Upper airway surgery

Question 1

sources of nasal discharge

Answer 1

nasal passageway

sinus

guttural pouch

LRT-trachea, lungs

Question 2

if in front of _________, discharge will be unilateral

Answer 2

nasal septum

Question 3

DDx for sinusitis in equine

Answer 3

primary infection

tooth root infection

facial fracture

mass within sinus

Question 4

Primary sinusitis in horses

Answer 4

viral infection

fungal infection-aspergillus

bacterial infection-strep equi

Question 5

which sinus is likely to get sinusitis secondary to tooth root infection

Answer 5

especially maxillary sinus

Question 6

sinusitis due to tumor

Answer 6

necrosis occurs

blockage of nasomaxillary aperture

Question 7

DDx for sinusitis in cows

Answer 7

primary infection

dehorning infection

Question 8

Clinical signs of sinusitis in large animals

Answer 8

nasal d/c-intermittent or unilateral

ADR

fever

facial distortion

neurological abn-blindness, optic atrophy from sphenopalatine

Question 9

diagnostic tests for sinusitis

Answer 9

oral exam

other sites (LN, chest rads, titers)

rads

endoscopy -+/- deep cultures, bx

flush (via trephination)

CT scan

MRI

Question 10

sinus trephine

Answer 10

bx

aspirate (c&s)

contrast rads

flush

Question 12

tx for sinusitis

Answer 12

abx, NSAIDs, sinus drainage (on own, lavage via trephine, new hole into nasal cavity)

get rid of primary cause-remove tooth, tumor, sequestrum

Question 13

Ethmoid hematoma

Answer 13

benign tumor-like mass originating from ethmoid turbinates

unknown etiology

thoroughbreds, warmbloods>quarter horses

geldings

Question 14

Ethmoid hematoma clinical signs

Answer 14

nasal d/c: pus + blood, intermittent, smelly, unilateral,

bad breath

nasal obstruction: decreased airflow

more like dog neoplasia

Question 15

ethmoid hematoma diagnostics

Answer 15

endoscopy, radiographs, CT

Question 16

Answer 16

Ethmoid hematoma radiograph

Question 17

Answer 17

ethmoid hematoma CT scan

Question 18

ethmoid hematoma treatment

Answer 18

remove via sinus flap, +/- cryo/laser sx

do sx standing due to blood loss

laser ablation

formalin injection

comes back

Question 19

Answer 19

endoscopic view of guttural pouch normal anatomy

Question 20

guttural pouch empyema

Answer 20

uni/bilateral discharge from guttural pouch openings

usually secondary to URT infection, extension of Strep inf

ISOLATE horse

cnodroids form

Question 21

guttural pouch empyema clinical signs

Answer 21

intermittent nasal d/c

swelling of adjacent LNs

parotid swelling and pain

extended head carriage due to pain

Question 22

guttural pouch empyema diagnosticcs

Answer 22

endoscopy, radiographs, C&S

Question 23

Answer 23

guttural pouch empyema

Question 24

Answer 24

radiograph of chondroids

guttural pouch empyema

Question 25

Guttural pouch empyema treatment

Answer 25

medical: daily irrigation, +/- abx, +/- acetylcysteine surgical: create drainage, remove chondroids if approaching ventrally, be careful of the hypoglossal nerve

Question 26

which disease is least likely to show fluid line on radiograph? guttural pouch empyema nasal adenocarcionma dehorning sinusitis maxillary tooth root infection

Answer 26

nasal adenocarcinoma

Question 27

a sinus flap can be useful for all but: treating an ethmoid hematoma treating guttural pouch empyema diagnosing conchal cyst diagnosing a maxillary sinus tumor

Answer 27

treating guttural pouch empyema

Question 28

guttural pouch mycosis

Answer 28

hemorrhagic nasal discharge fungus enters pouch grows over an artery for nutrition erodes artery

Question 29

guttural pouch mycosis clinical signs

Answer 29

uni/bilateral epistaxis anemia nerve damage: IX, X, XII dysphagia laryngeal hemiplegia horner's syndrome death due to exsanguination

Question 30

guttural pouch mycosis diagnostics

Answer 30

endoscopy +/- culture PCV/TPP

Question 31

Answer 31

guttural pouch mycosis

Question 32

guttural pouch mycosis treatment

Answer 32

medical: mechanil removal of plaques, cryotherapy, lavage system + antifungals, blood transfusion surgical: occlude affected artery so fungus dies

Question 33

surgical tx of guttural pouch mycosis

Answer 33

circle of Willis--\>directional blood flow need to occlude from both directions 50% fatal hemorrhage if only one side

Question 34

prognosis

Answer 34

dysphagia may take 6-18 months to recover laryngeal hemiplegia-often permanent

Question 35

Hemorrhagic nasal discharge DDx

Answer 35

guttural pouch mycosis ethmoid hematoma trauma tumor infection nasolacrimal gland coagulopathy EIPH atrial fibrillation