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Y3 MOD soft tissue surgery > Upper respiratory tract disease > Flashcards

Upper respiratory tract disease Flashcards

1
Q

Describe how selective breeding has caused Brachycephalic obstructive syndrome

A

Selective breeding has led to the skull becoming greatly shortened without a corresponding reduction in the volume of soft tissues, leading to upper airway obstruction, inspiratory effort and marked negative pharyngeal and laryngeal pressures on inspiration

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2
Q

What are the consequences of a shortened skull?

A
  • Overlong soft palate
  • Stenotic nares
  • Tracheal/laryngeal hypoplasia
  • Pharyngeal collapse, excessive turbinates
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3
Q

Describe the secondary changes of Brachycephalic obstructive syndrome

A
  • Everted laryngeal saccules
  • Tonsillar enlargement/protrusion
  • Laryngeal collapse (eversion of the laryngeal saccules then progressive medial deviation of the corniculate and cuneiform processes of the arytenoid cartilages).
  • Tracheal collapse
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4
Q

What are the clinical signs of Brachycephalic obstructive syndrome

A
  • Inspiratory stertor
  • Dyspnoea
  • Snoring / sleep apnoea
  • Exercise intolerance
  • Cyanosis
  • Fainting / collapse
  • Gagging / dysphagia
  • Regurgitation
  • Cough, pyrexia, dullness with aspiration
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5
Q

What is inspiratory stertor?

A

Snoring noise, deep, low pitch, reverberates in the upper airway

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6
Q

How is Brachycephalic obstructive syndrome diagnosed?

A
  • Signalment and clinical signs
  • Examination of airway: tonsils, soft palate, larynx
  • Radiography: pharynx/neck, thorax
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7
Q

How can Brachycephalic obstructive syndrome be diagnosed?

A
  • Surgical modification of airway

- Decide whether to perform surgery based on severity of clinical signs

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8
Q

Which surgical treatments can be performed for BOAS?

A
  • Rhinoplasty: lateral, vertical or horizontal wedge resection of the dorsal lateral nasal cartilages
  • Palatoplasty
  • Laryngeal sacculoectomy
  • Tonsillectomy
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9
Q

Describe emergency stabilisation of a BOS pateint

A
  • Cool, quiet environment
  • Supplementary oxygen
  • Sedation
  • Intravenous corticosteroids
  • Anaesthetise and intubate if required
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10
Q

Describe stage 1 of laryngeal collapse

A

Eversion of laryngeal saccules

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11
Q

Describe stage 2 of laryngeal collapse

A

Eversion of the laryngeal saccules and medial deviation of the cuneiform process of the arytenoids

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12
Q

Describe stage 3 of laryngeal collapse

A

Eversion of the laryngeal saccules and medial deviation of the cuneiform and corniculate processes of the arytenoid cartilage

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13
Q

How can laryngeal collapse be treated?

A

Stage 1 - laryngeal sacculectomy
Stages 2 and 3 - laryngeal sacculectomy +/- arytenoid caudolateralisation
Permanent tracheostomy

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14
Q

What is laryngeal paralysis?

A

Failure of dorsal cricoarytenoid muscle to abduct arytenoid cartilage on inspiration
-> Reduced glottis size and increased airway resistance

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15
Q

Which nerve is affected in laryngeal paralysis?

A

Recurrent laryngeal nerve

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16
Q

What are some causes of laryngeal paralysis?

A
  • Metabolic neuropathy: hypothyroidism, myasthenia gravis
  • Generalised myopathy
  • Damage to recurrent laryngeal nerve: trauma, neoplasia or other space-occupying lesion
  • Most cases are idiopathic
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17
Q

Which breeds are most likely to acquire laryngeal paralysis?

A

Golden retrievers, Labradors, Irish setters, Afghan hounds

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18
Q

What are the clinical signs of laryngeal paralysis?

A
  • Inspiratory stridor
  • Exercise intolerance
  • Fainting / collapse
  • Altered phonation: change in pitch or loss of bark
  • Cough / gagging during swallowing
  • Dysphagia
19
Q

How can laryngeal paralysis be diagnosed?

A
  • History and clinical signs
  • Laryngoscopy to assess laryngeal function
  • Thoracic / cervical radiographs: look for mass lesions and concurrent aspiration
  • Blood tests: rule out metabolic disease
  • Electromyography / nerve and muscle biopsy
  • Edrophonium response test: if myasthenia gravis is suspected
20
Q

Describe normal and abnormal laryngeal function

A
  • In a normal dog the arytenoid cartilages abduct during inspiration and adduct during expiration
  • Failure of the arytenoids to abduct during inspiration indicates laryngeal paralysis
  • Paradoxical movement of the arytenoids can occur where they are pulled medially by reduced airway pressure during inspiration and passively abduct during expiration
21
Q

How is laryngeal paralysis treated?

A

Left arytenoid lateralisation: easier than right, unilateral gives adequate airway

22
Q

What are some complications associated with arytenoid lateralisation?

A
  • Aspiration pneumonia
  • Failure of tieback
  • Seroma
  • Development of other signs of neuropathy
23
Q

How is tracheal disease investigated on clinical exam?

A
  • Auscultation
  • Palpation of the cervical trachea may reveal changes in shape of the trachea e.g. in tracheal collapse or elicit a cough if the tracheal mucosa is inflamed.
24
Q

What are some other investigative methods for tracheal disease?

A
  • Diagnostic imaging
  • Tracheobronchoscopy
  • Biopsy
  • Tracheal wash and bronchioalveolar lavage for bacterial culture and sensitivity testing and cytology
25
Q

Describe tracheal tears and how to treat them

A
  • Due to sharp or blunt trauma
  • Asymptomatic or SC emphysema / pneumothorax / pneumomediastinum
    Treatment:
  • Conservative with cage rest
  • Tracheoscopy then surgical repair
26
Q

Describe tracheal avulsion

A
  • The complete severance of the intrathoracic trachea
  • Usually due to blunt trauma
  • May be asymptomatic initially: pseudotrachea formation, progressive dyspnoea due to obstruction
27
Q

How is tracheal avulsion diagnosed?

A

History, tracheoscopy, radiographs:

  • Tracheoscopy reveals circumferential tracheal ring disruption or tracheal stenosis depending on the chronicity of the condition.
  • Thoracic radiography reveals an intrathoracic pseudotrachea (area of gas density in line with the trachea with indistinct tracheal walls at this location)
28
Q

How is tracheal avulsion treated?

A

Debridement and anastomosis

29
Q

Describe tracheal collapse

A

Laxity of tracheal muscle and chondromalacia of tracheal rings leads to dorsoventral collapse of lumen

30
Q

Describe dynamic tracheal collapse

A

Cervical trachea collapses during inspiration

Intrathoracic trachea collapses during expiration

31
Q

Which breeds are predisposed to tracheal collapse?

A

Middle-aged miniature or toy breeds

32
Q

What are the clinical signs of tracheal collapse?

A
  • “Goose honk” cough
  • Waxing / waning dyspnoea, exercise intolerance, cyanosis
  • Flattening of cervical trachea on palpation
33
Q

How can tracheal collapse be diagnosed?

A
  • Signalment, history, clinical signs
  • Examination of upper airway
  • Fluoroscopy
  • Radiography: trachea, heart, lungs
  • Tracheoscopy
  • Bronchiolar lavage
34
Q

How can tracheal collapse be treated?

A
  • Medical management often successful: corticosteroids, antitussives, bronchodilators, antibacterials
  • Weight loss
  • Avoid stress, excitement, vigorous exercise, heat
  • Harness
  • Treat concurrent disease
35
Q

Describe tracheal stenosis?

A

Abnormal narrowing due to granulation tissue formation after trauma

  • Blunt/sharp
  • Iatrogenic
  • Foreign bodies
36
Q

How is tracheal stenosis diagnosed and treated?

A
  • Diagnose on history / signs, imaging, tracheostomy

- Treat by resection and anastomosis

37
Q

Where can the trachea be accessed for surgery?

A
  • Ventral midline cervical approach

- Right 3rd-5th ICS thoracotomy

38
Q

When and for what use is a temporary tracheostomy placed?

A
  • Bypasses potentially life-threatening URT obstruction

- Access to tracheal lumen: ventilation, suction, inhalational anaesthesia

39
Q

How is temporary tracheostomy tube managed/maintained?

A
  • Tube exchange q12h or as required
  • Suction of airway as required
  • Moisturise airway q1-4h
40
Q

What are some complications associated with a tracheostomy tube?

A
  • Tube obstruction (esp. in cats)
  • Premature removal
  • Gagging / coughing
  • Subcutaneous emphysema, pneumomediastinum, pneumothorax
  • Infection
  • Stenosis
41
Q

When is a permanent tracheostomy tube placed?

A
  • To bypass chronic / unresolvable URT obstruction

- At 4th-6th tracheal rings

42
Q

How is a permanent tracheostomy tube mainaained?

A
  • Clean skin / stoma
  • Trim hair
  • Maintain body condition
  • No swimming!
43
Q

When is tracheal resection indicated?

A

Tracheal stricture / stenosis, neoplasia, granuloma

  • Resect no more than 5-6 rings
  • End-to-end appositional anastomosis
  • Tension-relieving sutures if required

Y3 MOD soft tissue surgery (7 decks)

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