Upper airway/sinus/GP/trachea/Thorax - Bauck Flashcards
1
Q
Maxillary sinus anatomy
A
Rostral and caudal maxillary sinuses separated by septum
2
Q
Infraorbital canal separates
A
Cranial maxillary sinus from ventral conchal sinus
and
Caudal maxillary from sphenopalatine
3
Q
Dorsal conchal sinus communicates with
A
frontal sinus
4
Q
Frontal sinus communicates with
A
caudal maxillary sinus through frontomaxillary opening
5
Q
Maxillary sinus drains into
A
nasal cavity
6
Q
Primary sinusitis caused by
A
URT infection
-ush strep species
7
Q
Secondary sinusitis caused by
A
Dental disease usually
8
Q
Sinusitis
A
Can be localized or extensive
9
Q
Sinusitis DX
A
HX PE Endoscopy CS Rads CT
10
Q
Primary Sinusitis TX
A
- Drainage, irrigation (trephination)
- abx
- surgical debridement
11
Q
Secondary Sinusitis TX
A
- Address primary cause
- tooth removal
- mass removal - Then treat as primary sinusitis
12
Q
Progressive Ethmoid Hematoma
A
- Unknown etiology
- Capsule is respiratory epithelium
- Arises from ethmoid labyrinth, or floor of sinus
- Horses > 6 yrs old
- Classically unilateral
13
Q
Progressive Ethmoid Hematoma CS
A
- Mild, intermittent epistaxis
- +/- upper respiratory noise
- Facial deformity uncommon
14
Q
Progressive Ethmoid Hematoma DX
A
Endoscopy, rads, CT (SX planning)
15
Q
Progressive Ethmoid Hematoma TX
A
- Intralesional 10% formalin - q 3-4 weeks until gone
- Laser photoablation if < 5 cm diameter
- Possible recurrence (esp. if bilateral)
16
Q
Paranasal sinus cyst
A
- single or loculated fluid-filled cavitis
- maxillary and conchal sinuses
- Unknown etiology
- Any age
17
Q
Paranasal sinus cyst CS
A
- Nasal d/c
- Facial swelling
- airway obstruction
18
Q
Paranasal sinus cyst DX
A
- Endoscopy
- Radiographs
- CT (SX planning)
19
Q
Paranasal sinus cyst TX
A
Responds well to surgical removal
- Frontal flap or
- Maxillary sinus flap
- Must remove cyst lining
20
Q
Dzs that obliterate normal paranasal sinus anatomy (ethmoid labrynth, concha, etc)
A
- Ethmoid hematomas
2. Cysts
21
Q
If a fracture is into a sinus it is
A
open
22
Q
Biggest factor for fx reconstruction
A
being able to elevate it
23
Q
Neoplasia
A
Squam most common
prognosis generally poor
24
Q
Frontal sinus sinoscopy/sinocentesis landmarks
A
-60% from midline and 0.5 cm caudal to line drawn from midline to medial canthus
25
Caudal maxillary sinus sinoscopy/sinocentesis landmarks
-2 cm ventral to medial canthus
26
Rostral maxillary sinus sinoscopy/sinocentesis landmarks
- halfway between medial canthus and rostral extent of facial creast
- 1 cm ventral to line from medial canthus to infraorbital canal
27
Sinus sx prep considerations
1. cross-matches for equine blood donors
2. Pre-op/intra-op abx and antiinflammatories
3. Blood donor avail
28
Frontonasal bone flap
Preferred
| -good access to maxillary sinus via frontomaxillary opening
29
Frontonasal bone flap margins
1. Caudal: perpindicular line from midline to midway point between surpaorbital foramen and medial canthus
2. Lateral: begins at caudal margin, 2.5 cm medial to medial canthus of eye and extends 2/3 the distance from medial canthus of eye to infraorbital foramen
3. Rostral: perpindicular line from dorsal midline to rostral extension of lateral margin
30
Maxillary bone flap should avoid
1. infraorbital canal
| 2. nasolacrimal duct
31
For bone flaps, skin closure should be
Intradermal
32
Post-op bone flap
1. Pull packing after 24-36 hours
2. Change bandage q2-3 days
3. IV abx 24-48 hrs, can d/c with 10-14 days TMS
4. Flunixin 7-10 days
5. Confined to stall with hand walking 3-4 weeks for bone flap to stabilize
33
Medial compartment of guttural pouch
1. Internal carotid artery
2. Cranial cervical ganglion
3. Cervical sympathetic trunk
4. CN 9, 10, 11, 12
5. Ventral straight muscles
34
Lateral compartment guttural pouch
External carotid -> maxillary artery
35
Nerves close to GP
CN 5, 7, 8
36
Guttural pouch tympany
```
Air in pouch
Foals
Ush unilateral
fillies > colts
Nonpainful, can cause dyspnea
PE, Rads
```
37
Guttural pouch tympany TX
```
Indwelling foley cath
Surgical
1. enlarge internal plica
2. stoma in median septum
3. salpingopharyngeal fistula-comm btwn GP and pharynx
4. laser/sharp dissection
*prognosis is good, can recur
```
38
Guttural pouch empyema
```
Purulent infection ush secondary to URT infection, S. equi
Bilateral mucopurulent nasal discharge
IDDSP, dyspnea, dysphagia
Endoscopy, rads
ABX, NSAIDS, lavage
prognosis good if no neuro defects
```
39
Guttural pouch mycosis
Aspergillus, ush medial compartment
- arteries (ICA, ECA, MA)
- nerves (cranial 9-12, sympathetic)
40
Guttural pouch mycosis CS
1. Epistaxis - most common
2. Dysphagia - most serious
3. Horner's syndrome
4. Abnormal resp noise
5. Nasal d/c, corneal ulcer, abn head post, colic
41
Guttural pouch mycosis tx
1. Medical tx of fungus - not ush effective, too slow
2. NSAIDS - for inflammation and neuritis
3. transfusions/fluids
4. nutritional support if dysphagia
5. surgical debridement
6. vascular occlusion
42
Guttural pouch mycosis prognosis
1. 50% of horses with hemorrhage die
2. 90% of horses survive after vascular occlusion of affected arteries
3. Neuropathies
- Horner's - good
- Dysphagia - very poor
- Laryngeal hemiplasia - poor
43
DDX for huge neck swelling
1. Guttural pouch mycosis
| 2. Ventral straight m.m.
44
Rupture of ventral straight muscles
1. Longus capitus and rectus capitus ventralis m.m.
2. Avulsion fx of basisphenoid bone
3. trauma (flipping over)
4. severe epistaxis, neuro signs, ataxia, hemorrhage into retropharyngeal tissues, dyspnea
45
Rupture of ventral straight m.m. DX/TX
```
Endoscopy/rads
TX:
-stall rest
-prophy abxs
-NSAIDS
```
46
Temperohyoid osteoarthropathy (THO)
- Progressive dz of squamous portion of hyoid bone and stylohyoid bone
- causes ankylosis of THO, callus, repeated fractures
- wide age range affected
47
THO possible etiologies
1. Middle/inner ear infection (hematogenous origin)
| 2. Degenerative changes with age
48
THO TX
Ceratohyoidectomy, prog good
49
Important things at approach to ceratohyoidectomy
1. Lingual a.
2. Hypoglossal n.
3. Facial a.
4. Parotid duct
50
Surgical approaches to GP
1. Hyovertebrotomy-no ventral drainage
2. Viborg's triangle
- linguofacial vein
- ramus of mandible
- sternomandibularis tendon
3. Modified Whitehouse
- most popular
- good ventral drainage
4. Whitehouse
51
Viborg's triangle
1. linguofacial vein
2. ramus of the mandible
3. sternomandibularis tendon
52
Trachea anatomy
1. 48-60 hyaline cartilage rings
2. Rings incomplete dorsally
3. Four layers
- tracheal adventitia
- musculocartilagenous layer
- submucosa
- mucosa
53
Tracheotomy complications
1. cellulitis
2. emphysema
3. cartilage damage
4. stricture
54
Tracheotomy layers
1. Skin
2. cutaneous colli m.
3. sternothyrohyoideus m.
4. trachea
55
Incision length should not exceed
1/2 circumference of rings
56
Permanent tracheostomy indications
Permanent impairment laryngotracheal apparatus
- cicatrix
- bilateral hemiplagia
- bilateral arytenoid chondritis
57
Permanent tracheostomy performed in cranial
1/3 of cervical region (more cranial than a temp)
| Good long term prognosis
