Upper airway surgery Flashcards
sources of nasal discharge
nasal passageway
sinus
guttural pouch
LRT-trachea, lungs
if in front of _________, discharge will be unilateral
nasal septum
DDx for sinusitis in equine
primary infection
tooth root infection
facial fracture
mass within sinus
Primary sinusitis in horses
viral infection
fungal infection-aspergillus
bacterial infection-strep equi
which sinus is likely to get sinusitis secondary to tooth root infection
especially maxillary sinus
sinusitis due to tumor
necrosis occurs
blockage of nasomaxillary aperture
DDx for sinusitis in cows
primary infection
dehorning infection
Clinical signs of sinusitis in large animals
nasal d/c-intermittent or unilateral
ADR
fever
facial distortion
neurological abn-blindness, optic atrophy from sphenopalatine
diagnostic tests for sinusitis
oral exam
other sites (LN, chest rads, titers)
rads
endoscopy -+/- deep cultures, bx
flush (via trephination)
CT scan
MRI
sinus trephine
bx
aspirate (c&s)
contrast rads
flush
tx for sinusitis
abx, NSAIDs, sinus drainage (on own, lavage via trephine, new hole into nasal cavity)
get rid of primary cause-remove tooth, tumor, sequestrum
Ethmoid hematoma
benign tumor-like mass originating from ethmoid turbinates
unknown etiology
thoroughbreds, warmbloods>quarter horses
geldings
Ethmoid hematoma clinical signs
nasal d/c: pus + blood, intermittent, smelly, unilateral,
bad breath
nasal obstruction: decreased airflow
more like dog neoplasia
ethmoid hematoma diagnostics
endoscopy, radiographs, CT
Ethmoid hematoma radiograph
ethmoid hematoma CT scan
ethmoid hematoma treatment
remove via sinus flap, +/- cryo/laser sx
do sx standing due to blood loss
laser ablation
formalin injection
comes back
endoscopic view of guttural pouch normal anatomy
guttural pouch empyema
uni/bilateral discharge from guttural pouch openings
usually secondary to URT infection, extension of Strep inf
ISOLATE horse
cnodroids form
guttural pouch empyema clinical signs
intermittent nasal d/c
swelling of adjacent LNs
parotid swelling and pain
extended head carriage due to pain
guttural pouch empyema diagnosticcs
endoscopy, radiographs, C&S
guttural pouch empyema
radiograph of chondroids
guttural pouch empyema
Guttural pouch empyema treatment
medical: daily irrigation, +/- abx, +/- acetylcysteine
surgical: create drainage, remove chondroids
if approaching ventrally, be careful of the hypoglossal nerve
which disease is least likely to show fluid line on radiograph?
guttural pouch empyema
nasal adenocarcionma
dehorning sinusitis
maxillary tooth root infection
nasal adenocarcinoma
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
treating guttural pouch empyema
guttural pouch mycosis
hemorrhagic nasal discharge
fungus enters pouch
grows over an artery for nutrition
erodes artery
guttural pouch mycosis
clinical signs
uni/bilateral epistaxis
anemia
nerve damage: IX, X, XII
dysphagia
laryngeal hemiplegia
horner’s syndrome
death due to exsanguination
guttural pouch mycosis diagnostics
endoscopy
+/- culture
PCV/TPP
guttural pouch mycosis
guttural pouch mycosis treatment
medical: mechanil removal of plaques, cryotherapy, lavage system + antifungals, blood transfusion
surgical: occlude affected artery so fungus dies
surgical tx of guttural pouch mycosis
circle of Willis–>directional blood flow
need to occlude from both directions
50% fatal hemorrhage if only one side
prognosis
dysphagia may take 6-18 months to recover
laryngeal hemiplegia-often permanent
Hemorrhagic nasal discharge DDx
guttural pouch mycosis
ethmoid hematoma
trauma
tumor
infection
nasolacrimal gland
coagulopathy
EIPH
atrial fibrillation
