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CRS2 > URT surgery > Flashcards

URT surgery Flashcards

1
Q

Which clinical signs may mean URT surgery is required?

A
  • Dyspnoea
  • URT noise
  • Poor performance (primary cause for URT surgery)
  • Dysphagia
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2
Q

Conditions of the external nares?

A
  • Atheromas
  • Redundant alar folds
  • Lacerations affecting nostrils
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3
Q

What are atheromas?

A

Cystic structures that sit at the top of the diverticulum

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4
Q

Where does the maxillary sinus open into?

A

Opens into caudal middle meatus via nasomaxillary opening

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5
Q

Why should you be in the ventral meatus rather than the middle meatus to pass a tube or endoscope?

A

If you pass up the middle meatus you are close to the ethmoid turbinates and risk profuse epistaxis

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6
Q

Structure of the paranasal sinuses?

A
  • 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)
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7
Q

Which tooth roots lie in the maxillary sinus?

A
  • Tooth roots of 4th, 5th and 6th cheek teeth lie within the maxillary sinuses
  • infection causes sinusitis
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8
Q

Which tooth root forms the rostral wall of the rostral maxillary sinus?

A
  • Roots of 3rd cheek tooth forms rostral wall of rostral maxillary sinus
  • infection may cause sinusitis
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9
Q

Which other structures lie within the maxillary sinuses?

A

nasolacrimal canal and infra-orbital canal

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10
Q

What conditions might you see in the nasal passages?

A
  • Masses
    • Fungal granuloma
    • Neoplasia
    • Ethmoid hematoma
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11
Q

When is sinus surgery indicated?

A
  • Expansive lesions in paranasal sinus e.g. sinus cyst, neoplasia, ethmoid haematoma, tooth root abscess
  • Primary sinusitis
  • Severe trauma of facial bones
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12
Q

Why is sinus surgery indicated for primary sinusitis but often not secondary sinusitis?

A
  • Secondary sinusitis will not resolve without sorting the primary disease
  • With primary sinusitis flushing it out and treating the sinus should resolve it
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13
Q

5 cartilages of the larynx?

A

Epiglottis, cricoid, thyroid, paired arytenoids

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14
Q

What is the Rima Glottidis?

A

The aperture of the larynx which goes down into the trachea

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15
Q

List conditions of the pharynx and larynx.

A
  • Cleft palate
  • DDSP
  • Laryngeal hemiplegia
  • Arytenoid chondropathy
  • Subepiglottic cysts
  • Epiglottic entrapment
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16
Q

What are the consequences of Cleft palate?

A

Nasal reflux of milk / food material and aspiration pneumonia

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17
Q

Diagnosis, treatment and prognosis of cleft palate?

A
  • Diagnosed on endoscopy
  • Poor prognosis - recurrent infections and poor athletic function
  • Tx: surgery - poor success rate
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18
Q

Surgical options for Dorsal Displacement of the Soft Palate (DDSP)?

A
  • Myectomy (sternothyroid +/- sternohyoid)
  • Palatal fibrosis (thermocautery or laser)
  • Tie forward (prosthesis to replace thyrohyoid muscle)
19
Q

Which surgical option for DDSP has the best success rate?

A
  • Tie forward – currently most popular and best success rate (80%)
  • Most have 60% success rate
20
Q

What is a Myectomy?

A

Cutting through some of the muscles that insert onto the larynx

21
Q

When is arytenoidectomy indicated for laryngeal hemiplegia?

A

Generally only indicated if other techniques fail.

More commonly indicated for arytenoid chondropathy

22
Q

How is arytenoid chondritis diagnosed?

A
  • Endoscopy (resting)
    • Size—compare to other side (tricky if bilateral)
    • Mucosa—loss of “bumps”, breaks in surface
    • Drainage, granulation tissue
  • Palpation—rounded muscular process
23
Q

How is arytenoid chondritis treated medically?

A
  • Antimicrobial
  • Anti-inflammatories (systemic and local)
  • Often improves significantly
24
Q

How is arytenoid chondritis treated surgically?

A
  • Local excision (via endoscope or laryngotomy)
  • Arytenoidectomy—failure of medical management
  • Permanent tracheostomy— esp if bilateral
25
Q

How is intralaryngeal granulation tissue treated?

A
  • Excision—endoscopic, laryngotomy
  • W/ concurrent chondritis
    • Excision can make worse
    • May require arytenoidectomy
  • W/ abscessation
    • Curettage via laryngotomy
26
Q

What is the prognosis with all surgical treatments of the pharynx and larynx?

A

Poor for full athletic function

27
Q

How are subepiglottic cysts (congenital or acquired) or granulomas treated?

A
  • surgical excision through laryngotomy
  • oral removal using Nd:YAG laser or snare wire
  • Good prognosis
28
Q

How are subepiglottic cysts diagnosed?

A
  • URT endoscopy (may not see)
  • Oral examination
  • Radiographs
29
Q

Clinical signs of epiglottic entrapment?

A
  • Poor performance?
  • Respiratory noise (most common clinical sign)
  • +/- cough
  • +/- nasal discharge
30
Q

Diagnosis of epiglottic entrapment?

A
  • Endoscopy
    • Lose scalloped border and vascular pattern on dorsal aspect of epiglottis
    • +/- mucosal ulceration
  • Intermittent entrapment may require exercising endoscopy
31
Q

Epiglottic entrapment options?

A
  1. Resection of aryepiglottic folds
  2. Axial division per os
  3. Axial division per nasum
  4. Transendoscopic laser division
  • 3 and 4 no requirement for anaesthesia
32
Q

What is contained in the medial compartment of the gutteral pouch?

A

internal carotid, cranial sympathetic nerves, cranial cervical ganglion, and cranial nerves IX (glossopharyngeal), X (vagus)and XII (hypoglossal).

33
Q

What is contained in the lateral compartment of the gutteral pouch?

A

external carotid, maxillary artery and cranial nerve VII (facial nerve on the outside of the lateral compartment ).

34
Q

Which compartment of the gutteral pouch is more likely to be affected by mycotic lesions?

A

Most mycotic lesions affect the medial compartment.

35
Q

Which compartment of the gutteral pouch is more likely to be affected by injury and trauma?

A

Lateral compartment

36
Q

List conditions of the gutteral pouch.

A
  • Guttural pouch tympany
  • Guttural pouch empyema
    • Other masses
  • Stylohoid fractures
  • Guttural pouch mycosis
37
Q

Why can gutteral pouch mycosis be so serious?

A
  • The fungus will erode through the soft tissues
  • Eventually erodes through the carotid which haemorrhages and the horse will bleed out
  • If you see a horse with epistaxis should always investigate for this one
38
Q

How is gutteral pouch mycosis treated?

A
  • Ligation (can safely occlude one of the carotids)
  • Balloon catheter
  • Transarterial coil embolization
39
Q

Difference between tracheotomy and tracheostomy?

A
  • TRACHEOTOMY (temporary)
  • TRACHEOSTOMY (permanent)
40
Q

Describe process of placing a tracheotomy.

A
  • Cranial/mid third of neck - midline dissection to trachea
  • Incision made between and parallel to cartilage rings
  • Tracheotomy tube placed and secured with sutures or bandage
  • Aftercare - basic wound management and removing excess discharge
41
Q

Complications and considerations of a tracheostomy?

A
  • Wound care and aftercare is significant (advise owner)
  • Potential complications include pulmonary infection and drowning
  • With both techniques there is considerable discharge, and the owner should be advised of the cosmetic appearance beforehand
42
Q

How are tracheal conditions diagnosed?

A

Endoscopy, radiographs, fluoroscopy, ultrasound

43
Q

What treatments are available for tracheal conditions?

A
  • Intraluminal granulation tissue—laser
  • Extraluminal compression
    • Remove/treat compressing structure
    • May need to reconstruct ring
  • Collapse
    • Intra and extra-luminal stenting has been reported
    • Success poor

CRS2 (64 decks)

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