap palatoplasty —> excision of part of the oropharyngeal soft palate and underlying muscle —> nasopharyngeal side folded forward and sutured to the orophargyneal border resulting in both shortening and thinning of the palate
31
What are common complications to staphylectomy?
Acute - hemorrhage and inflammation Chronic -undershortening Overshortened —> nasal reflux and aspiration
32
What is the surgery done to correct everted laryngeal saccules ?
Excision | —> cut with scissors and left to heal by second intention
33
What are methods that can be used to correct stenotic nares?
Wedge resection (horizontal/vertical/dorsolatera) Amputation - alar wing +/- alar fold Alapexy
34
What is the surgery to correct a stage II laryngeal collapse??
Partial arytenoidectomy and ventriculochordectomy
35
What complications can arise from an arytenoidectomy and ventriculochrordectomy?
“Webbing” or stricture | -> can be avoided by NOT cutting to the ventral and dorsal extends of the corniculate processes and vocal folds
36
What is the surgical corrections for a stage 3 laryngeal collapse?
Permanent tracheostomy This is an end stage processes —> salvage procedure
37
post-op care for BAS patient?
``` +/- nasal O2 Avoid overheating (decrease panting and labored breathing) ``` Leave intubate as long as possible Sternal recumbency with head up Analgesia - buprenorphine +/- sedation Anti-inflammatory NPO for 24hours Treatment of GI signs E-collar
38
What is the medical treatment for BAS?
``` Weight loss Environmental changes -cool -decreased activity -reduce exposure to respiratory irritants ``` Harness Treat underlying GI disease
39
What is the outcome for correction of any component of BAS?
Success rate 61-95% Will not resolve snoring Mortality 3-6% - English bulldogs secondary to aspiration pneumonia
40
Laxity of the hypepiglotticus muscle in the face of extreme inspiratory effort can lead to??
Epiglottic retroversion
41
What is the treatment for epiglottic retroversion?
Surgical pexy of the ventral aspect of the epiglottis and the dorsal base of the tongue
42
What muscle is responsible for laryngeal abduction?
Crycoarytenoidus dorsalis
43
What nerves innervate the muscles of the larynx?
Cranial (sensory) and caudal (motor) laryngeal nerves -> vagus nerve —> cranial laryngeal —> recurrent laryngeal —> caudal laryngeal
44
What are the diseases of the larynx?
Paralysis Collapse ``` Neoplasia Cyst Trauma Foreign bodies Laryngeal web formation ```
45
What are the clinical signs of laryngeal dz?
``` Stridor Exercise intolerance Gagging/dysphagia Dysphoria Coughing ``` Dyspnea that does not improve with open mouth breathing
46
Etiology of largyneal paralysis ?
Dysfuntion/damage to vagus and branches - acquired vs congenital - unilateral vs bilateral
47
Congenital largyneal paralysis is seen in what breeds??
Bouvier de Flanders, huskies, bull terriers, and Dalmatians —> progressive nerve degeneration Rottweilers —> progressive generalized degenerative disease —> ataxia, paresis, head tremors, neurogenic muscle atrophy
48
Signalment of acquired laryngeal paralysis?
Large breed, older dog Poster children are the overconditioned labs and retrievers
49
What is the cause of acquired laryngeal paralysis ??
Part of a generalized neuropathy —geriatric onset largyneal paralysis polyneuropathy (GOLPP) ``` Idiopathic is most common Hypothyroid Trauma Immune mediated (myasthenia gravis) Infectious Toxin (lead or OP) ```
50
What should you be looking for on radiographs of a dog with suspected laryngeal paralysis ?
Thoracic rads - Aspiration pneumonia - Megaesophagus - Cranial mediastinal masses (thymoma) - Non cardiogenic pulmonary edema Cervical rads - laryngeal cartilages - masses
51
In what case would an acetylcholine receptor antibody titer help to diagnose largyneal paralysis?
Thymoma associated with myasthenia gravis
52
What is the treatment for laryngeal paralysis??
unilateral arytenoid lateralization (THE ONLY TREATMENT) —> decrease airway resistance Medical -> weight loss, stress reduction, exercise restriction, environmental changes
53
Post-op care for arytenoid lateralization?
Maintain ET tube until patient sufficiently awake Avoid heavy sedation or meds that may cause nausea/vomiting NPO for 24hrs - small amount of water and food with close monitoring Monitor for signs of aspiration pneumonia
54
What is the most important complication of unilateral arytenoid lateralization ??
Aspiration pneumonia | LIFE long risk
55
Devocalization surgery is AKA?
Ventriculocordectomy
56
In a ventricuocordectomy, it is important to leave 1-2mm ventral cord intact. Why?
To decrease risk of webbing

RUSVM Small Animal Surgery 1 (39 decks)

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