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3. Equine 2 > mouth and upper resp tract 2 > Flashcards

mouth and upper resp tract 2 Flashcards

1
Q

reasons for purulent nasal discharge

A
  • Sinusitis > Primary, Secondary
  • Guttural Pouch Empyema
  • Lower Respiratory disease
  • Others: Tumour
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2
Q

drainage of paranasal sinuses:

A
  • Frontal, maxillary, dorsal & ventral conchal, & sphenopalatine
  • All drainage occurs into nasal cavity via the left & right nasomaxillary openings (rostral to the nasopharynx, nasal cavity divided by nasal septum)
    > into medial meatus
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3
Q

which teeth have roots in the rostral maxillary sinus?
which teeth have roots in the caudal maxillary sinus?

A

(1) Roots of 3rd & 4th cheek teeth (P4 & M1) project into the rostral maxillary sinus
(2) Roots of 5th & 6th cheek teeth (M2 & M3) project into the caudal maxillary sinus

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4
Q

Primary Sinus Infection
a. Etiology & Clinical Signs

A

(1) Upper respiratory tract infections (viral ± bacterial) > generalized mucosal inflammation > initial bilateral mucous or mucopurulent nasal discharge
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(2) After resolution of the generalized disease, sinus inflammation may remain due to poor drainage > bacterial infection > usually unilateral purulent nasal discharge
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(3) Percussion: Dull over involved sinus
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(4) If sinus exudate becomes inspissated &/or drainage obstructed > chronic increase in sinus pressure > distortion of relatively thin surrounding bone, medially (internal) & laterally (external) > decreased air flow ± facial swelling
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(5) Foul odor: No foul odor, compare with tooth root infection
(6) Oral exam: Normal, compare with tooth root infection

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5
Q

primary sinus infection endoscopy

A

(1) Purulent material originating from middle nasal meatus
(2) In chronic cases, may see distortion of nasal cavity

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6
Q

primary sinus infection radiographs

A

(1) Fluid line, if exudate has fluid consistency & sinus not filled completely
(2) Increased density with no fluid line, if sinus filled completely with inspissated exudate or proliferative tissue
(3) Inflammed tissue

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7
Q

Lab Work-Cytology/Culture for primary sinus infection

A
  • Sinocenthesis-trough Steinman pin hole
  • Usually Strep (more indicative of primary sinusitis)
  • take from:
  • Frontal sinus (1)
  • Caudal maxillary (2)
  • Rostral maxillary (3)
  • If no rads take sample in rostral and caudal maxillary
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8
Q

Treatment-Primary sinusitis:

A
  • Antibiotherapy
  • Sinus flush
  • Surgical debridement -chronic cases
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9
Q

tooth root infection connection with sinusitis
- usually secondary to what?

A

(1) 50% of chronic sinus infection from extension of dental disease involving P4, M1, M2 or M3 in the upper arcade
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(2) Usually secondary to:
(a) Severe periodontal disease
(b) Fractured tooth &/or surrounding bone
(c) Dental carie (cavity) > contamination of pulp cavity
(d) Impaction of developing tooth between surrounding teeth

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10
Q

tooth root infection and secondary sinus infection signs

A
  • Variable signs, if any, relating to dental pain – i.e. no signs; or ± abnormal appetite, ± abnormal eating behavior, ± weight loss, etc.
    <><>
  • Many signs similar to primary sinus infection: Unilateral nasal discharge, dull on percussion, ± facial swelling, ± decreased air flow, & endoscopy
    <><>
  • However, the unilateral nasal discharge is usually foul-smelling, typical of anaerobes & necrotic tissue
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11
Q

tooth root infection with secondary sinus infection
- cytology / culture results

A

Purulent material from sinus, often with multiple organisms (including anaerobes) on culture

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12
Q

tooth root infection, secondary sinusitis oral exam findings

A

(1) May be normal
(2) Impacted food material
(3) Signs of gingivitis: Hyperemia, swelling, retraction, pocket formation
(4) Loose, fractured or missing tooth
(5) Use dental pick/needle to examine occlusal surface of teeth for caries

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13
Q

radiology results for tooth root infection with secondary sinusitis

A

(1) ± Similar to primary sinus infection
(2) ± Destructive &/or productive changes (decreased/increased density) associated with tooth root &/or adjacent alveolar bone

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14
Q

tooth root infection with secondary sinusitis treatment

A

(1) Usually removal of affected tooth, debridement of infected bone, & repeated lavage
(a) If the tooth is sufficiently diseased (i.e. loosened), it may be extracted via the oral cavity
(b) However, removal of cheek teeth (premolars & molars) often requires repulsion from the root side, via a trephine hole or bone flap
(c) Remember subsequent tooth wear problems & appropriate care
(2) An endodontic (root-canal) procedure may sometimes be used to save the tooth, if the disease process has not extensively involved surrounding bone or loosened the tooth

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15
Q

Secondary sinusitis: Neoplasia/Sinus Cyst
Treatment and prognosis?
- what are more vs less common causes?

A
  • Surgical excision
  • Good prognosis for sinus cyst, guarded for neoplasia
    <><>
  • Uncommon: Fibroma, Fibrosarcoma, osteoma, osteosarcoma, SCC
  • More common: Sinus Cyst
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16
Q

secondary sinusitis due to trauma
- cause, dx, tx

A

Trauma:
- Penetrating wound, facial Fx
- Possible infection
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Radiology, Ultrasound
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Treatment
- Wound care =/- stabilization

17
Q

guttural pouch anatomy and structures

A

a. Divided by stylohyoid bone into lateral & medial compartments
b. In walls of each pouch: Internal carotid & maxillary arteries; cranial nerves VII, IX,
X, XI, & XII; sympathetic branches to face; & retropharyngeal lymph nodes
c. Pouches open into pharynx on dorsolateral walls of pharynx at 10 & 2 o’clock
(1) This opening does not originate on the ventral floor of the pouch
(2) Therefore, poor drainage of pouch when horse standing with head up

18
Q

guttural pouch emyema etiology and clinical signs

A

a. Usually secondary to upper respiratory tract infection (be wary of Strep equi equi)
b. Usually bilateral nasal discharge, even if only 1 pouch affected, because openings are caudal to nasal septum
c. Discharge worse when horse’s head down, due to position of pharyngeal openings
d. Other signs may include: Cranial cervical swelling (Viborg’s triangle), dysphagia, respiratory noise, & general signs of illness
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- Bilateral discharge often (even if 1 affected)
+/- Swelling
+/- Neurological sign
- dysphagia-food material at nostril
- Laryngeal hemiplegia
- Horner’s Syndrome
- Facial paralysis

19
Q

guttural pouch emyema dx

A
  • Endoscopy
    a. Pus from pharyngeal opening(s) of pouch(es)
    b. Can introduce scope into pouch for direct visualization
  • Radiology
    a. Fluid line, if pus has fluid consistency & pouch not filled completely
    b. If pouch filled with inspissated pus, generalized increased density & loss of pouch borders
    c. Chronic disease may form concretions of pus (“chondroids”) ventrally in pouch
20
Q

guttural pouch emyema tx, prognosis

A
  • Medical treatment (common) – Similar to an abscess, encourage drainage by:
    (1) Systemic antibiotics (Strep most common organism)
    (2) Feed on ground, to lower horse’s head & promote drainage
    (3) Lavage with saline or Ringer’s via a catheter (intermittent or indwelling) through the nostril into the pouch opening
    <><><><>
  • Surgical drainage (uncommon)
    (1) If unsuccessful medical therapy, or if inspissated pus or chondroids present
    (2) Several possible surgical approaches
    <><><>
  • Prognosis favorable, unless neurologic involvement
21
Q

bloody nasal discharge - common reasons

A
  • Guttural Pouch Mycosis
  • Ethmoid hematoma
  • EIPH
  • Trauma
  • Nasal or Sinus Tumor
22
Q

Guttural Pouch Mycosis
Etiology:

A
  • Fungal infection invading vessel wall
  • May be fatal
23
Q

Guttural Pouch Mycosis
Clinical Signs:

A
  • Bilateral discharge often (even if 1 affected)
  • Medial compartment more common
  • May cause neurological signs
24
Q

Guttural Pouch Mycosis
Dx

A
  • Endoscopy
    a. Blood from pharyngeal opening of pouch
    b. Entering pouch to evaluate fungal lesion & determine which artery(s) involved will help determine appropriate treatment
    > However, endoscopic procedure may cause acute hemorrhage
    <><>
  • Radiology: Fluid line or, if pouch filled, generalized increased density
25
Q

Guttural Pouch Mycosis
Treatment:

A
  • Medical
    > Local antifungal
  • Surgical
    > Ligation of artery on both side of the lesion to avoid Circle of Willis (coil, balloon catheter)

3. Equine 2 (16 decks)

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