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Module 15 > Approach to Horses with Facial Swelling & Nasal Discharge > Flashcards

Approach to Horses with Facial Swelling & Nasal Discharge Flashcards

(93 cards)

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1
Q

What are the nasal conchae

A

thin, scrolled shaped bony structures

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2
Q

what is the function of nasal conchae

A

increases surface area of the nasal cavity

provides rapid warmings and humidification of air as it passes into lungs

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3
Q

what are the nasal conchae divided into

A

dorsal

middle

ventral

common meatuses

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4
Q

what do the dorsal and ventral conchae enclose

A

a recess and a bulla

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5
Q

what are the structures of the nasal conchae

A

caudal to the dorsal and ventral conchae are the dorsal conchal sinus and ventral conchal sinus

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6
Q

what can cause infections of the bullae

A

cause chronic unilateral nasal discharge with and without concurrent paranasal sinusitis

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7
Q

how many paranasal sinuses are there

A

7

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8
Q

what are the paranasal sinuses

A
  1. dorsal (endoturbinate I) conchal sinus
  2. middle (endoturbinate II; ethmoid) conchal sinus
  3. ventral conchal sinus
  4. sphenopalatine sinus
  5. frontal sinus
  6. rostral maxillary sinus
  7. caudal maxillary sinus
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9
Q

name the paranasal sinuses

A
  1. rostral maxillary sinus (RMS)
  2. caudal maxillary sinus (CMS)
  3. ventral conchal sinus (VCS)
  4. sphenopalatine sinus (SPS)
  5. frontal sinus (FS)
  6. ethmoid (E)
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10
Q

name the paranasal sinus anatomy

A
  1. frontomaxillary opening
  2. dorsal conchal sinus (DCS)
  3. infraorbital canal
  4. septum between RMS and CMS
  5. caudal bulla of VCS
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11
Q

name the paranasal sinus anatomy

A
  1. rostral maxillary sinus
  2. caudal maxillary sinus
  3. sphenopalatine sinus
  4. frontal sinus
  5. dorsal conchal sinus
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12
Q

how do the sinuses relate to dentition

A

tooth roots of the caudal four maxillary cheek teeth are closely associated with maxillary sinuses

triadan 08 and 09: associated with rostral maxillary sinus

triadan 10 and 11: associated with caudal maxillary sinus

triadan 07 may be associated with rostral sinus

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13
Q

how do the sinuses related to dentition in young horses

A

alveoli of large cheek teeth reserve crowns occupy much of these maxillary sinuses

with age, alveoli remodel and retract, resulting in increased sinus cavity volume

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14
Q

which cheeck teeth can result in secondary sinusitis

A

periapical infection of the caudal maxillary cheek teeth

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15
Q

how do the paranasal sinuses communicate

A

directly: maxillary sinuses communicate with the middle nasal meatus through nasomaxillary aperture
indirectly: dorsal, middle, and ventral conchal sinuses, the frontal sinus and the sphenopalatine sinus communicate indirectly with the middle nasal meatus through the caudal maxillary sinus

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16
Q

what are the most common clinical signs of paranasal sinus disease

A

persistent, purulent unilateral nasal discharge

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17
Q

what are the less common clinical signs of paranasal sinus disease (8)

A
  1. facial swelling
  2. focal or diffuse and progressive or static as well a reduced airflow through a nostril(s)
  3. external draining tracts
  4. halitosis (malodorous breath)
  5. epiphora (excessive tearing from eyes)
  6. respiratory stertor (abnormal respiratory noise)
  7. enlarged submandibular lymph nodes
  8. head tilting
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18
Q

what does the clnical exam of a horse with unilateral, malodorous purulent nasal discharge

A

make sure to thoroughly palpate the patient’s face/skull

facial symmetry

any abnormalities including lumps or depressions, submandibular lymph node swelling or evidence of external draining tracts

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19
Q

what abnormalities can be seen on upper airway endoscopy

A

exudate coming from nasomaxillary aperture, ethmoid hematomas and/or distortion of the nasal septum or conchae

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20
Q

why is a dental exam important

A

dnetal disease is the most common cause of paranasal sinusitis in horses

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21
Q

what should an oral exam entail

A

use a dental mirror and evaluate the dental arcades thoroughly

assess one Triadan row at a time, looking at the occlusal surface and interdental space of every cheek tooth

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22
Q

what are the radiographic views used to assess the sinuses

A
  1. latero-lateral
  2. dorsoventral
  3. dorso30lateral-ventrolateral oblique views for maxillary arcades
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23
Q

what view is this

A

latero-lateral

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24
Q

what view is this

A

oblique views

dorso30lateral-ventrolateral oblique

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25
what view is this
dorsal-ventral
26
how are radiographs labelled
the image should always be labelled as the side adjacent to plate
27
what are the landmarks for radiographic positioning
1. lateral canthus 2. midline of face 3. facial crest
28
what does the latero-lateral view assess
paranasal sinuses
29
how is a latero-lateral view taken
centre the x-ray beam just dorsal to the facial crest and collimate to dorsal midline and the lateral canthus of the eye
30
what abnormalities can be seen on latero-lateral view
fluid lines intra-sinus soft tissue opacities fractures
31
what view is this and what are the structures
normal latero-lateral blue: frontal sinus green: dorsal conchal sinus red: rostral maxillary sinus purple: caudal maxillary sinus yellow: sphenopalatine sinus
32
what view is this and structures
normal latero-lateral view blue: dorsal conchae green: ventral conchae
33
what is shown here
34
what are fluid lines
represent a collection of fluid (most likely purulent exudate in cases of sinusitis) within the paranasal sinuses
35
what is shown here and what view is this
latero-lateral soft tissue opacity in the dorsal conchal sinus
36
what is shown here and what view
latero-lateral view horse with chronic bilateral purulent nasal discharge fracture of the maxillar
37
what are the dorso30lateral-ventrolateral oblique views used to assess
apices of the maxillary cheek theeth to help rule out dental disease as a cause of paranasal sinus disease
38
how is a dorso30lateral-ventrolateral view taken
beam should be centred 1cm dorsal to the rostral aspect of the facial crest and aimed roughly 30 degrees ventrally the window for collimation is the same as a latero-lateral view
39
what are radiographic anatomy of significance with regards to teeth on oblique views (3)
1. enamel 2. periodontal ligament 3. lamina dura: radiographic representation of cortical alveolar bone, which lines the alveolus in permanent teeth
40
what are radiographic abnormalities that can be seen on oblique views (5)
1. periapical sclerosis and halo formation 2. periodontal ligament widening 3. loss of the lamina dura 4. clubbing of tooth apices 5. hypercemetosis
41
what are the structures shown here
42
what abnormality is shown here
periapical infection
43
what is shown here and what is the abnormality
periapical infection
44
what abnormality is shown
45
what abnormality is shown here
periapical clubbing periapical infection
46
what is shown here
hypercementosis periapical infection
47
what does the dorso-ventral view used to assess
nasal caivty and axial compartments of the paranasal sinuses
48
how is the dorsal-ventral view taken
x-ray plate is placed under the mandible and the beam is centred between facial crests
49
what abnormalities can be identified on dorso-ventral views
ventral conchal sinusitis and space occupying lesions
50
what are the normal structures of the dorso-ventral views
caudal maxillary sinus rostral maxillary sinus ventral conchal sinus
51
what is shown here
ventral conchal sinusitis
52
what are the disadvantages of radiographs
2D image of a complex 3D structure identifying diseases can be difficult esp those that are subtle
53
whehn is CT indicated (3)
1. when radiographic findings are equivocal or normal in the face of disease 2. when medical and/or surgical treatment is unsuccessful 3. evidence of multifocal or extensive disease or the extent of the disease is unknown
54
what are the two types of sinus surgeries
1. sinus trephination: making a small hole into the sinus 2. sinusotomy: making a large window into the sinus
55
where is sinus trephination done
into the frontal sinus
56
what does sinus trephination allow and when is it useful
evaluation of all paranasal sinuses compared to protals made into the maxillary sinuses ## Footnote useful in young horses whose cheek teeth occupy much of the maxillary sinuses
57
what are the landmarks for sinus trephination into the frontal sinus
usually made 0.5cm cadual to an imaginary line drawn between the left and right medial canthi and halfway between midline and the ipsilateral medial canthus
58
what is sinuscopy
direct endoscopy of the paranasal sinuses following trephination all sinuses can be evaluated if using a frontal trephination portal once the maxillary septal bulla is broken down surgically
59
what is the maxillary septal bulla
anatomical division between rostral paranasal sinuses (rostral maxillary and ventral conchal sinuses) and caudal paranasal sinuses (dorsal conchal sinus and caudal maxillary sinus)
60
what is sinusotomy
makes a large window into the paranasal sinuses for direct visualization via a three sided flap
61
when is sinusotomy indicated
if removal of a large mass or a significant amount of inspissated material is required
62
what are the causes of primary sinusitis
bacteria sinusitis fungal sinusitis
63
what are secondary sinusitis
dental disease paranasal sinus cysts ethmoidal hematomas trauma neoplasia
64
what does primary sinusitis most commonly occur after
a transient upper resp viral infection
65
how does purulent exudate accumulate witihn the paranasal sinuses during primary sinusitis
increased mucous production, mucosal inflammation, impaired drainage from nasomaxillary aperture and impaired mucociliary clearance this is due to a upper resp viral infection
66
what is the most common bacterial isolate in primary sinusitis
*Streptococcus zooepidemicus*
67
how is acute primary sinusitis treated
most spont resolve but may also require 2 week course of antimicrobials (*Strep. zooepidemicus* is responsive to penicillin or trimethoprim/sulfamethoxazole) and anti-inflammatories (NSAIDs such as phenylbutazone) plus feeding from the floor to facilitate drainage from the sinuses
68
how are chronic cases of primary sinusitis treated
it's important to rule out secondary sinusitis as a cause (dental disease) if the c/s have been present for more than 2 months where there is gross thickening of sinus mucosa (impedes drainage) a foley catheter may be placed to drain + irrigate to remove any purulent exudate present
69
how is sinus irrigation done
best performed through a trephination site made into the frontal sinus foley catheter and irrigated using warm plain isotonic saline or isotonic saline with 0.01% povidine iodine should drain freely through the nose after it comes through the nasomaxillary aperture
70
what is primary fungal sinusitis
fungal infection of paranasal sinuses
71
what can primary fungal sinustis cause as a clinical sign
head shaking where fungal plaques have been identified on the infraorbital canal within the paranasal sinuses
72
how is primary fungal sinusitis treated
surgical debridement via trephination or a bone flap followed by topical antifungal therapy
73
what is the most common cause of secondary sinusitis
dental disease most often due to apical infection of the caudal 07s to 11s of the maxillary arcades
74
how is secondary sinusitis treated due to dental disease
removal of affected tooth/teeth, followed by sinus irrigation through a foley catheter placed via a trephine opening into the frontal sinus 2. perioperative antimicrobials (penicillin +/- metronidazole) and anti-inflammatories (NSAIDs such as phenylbutazone)
75
what is a paranasal sinus cyst
expansive, fluid filled, space occupying mass which usually originates in the maxillary sinus but can extend into all paranasal sinuses can impair normal drainage from nasomaxillary aperture
76
what are the common clinical signs of paranasal sinus cysts (5)
1. mucopurulent nasal discharge 2. progressive distortion of the frontal, maxillary and/or conchal bones 3. reduced nasal airflow 4. epiphora (excessive tearing from eye) 5. exophthalmos (bulging of eye)
77
what are the diagnostic findings in paranasal sinus cyst
distortion of nasal conchae may be observed on upper airway endoscopy rounded, soft tissue opacity lesions may be identified within the frontal or maxillary sinuses on radiography
78
what is shown here
space occupying mass of soft tissue opacity
79
how are paranasal sinsu cysts treated
surgical removal either through bone flap or trephine followed by lavage of the sinus distortion of nasal cavities and septum remodel rapidly after surgery and facial distortion eventually resolves
80
do paranasal sinus cysts recurr normally
no its rare
81
what are progressive ethmoid hematomas
slow-expanding, non-neoplastic masses that originates in or around the ethmoid larnyrinth or occasionally the paranasal sinuses
82
what are the casues of progressive ethmoid hematomas
unknown but theorized that hemorrhage occurs into the submucosa of an endoturbinate, causing mucosa to stretch and thicken, forming the capsule of a hematoma over time they enlarge by repeated hemorrhage into the submucosa
83
are progressive ethmoid hematomas usually unilateral or bilateral
unilateral
84
what are common clinical signs of progressive ethmoid hematomas
1. intermittent unilateral serosanguinous nasal discharge 2. respiratory stritor 3. halitosis
85
what are less comon clinical signs of progressive ethmoid hematomas
1. head shaking 2. dyspnea 3. facial deformaties 4. presence of a mass at the level of the nares
86
how are ethmoid hematomas diagnosed
history + clinical exam + upper airway endoscopy + radiography a tan/brown/red mass may be visualized coming from the ethmiod labyrinth or nasomaxillary aperture
87
how are progressive ethmoid hematomas treated
surgical removal or ablation surgical removal typically for large masses smaller can be ablated through transendoscopic injection of 4% formaldehyde
88
is it common for progressive ethmoid hematomas to recurr
yes after surgical removal approx 43% will recurr
89
what is the most common neoplasia involving the paranasal sinuses
squamous cell carcinoma
90
what are the clinical signs of neoplasia in the paranasal sinuses
unilateral nasal discharge respiratory stritor facial swelling epiphora halitosis
91
what will be seen on oral exam with paranasal neoplasia
loose maxillary cheek teeth or abnormal tissue along the hard palate
92
how is paranasal neoplasia treated
pallitive through surgical removal of as much mass as possible --\> successful removal of the entire mass is usually not possible due to invasivness
93
what is the prognosis of paranasal neoplasia
long term prognosis is poor

Module 15 (27 decks)

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