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Surgery of the Upper Airways, Thyroid, Larynx and Trachea > Upper Airway Masses and Aspergillosis > Flashcards

Upper Airway Masses and Aspergillosis Flashcards

1
Q

Nasopharyngeal swellings in the dog and cat comprise (3)

A

neoplastic masses,
polyps,
congenital cysts

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2
Q

Breeds over represented of trauma and salivary ranula (2)

A

Poodle
Dachsund

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3
Q

Symptoms O may notice with nasopharygneal obstruction? (4)

A

sleeping disorders,
sneezing,
difficulties eating
nasal discharge

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4
Q

Signs O notice with pharygneal mass (2)

A

Dysphagia
Dyspnoea

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5
Q

Upper airway masses; diagnostics (6)

A
  • Bloods
  • Radiography
  • U/S
  • CT/MRI
  • Rhinoscopy
  • FNA
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6
Q

Differential diagnoses for nasopharyngeal and pharyngeal masses (5)

A

Neoplasia (lymphoma, sarcomas e.g., fibrosarcoma)
Polyp
Abscess/granuloma - pharyngeal stick injury
Salivary mucocele - ranula
Nasopharyngeal cysts

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7
Q

Calcification of masses on xray suggest?

A

Neoplasia

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8
Q

What may be seen on X-ray for naso/pharyneal masses (3)

A
  • Soft tissue opacity
  • Loss of air in nasopharynx
  • Calcification
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9
Q

What size rhinoscope in most dogs and cats to access the nasopharynx in a retrograde manner?

A

1.9mm

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10
Q

Traumatic stick injury :
Why might we wait until inflammation has subsided to perform advanced imaging in some cases?

A

Advanced imaging in the form of CT or MRI at the time of the acute injury will reveal large foreign bodies but small splinters are difficult to differentiate when there is extensive trauma with haemorrhage and air pockets. Thus, if the owner has a limited budget it may be preferable to image once the inflammation has subsided.

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11
Q

What approach for pharyngeal stick injury is preferred?

A

A ventral midline surgical approach to the neck is used, with rotation of the larynx if necessary

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12
Q

What is likely to form with a chronic pharyngeal stick injury?

A

Abscess

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13
Q

Pharyngeal stick injury- T of F
Any fibrous tissue reaction is NOT resected.

A

True

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14
Q

Why do we not remove fibrious tissue with pharygneal Fb?

A

Once the foreign body has been removed, this tissue will remodel and resolve over time and attempted resection may damage vital blood vessels/nerves within the cervical tissues.

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15
Q

An intra-oral mucocoele usually occurs under the tongue (ranula) and indicates damage to the what portion of sublingual gland.

A

polystomatic

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16
Q

Which stains can be used to positively diagnose a ranula? (2)

A

Mucin blue
PAS

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17
Q

Initial treatment for a ranula?

A

marsupialisation where a laceration is made in the ranula and the lingual mucosa sutured to the lining of the ranula to try and keep it open and draining.

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18
Q

Chronic ranula, not responding to treatment; what is treatment?

A

mandibular and sublingual sialoadenectomy is effective.

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19
Q

What age cats are polyps normally seen in?

A

Young

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20
Q

Clinical signs of polyps in cats? (3)

A

Sneeze
Nasal Dx
Aural Dx

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21
Q

Where are polyps normally located? (3)

A

Nasopharynx
Eustachian tube
Tympanic bulla

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22
Q

What is the proposed cause of polyps?

A

Chronic irritation of mucosa

Polyps may be a result of localised rupture of the respiratory epithelium followed by luminal protrusion of the lamina propria through the epithelial defect. This becomes epithelialised and the process repeats.

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23
Q

Treatment options for polyps? (2)

A

Traction +/- steroids

Ventral bulla osteotomy

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24
Q

Steroid dose/timings post polyp traction?

A

prednisolone 1-2 mg/kg daily for 14 days then tapered off for a further 14 days

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25
Q

Why is traction preferred to excision for polyps?

A

to excision to try and destroy the vascular supply to the polyp.

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26
Q

When is traction more likely to fail with a polyp? (2)

A

Radiographic changes in bulla
Recurrent polyp

27
Q

What is Aspergillosis normally caused by?

A

Aspergillus fumigatus

28
Q

Aspergillus fumigatus causes a what rhinitits?

A

destructive sinonasal rhinitis

29
Q

Which breed TYPE does Aspergillus fumigatus effect?

A

dolicocephalic

30
Q

Breeds predisposed to Aspergillus fumigatus? (3)

A

Collies,
Golden Retrievers
German Shepherds

31
Q

Aspergillosis account for what % of nasal dx?

A

7-11

32
Q

What is the relation between immunology and aspergillosis?

A

No systemic immunocompromise

abnormality in local response, particularly local immunosuppression with an over-expression of interleukins, specifically IL 10 and Th1 cytokines identified.

33
Q

In dogs where does aspergillosis normally originate?

A

Frontal sinus

34
Q

Clinical signs of aspergillosis (3)

A

Nasal discharge - often initially mucopurulent developing to serosanguineous

Nasal depigmentation

Nasal pain - manifest by head shyness

35
Q

If aspergillosis is left untreated the fungal infection can extend through (2)

A

maxilla into the orbit or through the cribriform plate

36
Q

What are the 2 forms of aspergillosis in cats?

Which is like the dog and which is more destructive?

A
  • Sinonasal (Dog)
  • Sino-orbital (destructive)
37
Q

Although aspergillosis is ubiquitous a number of cases have clues in the history - such as what farms?

A

Duck

38
Q

What test is described below for aspergillosis:
Positive - exposure to aspergillosis and is supportive of the diagnosis.
negative result does not exclude aspergillosis.

A

Serology

39
Q

What is seen on xrays with aspergillosis? (2)

A

destructive rhinitis is evident with punctate lucencies

40
Q

What can specifically be evaluated with CT (Which cannot with xray) with aspergillosis?

A

cribriform plate
frontal sinuses

41
Q

What does MRI evaluate (that xrays do not) with aspergillosis? (3)

A
  • Visualise lesion
  • Particularly frontal sinus
  • Any meningeal involved?
42
Q

Aspergillosis:
With CT it is not always easy to differentiate granuloma from ?.

A

fluid

43
Q

Defintiively diagnose aspergillosis?

A

Imaging
rhinoscopic visualisation of lesions
biopsy of the fungal plaques for culture and histopathology.

44
Q

Aspergillosis - is histopath more likely to reveal a positive culture or result?

A

Result

45
Q

Aspergillosis:
The treatment currently advocated as relatively humane and less time consuming than the clotrimazole soak is

A

trephination of the frontal sinuses, flushing of the sinuses and then installation of clotrimazole cream (usually 50-60 ml of 1% canesten cream) per frontal sinus depending on size with the idea that this will gradually disperse into the nasal cavity,

46
Q

Non invasive tx option of aspergillosis?

A

debride and flush the sinuses endoscopically and then inject clotrimazole cream by endoscopically assisted placed urinary catheters.

47
Q

Tx success rate of aspergillosis?

A

60-70

48
Q

Trephination of frontal sinus:
Before any incision, (after imaging). What must be done?

A

Pack nasopharynx with a swab

49
Q

Trephination of frontal sinus:
Where is the stab incision made? (normal size)

A

1 cm caudal to a line that connects the zygomatic process of the frontal bone, midway between the zygomatic process and the midline

50
Q

Trephination of frontal sinus:
Where is the stab incision in smaller breed dogs?

A

use the line that connects the zygomatic processes as the marker.

51
Q

If using a pin for Trephination of frontal sinus, how far in should it go and why?

A

1 cm to avoid inadvertent damage to the calvarium.

52
Q

Trephination of frontal sinus:
How to remove fungal plaques of thickened epithelium?

A

Curette

53
Q

Trephination of frontal sinus:
How much saline (warm) to flush the sinuses?

A

500ml; ensure it drips out the nostrils

54
Q

Trephination of frontal sinus:
What occurs after the nasal flush?
A) How much is >10kg
B) <10kg

A

close the nares with foley catheters and infuse 1% clotrimazole solution (polyethylene base) into each sinus
A) 50ml
B) 25ml

55
Q

Trephination of frontal sinus:
After the infusion, what is injected into the sinus?
How much if
A) >10kg
B) <10kg

A

1% clotrimazole cream into each sinus
A) 20g
B) 10g

56
Q

How do you know aspergillosis has cleared post tx?

A

Repeat rhinoscopy after 4-8weeks

57
Q

Frontal sinus trephination for aspergillosis. Complications (3)

A
  • subcutaneous emphysema
  • leakage of the cream.
  • damage to the calvarium
58
Q

Why is CT or xrays advised before frontal trephination?

A

Frontal sinus anatomy can vary in dogs

59
Q

If SNA (sinonasal aspergilosis) is refractory to topical treatments; what is the next step?

A

Oral anti-fungal

60
Q

Why do oral antifungals often result in aspergillosis relapse?

A

nidus of aspergillosis in granulomas or biofilms.

61
Q

What is the toxic risk of oral anti fungal?

A

Hepatotoxic

62
Q

How can life threatening haemorrhage occur with aspergillosis?

A

erode the medial wall of the orbit and involve the eye

63
Q

Aspergillosis; if the infection has led to erode the medial wall of the orbit and involve the eye. What is the tx option?

A

open debridement of the infection (including enucleation if the eye is infected or haemorrhaging) and treatment with povidone impregnated dressings (which are changed every 2-3 days under sedation) or topical antifungals can resolve the infection

Surgery of the Upper Airways, Thyroid, Larynx and Trachea (10 decks)

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