Upper Airway Dz

Question 1

When dealing with surgery on the nose what is the use of silicon tubes places in the nares:

Answer 1

• • Realign the tissue

- - prevents nasal stenosis

Question 2

Surgical procedure referring to removal of the nose

Answer 2

Nasal planum resection

Question 3

Most common neoplasia corrected by a nasal planum resection:

Answer 3

_ SCC

Most common neoplasia that is corrected by nasal planum resection

Question 4

Is the most common nasal planum resection complete or unilateral?

Answer 4

Complete – most common nasal planum resection

– usually the unilateral SCC will be corrected by a complete nasal planum resection because cosmetically & long term will provide better results

Question 5

What is helpful for planning a nasal planum resection:

Answer 5

CT

– local recurrence due to incomplete excision is one of the most complications, especially dogs.

Question 6

Type of suture pattern used for nasal planum resection in cats.

Answer 6

Purse string suture works well in cats to decrease size of wound and then the remaining defect is allowed to heal by second intension

Question 7

T/F: Purse string sutures are used for nasal planum resection to decrease size of wound

Answer 7

FALSE–

Purse string sutures in dogs cause higher risk for nasal stenosis in dogs

Question 8

What tool can you use to tell if a nasal planum resection is successful

Answer 8

Deep Biopsy to assess margins

Question 9

T/F: In Nasal Planum resection, purse strings are used in the dog while reconstructive flaps are used in cats.

Answer 9

FALSE

• • Dogs: Reconstructive flaps
• -Cats: Purse string sutures

Question 10

2 common complications of a nasal planum resection:

Answer 10

1. Dehiscence – Tension on flaps
2. Stenosis – appears to be more common in dogs & techniques that result in good nasal mucosa (skin apposition preferred)

Question 11

What is the key to preventing stenosis in a nasal planum resection:

Answer 11

–Direct opposition: Oppose the SKIN & NASAL MUCOSA as much as possible around the defect.

Question 12

When the suture is under too much tension what is a common complications

Answer 12

Dehiscence

Question 13

Stenosis may require reconstruction with flaps from the _____ _____ to minimize recurrence

Answer 13

Mucocutaneous junction of the lip

Question 14

Treatment of a Fibrosarcoma

Answer 14

Nasal planectomy & Maxillectomy

Question 15

What tool is used in a Nasal planectomy & maxillectomy

Answer 15

Oscillating saw

– electrosurgery to achieve hemostasis

Question 16

What suture pattern is used with a nasal planectomy /maxillectomy in order to achieve skin to nasal mucosa

Answer 16

Modified figure 8 pattern

– wraps around the edge of the skin. This reduces the risk of post op stenosis problems.

Question 17

Name the openings from the caudal part of the nasopharynx

Answer 17

Choanal – bony structures covered by mucosa with no room for swelling if something were to occur, resulting in choanal atresia/stenosis

Question 18

What type of infection can get into the nasal cavity causing big white masses that grow into the nasal cavity.

Answer 18

Rhinosporodiosis

– surgical incision is almost impossible to eradicate the disease.

Question 19

Most common neoplasia of the nasal cavity:

Answer 19

Adenocarcinoma – treated by radiation therapy

other neoplasia of the nasal cavity: Adenocarcinoma, SCC, Lymphoma, mast cell tumors, polyps.

Question 20

3 most common problems in the nasal cavity:

Answer 20

• • Nasopharyngeal stenosis: common in brachycephalics; problem with he choani of the nasal turbinates creating an obstructive lesion. Creates problems moving air in through the nasal passages.
• • Trauma
• • Neoplasia: Adenocarcinoma, SCC, lymphoma, Mast cell tumors, polyps

Question 21

Inflammatory masses that normally originate from the top of the Eustachian tube close to the middle ear.

Answer 21

Nasal pharyngeal polyps

Question 22

In diagnosing nasal disease, what is the FIRST diagnostic with nasal disease.

Answer 22

Imaging –** Computed Tomography**

– Imaging is done first to avoid creating an artifact from bleeding.

Question 23

In diagnosing nasal disease, what is important about the order of the diagnostics

Answer 23

Imaging FIRST

Rhinoscopy & Naspharyngoscopy SECOND

Question 24

What instrument must be measured & marked to insure you do not go to the olfactory part of the brain ( if there is tumor erosion of the cribiform plate).

Answer 24

Rhinoscopy & Nasopharyngoscopy

Question 25

T/F: Bacterial culture is helpful in diagnosing nasal disease

Answer 25

FALSE -- normal bacteria in the nose. - Bacterial culture unlikely to be helpful in diagnosing nasal disease. - - PCR for Bartonella and mycoplasma sp.

Question 26

If you suspect bartonella or mycoplasma sp causing nasal disease, what would be the best diagnostic tool:

Answer 26

PCR -- for bartonella & Mycoplama sp.

Question 27

If you suspect nasal disease in the sinuses what surgical approach would you use with a rhinotomy.

Answer 27

Dorsal Rhinotomy: access to nasal cavity and SINUSES

Question 28

If you suspect nasal disease in the choanae, what would be the best surgical approach with a rhinotomy:

Answer 28

Ventral Rhinotomy: access to ventral nasal cavity & choanae

Question 29

Out of a dorsal & ventral rhinotomy, which is most commonly used:

Answer 29

Dorsal Rhinotomy

Question 30

Name some of the complications for nasal surgery

Answer 30

Nasal Sx complications: - - Hemorrhage - - flap necrosis - -oronasal fistula - -dehiscence - - stenosis of airway - -incomplete resection/local recurrence (for neoplasia)

Question 31

When all the contents of the nasal cavity is removed, it is disrupting of the normal clearing mechanism resulting in what long term complication

Answer 31

Chronic nasal discharge -- drainage usually moves cranial to caudal but with removal of the cilia sometimes it doesn't drain correctly resulting in chronic nasal discharge. -- This commonly occurs with stenosis of airways from partial removal of turbinates.

Question 32

What is commonly associated with stenosis of the airways after a partial removal of the turbinates

Answer 32

Chronic nasal discharge ***Pope went back to this concept.

Question 33

T/F: Brachycephalic breeds occur in both cats & dogs

Answer 33

True:

Question 34

Most common cat breeds associated with brachycephalic syndrome:

Answer 34

1. Persians | 2. Himalayans

Question 35

In brachycephalic breeds, why does the nose stop growing?

Answer 35

Early fusion of growth plates | "Local Chrondrodysplasia"

Question 36

What is the cause of a shortened & broadened skull in brachycephalic breeds:

Answer 36

Local Chrondrodysplasia resulting in early ankyloses of the basioccipital & basisphenoid bones.

Question 37

What two bones are involved in early ankylosis for brachycephalic breeds:

Answer 37

Basioccipital | Basisphenoid

Question 38

Name 2 primary components of brachycephalic airway syndrome that can be corrected at birth:

Answer 38

1. Elongated soft palate 2. Stenotic Nares - hypoplastic trachea can not be corrected

Question 39

It is important to correct primary components of brachycephalic syndrome for what reason

Answer 39

Primary components can lead to secondary components effecting the laryngeal & pharyngeal structures (edema, swelling, tonsil enlargement).

Question 40

Name some secondary/acquired components involved in BAS:

Answer 40

1. Everted laryngeal saccules/ stage 1 laryngeal collapse 2. pharyngeal/ laryngeal mucosal edema 3. tonsillar eversion 4. macroglossia 5. stage II/III largngeal collapse 6. Tracheal collapse

Question 41

List the steps of pathophysiology of upper airway obstructive disease

Answer 41

1. Higher negative pressure to overcome obstruction 2. Secondary soft tissue changes (edema, hyperplasia, collapse) 3. Decreased air flow with increased obstruction

Question 42

Most common component of BAS

Answer 42

Elongated soft palate

Question 43

Term referring to mainly inspiratory dyspnea in BAS:

Answer 43

STERTOR!!!!

Question 44

Term referring to extension into rima glottides ( Severe obstruction & loss of protective laryngeal function)

Answer 44

Elongated Soft palate

Question 45

Term referring to dyspnea with airway obstruction at the larynx where the animal has a harder time getting air in. Seen in laryngeal paralysis.

Answer 45

STRIDOR - - stridor = below larynx (trachea) - -stertor = above larynx

Question 46

T/F: Endoscopy is a useful tool for elongated soft palate to look in the nasal pharynx.

Answer 46

TRUE

Question 47

Air passage through nasal cavities accounts for ___% of airway resistance

Answer 47

76.5% of airway resistance -- Abnormal anatomy causes external & internal resistance (Static/ dynamic abnormalities) = inability to dilate the nostrils