Nasal Disease: Recognition and Diagnosis

Question 1

Common nasal dx of canine and feline ? (5)

Answer 1

neoplasia, 
rhinitis,
foreign bodies, 
fungal infections,
polyps

Question 2

What are the nasal cavities separated by?

Answer 2

Nasal septum

Question 3

What structure marks the start of the nasopahrynx?

Answer 3

Choanea

Question 4

Nasal fossa:
A) What is it divided by?
B) Divided into? (2)

Answer 4

A) Dorsal concha; curved shelf of bone originating from the ethmoidal crest
B) Dorsal meatus and the middle meatus

Question 5

Nasal fossae:
A) What does the ventral nasal concha extend from?
B) What does concha divide the nasal cavity into?

Answer 5

A) Conchal crest
B) middle meatus and ventral meatus before forming the alar fold rostrally

Question 6

Ethmoturbinates:
A) Caudally; where to they extended from?
B) and to?

Answer 6

A) the midline ethmoidal plate
B) Cribiform plate

Question 7

Ethmoturbinates:
What sinuses are they present in?

Answer 7

Presphenoid
Frontal sinus

Question 8

How can ethmoturbinates be sub divided? (2)

Answer 8

long, medially lying endoturbinates
smaller, more superficial ectoturbinates.

Question 9

Nasopharygeal meatus:
What is it formed by? (3)

Answer 9

The confluence of the caudal ends of the dorsal, middle and ventral meatuses

Question 10

Where does the nasopharyngeal meastus run to?

Answer 10

Choanea

Question 11

Nasal planum
A) Epitheliea type?

Answer 11

pigmented and consists of tough, thickened keratinized squamous epithelium.

Question 12

The external nares are supported by (4)

Answer 12

Dorsolateral cartilage,
ventrolateral cartilage,
accessory cartilage
cartilaginous septum

Question 13

What is the largest of the nasal cartilages and merges with the ventral nasal concha?

Answer 13

The dorsolateral cartilage

Question 14

Where are The olfactory receptors are located mainly?

Answer 14

ethmoturbinates and thus are in the caudodorsal section of the nasal cavity.

Question 15

Nasal mucosa:
The blood supply originates from the maxillary artery that arborises into (2,1)

Answer 15

sphenopalatine and major palatine branches before continuing as the infraorbital artery

Question 16

What supplies the nasal conchae, and its terminal branches are known as the caudal lateral nasal arteries

Answer 16

The sphenopalatine artery

Question 17

Lymphatic drainage of nasal mucosa? (3)

Answer 17

retropharyngeal,
parotid
submandibular lymph nodes.

Question 18

Clinical signs of nasal disease (9)

Answer 18

sneezing,
stertor,
nasal discharge,
epiphora,
epistaxis, 
inappetence,
sleep disorders,
dyspnoea
facial swelling or distortion

Question 19

A careful history is useful and should include: (5)

Answer 19

progression of clinical signs

response to previous treatments

outdoor exposure and environment

vaccination status

contact with other household or cattery cats.

Question 20

What areas of CE should be focussed on with nasal dx? (6)

Answer 20

• Teeth
• Larynx ausc
• Nasal airflow
• Epiphora - fluoro
• Assymetry
• Nasal planum

Question 21

Why use fluorecein dye for epiphora?

Answer 21

Assess nasolacrimal duct

Question 22

Diagnostic tests for nasal dx after CE? (3)

Answer 22

blood profiles including coagulation profiles (and ideally FeLV/FIV status)

imaging including rhinoscopy if available

culture and histology.

Question 23

Which biopsy techniques might commonly be required in cases of nasal disease? (4)

Answer 23

Rhinoscope
Blind biopsy
Nasal flush
Trephination though the maxillary bone

Question 24

Rhinoscope, size for:
A) Small dog/cat
B) Dog?

Answer 24

A) 1.9
B) 2.7

Question 25

Rhinoscope; what to do to a haemorrhaging biopsy site to take more samples?

Answer 25

flushed with cold isotonic fluid

Question 26

How to perform a larger biopsy with rhinoscope?

Answer 26

A pair of crocodile or cup forceps can also be passed parallel to the scope

Question 27

What should be performed before performing a blind biopsy? Why?

Answer 27

advanced imaging should ideally be used to locate the approximate area of disease

Question 28

How to avoid cribiform plate damage when performing blind biopsies?

Answer 28

A pair of crocodile or cup forceps is measured from the nares to the medial canthus of the eye and a piece of tape placed at this level to avoid damage to the cribriform plate

Question 29

Possible tools for blind biopsies? (3)

Answer 29

- Crocodile - Stylet - 16-gauge catheter with an end that is cut obliquely attached to a 10 ml syringe to apply negative pressure to the sample

Question 30

Nasal flush: A) How? B) Syringe size? C) Repeat?

Answer 30

A) high pressure saline being flushed through the nares whilst the other nostril is digitally occluded B) 20 ml syringe C) 2-3 times

Question 31

What is the risk if the cribiform plate is damaged?

Answer 31

Cerebral damage

Question 32

If repeated nasal biopsies have failed to yield a diagnostic result, any mass lesion seen on imaging can be biopsied via?

Answer 32

trephination through the maxillary bone

Question 33

Maxillary trephination: After making a small skin incision, the bone is perforated with a  A) (2) of large enough diameter to allow B) to be passed into the nasal cavity

Answer 33

A) Michel’s trephine or K wire B) crocodile forceps

Question 34

Maxillary trephination is rarely necessary but can be useful for?

Answer 34

tumours originating from the maxillary sinus.

Question 35

Nasal sampling - haemorrhage is expected; what should therefore happen?

Answer 35

pharynx should be packed with a conform bandage or large swab (dog)

Question 36

Ventral approach to the nasal cavity. Pros (1)

Answer 36

Good cosmetic results

Question 37

Ventral approach to the nasal cavity. cons (1)

Answer 37

Limited access for instruments and ET tube

Question 38

Dorsal approach to the nasal cavity Pros (1)

Answer 38

Good access

Question 39

Dorsal approach to the nasal cavity Cons (2)

Answer 39

poor cosmetic appearance subcutaneous emphysema.

Question 40

Pre-op prep for nasal surgery? (4)

Answer 40

- Blood profiles and coagulation profiles or at minimum a BMBT - +/- Temporary carotid ligation - Blood available if necessary - Arterial blood pressure monitoring

Question 41

Ventral Rhinotomy Position?

Answer 41

Dorsal recumbency with the head secured in a level position with tape around the maxillary canines.

Question 42

Ventral Rhinotomy If the oral cavity is compromised by the presence of an endotracheal tube what should be placed?

Answer 42

a guarded pharyngostomy tube

Question 43

How to place a guarded pharyngostomy tube? (incision site, intrument)

Answer 43

Small skin incision caudal to hyoid apparatus onto the point of some large forceps such as Rochester-Carmalt - bring the tube into the pharynx. It is then retroflexed into the trachea.

Question 44

During a ventral rhinotomy, what happens to the pharynx?

Answer 44

Pack with a swab

Question 45

Ventral rhinotomy: Where is the palate incision?

Answer 45

The palate is then incised over the midline from the level of the canine teeth to the fourth premolars.

Question 46

During palate incisions, electro-coagulation should be used sparingly - T or F

Answer 46

True

Question 47

Ventral rhinotomy: - What is elevated to expose the palatine bone?

Answer 47

The mucoperiosteum

Question 48

What runs alongside the dental arcade from the carnassial tooth? (Which you need to take care to avoid in ventral rhinotomy).

Answer 48

Major palatine a.

Question 49

If a large exposure is needed with ventral rhinotomy, what can be used?

Answer 49

A hinged mucoperiosteal flap of palate is raised and retracted

Question 50

During a ventral rhinotomy, what is used to access the nasal cavity?

Answer 50

A burr is then used to gently burr through the palatine bone

Question 51

If a burr isnt available for a ventral rhinotomy how can you access?

Answer 51

Two holes can be made with K-wires and then connected with rongeurs which can then be used to enlarge the cavity.

Question 52

What is used in a ventral rhinotomy to decrease haemorrhage and increase visualisation?

Answer 52

Ice saline

Question 53

How to close a ventral rhinotomynmucoperiosteum layer?material (2), number of layers, pattern)

Answer 53

Relatively long-lasting suture material e.g. polydiaxonone or glycomer 631  single layer simple interrupted suture.

Question 54

How many and name the layers of closure of the soft palate.

Answer 54

3 - nasal mucosa, - palatine subcutaneous tissue + muscles - oral mucosa

Question 55

Which animals should a ventral rhinotomy be avoided in and why?

Answer 55

skeletally immature dogs - affect the development of the muzzle

Question 56

Dorsal Rhinotomy: Position?

Answer 56

The patient is placed in sternal recumbency, with the nose positioned level on a sandbag. The pharynx is packed with a swab or bandage.

Question 57

Dorsal Rhinotomy Where is the initial incision?

Answer 57

A midline incision is made from the medial canthus of the eye rostrally over the nasal bone.

Question 58

Dorsal Rhinotomy: The skin and periosteum are elevated and retracted by (2)

Answer 58

Stay sutures Gelpi retractors

Question 59

Dorsal Rhinotomy: How to control haemorrhage?

Answer 59

- Bipolar electro-coagulation - Swab pressure

Question 60

Dorsal Rhinotomy: How to get through the nasal bone and access nasal cavity?

Answer 60

Burr

Question 61

Dorsal Rhinotomy: How to access nasal cavity if no burr available? (2)

Answer 61

- Two holes can be made with K-wires and then connected with rongeurs - An air saw can be used to cut a rectangular flap of bone

Question 62

Use of an air saw for dorsal rhinotomy is difficult in cats; why?

Answer 62

Confined incisional area

Question 63

Best suture material for closure of the periosteum in a dorsal rhinotomy?

Answer 63

polydioxanone or glycomer 631

Question 64

What layers are closed in a dorsal rhinotomy?

Answer 64

- Periosteum - Mucosa - Skin

Question 65

How to ensure drainage of S/C air accumulating with a dorsal rhinotomy/prevent emphysema? (3)

Answer 65

- A small piece of sterile tube is sutured into the wound dorsally connecting the nasal cavity with the air to act as a drain - A small gap is left at the dorsal aspect of the incision (can occlude) - Tie on bandage

Question 66

Post rhinotomy; what position to recover in?

Answer 66

Head down

Question 67

Post rhinotomy; after removing throat pack, check the pharynx for..?

Answer 67

Blood clots

Question 68

Post rhinotomy; what to use if there is ongoing haemorrhage? (2)

Answer 68

- Nasal tampons/pack nose - Adrenaline (vasoconstrict)

Question 69

Post rhinotomy; why are they commonly anorexic? (4)

Answer 69

temporary disruption of the normal sense of smell stress, discomfort medications

Question 70

What food to offer post rhinotomy?

Answer 70

Soft + pungent

Question 71

Post rhinotomy - restrict what toys?

Answer 71

Hard/chew

Question 72

What do you need to assist cats with post rhinotomy?

Answer 72

Grooming

Question 73

If the drain becomes occluded in a dorsal rhinotomy and subcutaneous emphysema occurs this is usually self-resolving in?

Answer 73

7- 10days

Question 74

Rhinotomy complications (5)

Answer 74

- Bleeding - Sneezing (can lead to epistaxis) - Anorexia - Subcut emphysema - Dehiscence