Intro to URT noise Flashcards

(43 cards)

1
Q

Reasons for treating URT noise

A
  • dyspnoea
  • cosmetics (i.e making a noise when exercising can be undesirable)
  • poor performance
  • other e.g. dysphagia
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2
Q

How can URT noise cause poor performance?

A

URT causes large portion of resistance in URT
-> decrease in diameter, increased resistance
-> decreased oxygen delivery

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3
Q

Diagnosis

A
  • hx
  • examination of URT at rest
  • dynamic observation (vary exercise intensities, consider effect of tack)
  • static respiratory endoscopy
  • overground dynamic endoscopy
  • also consider radiography, CT and occasionally US
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4
Q

What effect can tack have?

A
  • can change airway dynamics
  • neck ventroflexion in dressage horses
  • other countries sports can cause ‘overcheck’ which can change the way the airflow moves through the URT
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5
Q

Anatomy of external nares

A
  • nostril oval at rest -> round at exercise
  • alar fold
    – separates diverticulum (false nostril) from true nostril
    – supports dorsal and lateral nostril
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6
Q

Conditions of external nares

A
  • epidermal inclusion cysts (atheromas)
  • redundant alar folds
  • lacerations affecting nostrils
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7
Q

Aims of tx for conditions of external nares

A
  • restoration of normal anatomy and good cosmetic effect
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8
Q

Wry nose

A
  • congenital condition
  • lateral deviation of the maxilla and nose
  • usually euthanised at birth due to compromised welfare -> unable to breathe and swallow correctly
  • reconstruction can be complicated and expensive depending on degree of deviation
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9
Q

Anatomy of the nasal passages

A

Septum
- right and left nasal passage

Dorsal and ventral conchae
- dorsal, middle, ventral and meatus
- large surface area for humidification, temperature regulation and particulate removal
- constriction of blood vessels (sympathetic tone)

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10
Q

Caudal nasal sinuses - anatomy

A
  • ethmoid turbinates: caudal aspect
  • paranasal sinuses
    – 7 pairs
    – both maxillary sinus open into caudal middle meatus via nasomaxillary aperture
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11
Q

Paransal sinuses - anatomy

A

Caudal group
- caudal maxillary
- dorsal conchal
- ethmoidal
- frontal
- sphenopalatine

Rostral group
- rostral maxillary
- ventral conchal

Septum between caudal and rostral maxillary sinuses (variable location usually 5cm from rostral aspect of facial crest)

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12
Q

Teeth and the paranasal sinuses

A

Tooth roots of 4th, 5th and 6th cheek teeth lie within the maxillary sinuses
- infection causes sinusitis

Roots of 3rd cheek tooth forms rostral wall of rostral maxillary sinus
- infection may cause sinusitis

Other structures within maxillary sinuses: nasolacrimal canal and infra-orbital canal

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13
Q

Conditions of the nasal passages

A

Masses
- fungal granuloma
- neoplasia (particularly SCC)
- ethmoid haematoma

Tx
- attempt transendoscopic

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14
Q

What does an ethmoid haematoma look like?

A
  • dark red-purple structure in the ethmoid region
  • basically a big blood clot that forms under the mucosa
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15
Q

Sinus surgery indications

A
  • expansive lesions in paranasal sinus e.g. sinus cyst, neoplasia, ethmoid haematoma, tooth tooth abscess
  • primary sinusitis
  • severe trauma of facial bones
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16
Q

Sinus surgery considerations

A
  • must identify which sinus is affected
  • know anatomical landmarks for each region
  • consider endoscopic/laser surgery options 1st as minimally invasive
  • standing sinus sx has a number of advantages (no anaesthetic risk, less haemorrhage, tolerated well)
    — maxillary sinus flap
    — front sinus flap
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17
Q

Exodontia - methods & indications

A
  • commonly necessary for cheek teeth
  • oral extraction if possible
  • tooth repulsion via sinusotomy (care to get correct tooth, entire tooth and only the tooth)
  • difficult to tx -> high risk of complications
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18
Q

Anatomy of the pharynx

A

Soft palate
- complete soft palate that separates the nasopharynx and oropharynx
– no common pharynx in front of the larynx like in other spp
– why obligate nasal breathers
- contact with sub epiglottic tissue during breathing

Guttural pouches
- ostia
- dz may compress pharynx
- nerve supply to pharynx may be affected

19
Q

Conditions of the pharynx: DDSP - what is it?

A

Intermittent dorsal displacement of the soft palate

20
Q

Conditions of the pharynx: DDSP - tx options, success rate

A
  • staphylectomy (no longer recommended)
  • myectomy (sternothyroid ± sternohyoid)
  • palatal fibrosis (thermocautery or laser)
  • tie forward (prosthesis to replace thyrohyoid muscle) (currently most popular and best success rate [80%])
  • most have 60% success rate, determining success is difficult
  • can have potential to make condition worse
21
Q

Dynamic pharyngeal collapse - what is it? cause?

A
  • collapse of pharyngeal wall when negative pressure highest
  • ? dysfunction of mechanoreceptors and neuromuscular reflexes
  • may be associated with GP tympana and DDSP
  • tx options limited
22
Q

Cleft palate - signs, diagnosis, prognosis & tx

A
  • nasal reflex of milk / food material and aspiration pneumonia
  • uncommon
  • diagnosed on endoscopy
  • poor prognosis -> recurrent infections and poor athletic function
  • sx -> poor success rate, ? justified
23
Q

Anatomy of the larynx

A

5 cartilages
- epiglottis
- cricoid
- thryoid
- paired arytenoids

24
Q

Endoscopic view of the larynx

A
  • rima glottidis
  • soft tissue
    – aryepiglottic folds
    – vocal fold
    – lateral ventricles
    – laryngeal saccules
25
Conditions of the larynx: RLN - what is it?
- recurrent laryngeal neuropathy = failure of the recurrent laryngeal nerve
26
Conditions of the larynx: RLN - cause
- typically idiopathic condition
27
Conditions of the larynx: RLN - grading system
- at rest/exercise 1-4 (7 overall grades) - at rest to assess how well it opens - at exercise to assess how much it collapses during exercise - during exercising endoscopy (ABC)
28
Conditions of the larynx: RLN - tx options
- laryngoplasty (tie back) - ventriculectomy (Hobday) - ventriculocordectomy - arytenoidectomy - neuromuscular pedicle graft
29
Complications of laryngeal sx
- dysphagia - aspiration pneumonia (temporary or permanent) - avoid excessive abduction - implant failure with laryngoplasty
30
Arytenoid chondropathy/chondritis - diagnosis
Endoscopy (resting) - size: compare to other side (tricky if bilateral) - mucosa: loss of 'bumps', breaks in surface - drainage, granulation tissue Palpation - rounded muscular process
31
Arytenoid chondropathy/chondritis - what is it?
- inflammation of the arytenoid cartilages
32
Arytenoid chondropathy/chondritis - tx
Medical - antimicrobials - anti-inflammatories (systemic and local, very important acutely) - often improves significantly Surgery - local excision (via endoscope or laryngotomy) - arytenoidectomy: failure of medical management - permanent tracheotomy (esp if bilateral)
33
Intralaryngeal granulation tissue - tx
Excision - endoscopic - laryngotomy With concurrent chondritis - excision can make worse - may require arytenoidectomy With abscessation - curettage via laryngotomy Complications - loss of normal anatomy or function Ideally - local excision only (laser) Partial arytenoidectomy preserves muscular process and articular facet - optimal in terms of airway function
34
What is MDAF?
= medical deviation of the aryepiglottic folds
35
MDAF tx
- laser surgery to remove excess tissue - (can be done surgically under GA if no laser available)
36
Subepiglottic cysts (congenital or acquired) or granulomas - tx
Tx by removal - surgical excision through laryngotomy - oral removal using or snare wire Good prognosis
37
Epiglottic entrapment - tx
1. axial division per os 2. resection of aryepiglottic folds 3. axial division per nasum 4. transendoscopic laser division All have complications, make sure you cut the right structure. 2, 3 & 4: no requirement for GA.
38
Surgery of the GP
Access / visualisation is poor Endoscopic surgery preferred Tympany - fenestration of median septum (unilateral) - resection of plica salpingopharangeus - salpingopharangeal fistula Empyema - lavage via a Foley catheter Chondroids - basket removal - lavage - surgery
39
Anatomy of the trachea
- larynx -> bifurcation (ICS 5-6) - C-shaped cartilage rings with dorsal muscle/membrane - rings connected by annular ligaments - vascular and nervous supply in lateral pedicles - adjacent structures: --- oesophagus, carotid sheaths, jugular veins
40
Tracheal surgery
Most tracheal surgeries performed to bypass nasal passages, pharynx or larynx - tracheotomy (temporary) - tracheostomy (permanent) Intra-tracheal lesions ie FB, granulomas, neoplasia Tracheal collapse
41
Tracheotomy
- performed in the cranial or mid 3rd of neck -> midline dissection to trachea (avoiding neurovascular structures) - incision made between and parallel to cartilage rings (don't cut rings) - tracheotomy tube (self-retaining silicone or metal J tubes) placed and secured with sutures or bandage - aftercare: basic wound management and removing excess discharge
42
Tracheostomy
- creation of a permanent stoma - normally performed under anaesthesia - partial resection of cartilage rings then mucosa sutured to skin - wound care and aftercare is significant, and the O should be advised of this beforehand - potential complications include pulmonary infection and drowning
43
Other conditions of the trachea & their tx
Trachea rarely causes poor performance - stenosis secondary to trauma - external compression (abscess, neoplasia) - intraluminal granulation tissue (tracheotomy, trauma) 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