URT surgery Flashcards
Which clinical signs may mean URT surgery is required?
- Dyspnoea
- URT noise
- Poor performance (primary cause for URT surgery)
- Dysphagia
Conditions of the external nares?
- Atheromas
- Redundant alar folds
- Lacerations affecting nostrils
What are atheromas?
Cystic structures that sit at the top of the diverticulum
Where does the maxillary sinus open into?
Opens into caudal middle meatus via nasomaxillary opening
Why should you be in the ventral meatus rather than the middle meatus to pass a tube or endoscope?
If you pass up the middle meatus you are close to the ethmoid turbinates and risk profuse epistaxis
Structure of the paranasal sinuses?
- Sphenopalatine, frontal, caudal maxillary, rostral maxillary, dorsal conchal and ventral conchal sinuses (and ethmoidal)
- Horses have two sinus systems that don’t communicate (caudal and rostral), septum in between
- Ventral conchal and rostral maxillary form rostral compartments (completely distinct)
Which tooth roots lie in the maxillary sinus?
- Tooth roots of 4th, 5th and 6th cheek teeth lie within the maxillary sinuses
- infection causes sinusitis
Which tooth root forms the rostral wall of the rostral maxillary sinus?
- Roots of 3rd cheek tooth forms rostral wall of rostral maxillary sinus
- infection may cause sinusitis
Which other structures lie within the maxillary sinuses?
nasolacrimal canal and infra-orbital canal
What conditions might you see in the nasal passages?
- Masses
- Fungal granuloma
- Neoplasia
- Ethmoid hematoma
When is sinus surgery indicated?
- Expansive lesions in paranasal sinus e.g. sinus cyst, neoplasia, ethmoid haematoma, tooth root abscess
- Primary sinusitis
- Severe trauma of facial bones
Why is sinus surgery indicated for primary sinusitis but often not secondary sinusitis?
- Secondary sinusitis will not resolve without sorting the primary disease
- With primary sinusitis flushing it out and treating the sinus should resolve it
5 cartilages of the larynx?
Epiglottis, cricoid, thyroid, paired arytenoids
What is the Rima Glottidis?
The aperture of the larynx which goes down into the trachea
List conditions of the pharynx and larynx.
- Cleft palate
- DDSP
- Laryngeal hemiplegia
- Arytenoid chondropathy
- Subepiglottic cysts
- Epiglottic entrapment
What are the consequences of Cleft palate?
Nasal reflux of milk / food material and aspiration pneumonia
Diagnosis, treatment and prognosis of cleft palate?
- Diagnosed on endoscopy
- Poor prognosis - recurrent infections and poor athletic function
- Tx: surgery - poor success rate
Surgical options for Dorsal Displacement of the Soft Palate (DDSP)?
- Myectomy (sternothyroid +/- sternohyoid)
- Palatal fibrosis (thermocautery or laser)
- Tie forward (prosthesis to replace thyrohyoid muscle)
Which surgical option for DDSP has the best success rate?
- Tie forward – currently most popular and best success rate (80%)
- Most have 60% success rate
What is a Myectomy?
Cutting through some of the muscles that insert onto the larynx
When is arytenoidectomy indicated for laryngeal hemiplegia?
Generally only indicated if other techniques fail.
More commonly indicated for arytenoid chondropathy
How is arytenoid chondritis diagnosed?
- Endoscopy (resting)
- Size—compare to other side (tricky if bilateral)
- Mucosa—loss of “bumps”, breaks in surface
- Drainage, granulation tissue
- Palpation—rounded muscular process
How is arytenoid chondritis treated medically?
- Antimicrobial
- Anti-inflammatories (systemic and local)
- Often improves significantly
How is arytenoid chondritis treated surgically?
- Local excision (via endoscope or laryngotomy)
- Arytenoidectomy—failure of medical management
- Permanent tracheostomy— esp if bilateral
