Intranasal epidermoid cyst causing upper airway obstruction in three brachycephalic dogs

This case report describes three brachycephalic dogs with intranasal epidermoid cysts that were causing additional upper airway obstruction. Although epidermoid cysts have been described in several locations in dogs, to the authors’ knowledge intranasal epidermoid cysts have not been previously reported. All dogs had mucopurulent to haemorrhagic nasal discharge. Magnetic resonance imaging of the head revealed the presence of unilateral or bilateral intranasal cystic lesions obstructing the nasal cavities partially or completely, with atrophy of the ipsilateral nasal turbinates. The cystic lesions were surgically excised in all dogs using a modified lateral alveolar mucosal approach to the affected nasal cavity. Aerobic, anaerobic and fungal culture of the cystic contents were negative and histology of the excised tissue was consistent with a benign intranasal epidermoid cyst in each dog. Upper airway obstruction was clinically improved in two dogs.     

Long-term retrospective study of 52 horses with sinunasal cysts

REASONS FOR PERFORMING STUDY: The spectrum of clinical presentation, methods of diagnosis, management and prognosis in cases of sinunasal cysts (SNCs) requires more extensive study. Despite the extensive nature of SNCs, the prognosis for afflicted horses appears to have improved since earlier studies were conducted. OBJECTIVES: To evaluate prognosis and cosmetic outcome of surgical ablation in 52 cases of SNCs. METHODS: Fifty-two case records (1982-2005) of horses affected with SNCs were retrieved from the archives. Subject details, clinical signs, diagnostic techniques, surgical management and post surgical complications were extracted. Owners and referring veterinarians were contacted to assess the results of treatment. RESULTS: There was no biphasic age distribution. The major presenting signs in descending order of frequency were facial swelling, mucopurulent nasal discharge, nasal airflow obstruction and abnormal respiratory noise. Common endoscopic findings included narrowed nasal meati, a cyst in the nasal cavity and a cyst visible caudal to the nasal septum viewed from the contralateral unaffected nasal meatus. Typical radiological signs included a discrete mass in the sinunasal region, a diffuse increase in opacity over the sinunasal region, free fluid lines, nasal septal deviation, expansion of the ventral conchal sinus and distortion of dental apices. Cyst extirpation using an osteoplastic flap provided a successful outcome. Forty-five of 48 horses showed complete resolution of clinical signs after subtotal or total extirpation of the cyst wall. Follow-up information was not available for the other 3 horses. Thirty-nine of 45 horses had a good to fair cosmetic appearance, judged to be good in 26 horses, fair in 13 and poor in 6. Results confirmed that the prognosis for full recovery has improved since a previous report of 15 cases. CONCLUSIONS AND POTENTIAL RELEVANCE: Equine sinunasal cysts may arise in horses of any age; presenting signs should alert clinicians to their likely presence. A discrete well-circumscribed mass found during radiographic examination provides supporting evidence of a cyst. The vivid yellow, translucent, seromucoid fluid aspirated from cysts is characteristic of the condition.     

Surgical Correction of Congenital Bilateral Choanal Atresia in a Foal

Congenital bilateral choanal atresia was corrected surgically in a neonatal foal. Presenting clinical signs included complete obstruction of the upper airway, which had been relieved by tracheotomy. The diagnosis was confirmed by endoscopic examination and contrast radiography. Bilateral nasal flaps were used to gain access to the caudal nasal cavity, allowing removal of obstructive tissue and restoration of normal respiration. Malocclusion developed secondary to surgical intervention and resultant damage to suture lines of developing flat bones of the skull. Nine months postoperatively, the asynchronous growth of the mandible and maxilla had not resulted in difficulty during mastication. Respiration, although audible during periods of exercise, was acceptable to the owners.     

Equine paranasal sinus cysts: a report of 15 cases

The clinical and radiographic features of 15 cases of paranasal sinus cysts are described. Breed, sex and side frequency were unremarkable but two distinct categories of age incidence emerged. Onset of signs had occurred before one year of age in three cases, while all but two of the remaining 12 animals were older than nine years. The most common clinical signs were nasal airway obstruction, facial swelling and nasal discharge, often occurring in combination. Radiographic changes were recorded in all horses. Sinus opacification was a consistent finding and in several cases the bone surrounding the sinus had increased in thickness. Increase in intra-maxillary sinus pressure was demonstrated by septal displacement on ventro-dorsal radiographs in almost half the cases. Less common signs included expansion, free fluid accumulation within the affected sinus, dental distortion and displacement and mineralisation. Two horses were destroyed without treatment but in 13 animals surgical exploration was performed. Two of these were destroyed, one at the time of surgery and one five days postoperatively. In the remaining 11 cases, all accessible parts of the cyst were removed through a facial flap and drainage to the nasal meati was established. All these horses recovered satisfactorily and were followed up for periods between three months and six years without evidence of recurrence. Thirteen cysts arose in the caudal maxillary sinus and one each in the frontal and rostral maxillary compartments. Histopathological examination of portions of the cyst walls suggests that, like ethmoidal haematomas, they may originate from episodes of haemorrhage beneath the upper respiratory tract mucosa.     

Evaluation of the prognostic value of positive-contrast shoulder arthrography for bilateral osteochondrosis lesions in dogs

To investigate whether arthrographic findings had any prognostic value with respect to treatment and outcome of bilateral osteochondrosis, shoulder arthrograms (n = 80) from 40 dogs with bilateral lesions were evaluated. Arthrography was performed, using 1.5 to 4 ml of a 25% solution of meglumine-sodium diatrizoate, with admixture of 0.2 mg of epinephrine. A shoulder with signs of pain and lameness was surgically treated. The contralateral shoulder was treated conservatively, and the final outcome was compared with the arthrographic findings. In 37 dogs, signs of lameness and pain were associated with a loose cartilage flap and, in 3, with a detached cartilage flap. In 2 dogs, admitted with bilateral lameness, a loose cartilage flap was detected in both shoulders. Of 12 dogs with a detectable loose cartilage flap in the contralateral shoulder joint, 6 became lame 2 to 4 months after initial surgical intervention and needed bilateral surgery. In the contralateral joint, development of thick articular cartilage over the subchondral defect or a detached cartilage flap lodged in the caudal pouch of the shoulder joint was a favorable prognostic sign. Such dogs had no signs of lameness on the contralateral side during a follow-up period that ranged from 1 to 7 years.     

Surgical cleft soft palate repair in a foal

An Anglo-Arab foal with bilateral postprandial nasal discharge was diagnosed as having a full-length defect of the soft palate. Surgical repair was attempted using a combination of two surgical approaches. Initially a mandibular symphysiotomy approach was used. The posterior portion of the defect did not heal adequately, so a ventral laryngotomy, bisecting the body of the thyroid cartilage and extending to a pharyngotomy approach, was performed 5 months later. The foal has since matured fully despite a slight unilateral nasal discharge. This case report demonstrates that these two surgical approaches used simultaneously provide surgical access that is superior to either approach used individually.     

Hand-assisted laparoscopic cystotomy for cystic calculus removal in male horses (3 cases)

A technique for hand-assisted laparoscopic removal of cystic calculi in male horses is described. Three cystic calculi ranging from 5 to 10 cm in diameter were removed successfully using bilateral para-inguinal laparoscopic portals assisted by a human hand within the abdomen, effectively sealing the midline incision. Long-term follow-up information obtained from referring veterinarians and owners indicated that the patients returned to their previous activity level and had no recurrence of clinical signs in the following 6 to 12 months.Key clinical message:Hand-assisted recumbent laparoscopy is a satisfactory surgical technique for removal of cystic calculi in horses which cannot be operated on standing or whose body condition would make the parainguinal approach difficult.     

Chronic hypertrophic pyloric gastropathy as a cause of pyloric obstruction in the dog

Six small-breed, middle-age dogs with a history of chronic intermittent vomiting had benign pyloric lesions causing gastric outlet obstruction. Marked similarities were found in clinical signs, pathologic changes, and treatment results. The condition was classified as a syndrome and was named chronic hypertrophic pyloric gastropathy. The appearance of the obstructive lesions at surgery were various forms of mucosal hypertrophy. Microscopically, the syndrome was characterized by mucosal foveolar and glandular hyperplasia, cystic glandular dilatation, superficial mucosal ulcerations, and various cellular infiltrates. The affected dogs were successfully treated by surgical correction of the gastric outlet obstruction.     

Ovariectomy by left flank approach in prepubertal Nelore (Bos indicus) heifers

The main objective of this study was to evaluate a recumbent left flank approach to bilateral ovariectomy in prepubertal heifers and to develop an optimal surgical technique for this procedure. Both ovaries were removed from 6 Nelore heifers by left flank approach without any complications, except in 1 heifer, which was believed to have had only 1 ovary based on ultrasound and exploration during surgery, but was later found to have a remaining functional ovary. Ovariectomy via left flank approach in recumbent prepubertal heifers is feasible and technically easy. This procedure does not involve special instrumentation and, despite the invasive approach, it allows optimal visualization of the ovaries and uterus.     

Culture-positive persistence and serum agglutinating antibody response after intrauterine inoculation of Haemophilus somnus in virgin heifers

Viable Haemophilus somnus of reproductive tract origin (OSU-1167) was inoculated transcervically into the uterus of 6 virgin heifers. Five heifers were sham-inoculated (intrauterine) with sterile mycoplasmal medium and served as controls. After inoculation and observation, all heifers had nasal and vaginal vestibular swab specimens and serum obtained periodically for 44 days. Signs of systemic illness were not detected. On the day after inoculation, all inoculated heifers had signs of vulvovaginitis, whereas none of the control heifers had similar signs (P less than 0.002). Haemophilus somnus was not isolated from any nasal or vaginal vestibular swab specimens obtained before inoculation or from any nasal swab specimens obtained after inoculation. During the 44 days after inoculation, H somnus was isolated from 25 of 54 vestibular specimens obtained from inoculated heifers and from 3 of 45 specimens obtained from controls (P less than 0.02). Vulvovaginal lesions were associated with vestibular isolation of H somnus in 23 of 25 (92%) such isolations from inoculated heifers; lesions were never associated with concurrent isolation of H somnus in controls. All heifers had H somnus microagglutination test (MAT) titer less than or equal to 256 against a commercially prepared H somnus antigen at the beginning of the study. Considered as groups, neither inoculated nor control heifers achieved fourfold increases in MAT titer during the 44 days after inoculation. When compared by day of sample collection, inoculated heifers did have significantly (P less than 0.04) lower geometric mean titer at 7 days after inoculation than did control heifers when tested by use of a commercially prepared antigen.(ABSTRACT TRUNCATED AT 250 WORDS)     

Internal fixation of femoral capital physeal injuries in dogs: 40 cases (1979-1987)

Fractures of the femoral capital physis were stabilized with small pins or a lag screw in 36 dogs (4 bilateral injuries). Radiography was used to monitor the development of osteoarthritis in affected joints and narrowing of the femoral neck. More radiographic signs of arthritis (P less than 0.05) developed in the coxofemoral joints of dogs that were less than or equal to 4 months old when injured, compared with those in dogs greater than 4 months old. Of 40 capital physeal injuries, 35% had concurrent ipsilateral coxofemoral joint injuries and developed more radiographic signs of arthritis (P less than 0.05) than did those that had no other coxofemoral injury. Narrowing of the femoral neck developed in 70% of the healing capital physeal repairs, but in most dogs, narrowing was not associated with segmental collapse of the femoral neck. Neither time interval from injury to surgical fixation nor surgical approach used had an effect (P greater than 0.05) on the development of narrowing of the femoral neck.     

Surgical treatment of recurrent dacryocystitis secondary to cystic dilatation of the nasolacrimal duct in a dog

A 3-year-old, castrated male golden retriever was presented for evaluation of recurrent ocular discharge of 4 months' duration from the left eye. Dacryocystorhinography was performed and demarcated a cystic dilatation of the left nasolacrimal duct with obstruction of the duct distal to the cystic cavity. Surgical exploration of the left maxillary sinus was performed to confirm the diagnosis and reestablish drainage into the nasal cavity. Recovery was uneventful, and the dog has been asymptomatic for >36 months postoperatively. This report documents the third published case of surgical treatment for cystic dilatation of the nasolacrimal duct.     

Open Nasal Cavity and Frontal Sinus Treatment of Chronic Canine Aspergillosis

Five dogs with nasal aspergillosis were treated by surgical exposure and delayed closure of the nasal cavity and involved frontal sinus. Diseased tissue was excised, and 10% povidone-iodine solution was applied three times daily with cotton-tipped applicators. Skin wounds were closed at weeks 6 through 8. In one dog, the frontal sinus was partially obliterated with a temporalis muscle flap before skin closure. At months 6 through 34, all dogs were clinically free of aspergillosis. Open treatment has potential clinical application as a primary approach to nasal aspergillosis or for cases that are unresponsive to previous medical management.     

Paranasal Sinusitis Complicated by Inspissated Exudate in the Ventral Conchal Sinus

Primary paranasal sinusitis complicated by inspissated exudate within the ventral conchal sinus was diagnosed in five horses. Clinical signs included a unilateral, foul-smelling, mucopurulent nasal exudate of 2 to 7 months' duration. Two of the horses had partial nasal obstruction from distortion of the ventral concha. Radiographs of the skull showed a mass of soft tissue density dorsal to the roots of the superior third and fourth or fourth and fifth cheek teeth. Treatment included bone flap maxillary sinusotomy with exposure of the ventral nasal concha and removal of inspissated exudate. Resolution of the sinusitis occurred in all five horses.     

Pancreatic pseudocyst causing extrahepatic biliary obstruction in a dog

A 3-year-old Rhodesian Ridgeback was examined because of recurrent pancreatitis of 2 months duration. The dog had signs of abdominal pain and jaundice. Blood biochemical findings were consistent with extrahepatic bile duct obstruction, but on abdominal ultrasonography no cause of obstruction was identified. At surgery a pancreatic pseudocyst was found in the body of the pancreas. Cystoduodenostomy, cystic omentalisation and biliary diversion resulted in excellent long-term recovery.     

Evaluation of a modified castellated laryngofissure for alleviation of upper airway obstruction in dogs with laryngeal paralysis

A modified castellated laryngofissure procedure (castellated laryngofissure, vocal fold resection, and bilateral arytenoid lateralization) was performed on 12 dogs with bilateral laryngeal paralysis. Clinical signs of airway obstruction were assessed and a pulmonary function test (tidal breathing flow volume loop) was used to evaluate the severity of obstruction. The dogs were evaluated before surgery and at various periods from 4 days to 15 months after surgery. One dog died immediately after surgery and 3 dogs died due to nonrelated or unknown causes 1, 9, and 11 months after surgery. Clinical signs of upper airway obstruction disappeared or decreased in severity in the 11 dogs that recovered from surgery. Tidal breathing flow volume loop values were normal in 7 of 10 dogs evaluated within 5 to 189 days after surgery. The modified castellated laryngofissure procedure provided successful long-term relief of upper airway obstruction associated with bilateral laryngeal paralysis.     

A dorsal approach for the removal of the nasal septum in the horse

OBJECTIVE: To describe and evaluate a technique involving a dorsal approach for the removal of the nasal septum in adult horses. STUDY DESIGN: Retrospective clinical study. ANIMALS: Four client-owned horses. METHODS: Access for partial nasal septum resection was through a dorsal nasal bone flap. Septum resection was performed because of reduced airflow from septal deviation and/or thickening caused by traumatic insult or neoplasia. Preoperative clinical signs and diagnostic results were recorded. Intra- and postoperative complications were noted and follow-up information was obtained from telephone interviews of owners or by clinical examination. RESULTS: The abnormal segment of the nasal septum was completely removed in all horses. A dorsal nasal bone flap approach provided excellent access to the septum and allowed immediate control of hemorrhage; blood transfusion was not needed. Cosmetic results were considered good to excellent by owners and horses returned to their previous level of work without perceived limitations associated with airway function. CONCLUSIONS: Nasal septum resection by the dorsal approach permits good observation of the abnormal septum, and provides exposure that facilitates removal of nasal masses and reduction of depression fractures with minimal complications. CLINICAL RELEVANCE: A dorsal nasal bone flap approach should be considered for horses that require nasal septum resection because it can be achieved with minimal hemorrhage, good cosmetic results, and return to function.     

Laryngeal paralysis in cats: 16 cases (1990-1999)

OBJECTIVE: To determine clinical signs, physical examination findings, radiographic features, and concurrent diseases in cats with laryngeal paralysis, as well as evaluate the outcome of medical or surgical management. DESIGN: Retrospective study. ANIMALS: 16 cats. PROCEDURE: Medical records from January 1990 to April 1999 were examined for cats with laryngeal paralysis. Signalment, clinical signs, physical examination findings, cervical and thoracic radiographic findings, laryngeal examination results, and clinical outcome were reviewed. RESULTS: No breed or sex predilection was identified in 16 cats with laryngeal paralysis. The most common clinical signs included tachypnea or dyspnea, dysphagia, weight loss, change in vocalization, coughing, and lethargy. Clinical signs were evident for a median of 245 days. Airway obstruction was apparent on cervical and thoracic radiographic views in 9 cats. Examination of the larynx revealed bilateral laryngeal paralysis in 12 cats and unilateral laryngeal paralysis in 4 cats. The 4 cats with unilateral disease were managed with medical treatment, and 3 of these had acceptable long-term outcomes. Seven of 12 cats with bilateral paralysis underwent surgery; procedures performed included left arytenoid tie back, bilateral arytenoid tie back and ventriculo-cordectomy, and partial left arytenoidectomy. One cat was euthanatized as a result of complications from surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Laryngeal paralysis is an uncommon cause of airway obstruction in cats. Cats with less severe clinical signs (often with unilateral paralysis) may be successfully managed with medical treatment, whereas cats with severe airway obstruction (often with bilateral paralysis) may benefit from surgical intervention.     

Bilateral nasolacrimal duct atresia in a cria

A 2-month-old, male alpaca had a 1-month history of mucoid ocular discharge from the left eye. Signalment, history and clinical findings were suggestive of a congenital nasolacrimal outflow obstruction. A dacryocystorhinogram confirmed bilateral nasolacrimal duct atresia, which involved the distal half of both nasolacrimal ducts. In order to establish alternative outflow, a conjunctivomaxillosinusotomy and conjunctivorhinostomy were performed on the right and left eye, respectively. The surgical openings remain patent after 11 months, and there have been no clinical signs of nasolacrimal disease.     

Horner's syndrome in ten horses

Ten cases of equine Horner's syndrome were reviewed. None of the clinical signs in this series were transient (<48 hours). Sweating and ptosis were consistently observed by the attending clinician in over half of the affected horses. Enophthalmos and prolapse of the third eyelid were not reported consistently. The average duration of the clinical signs was 4.94 months and ranged from 14 days to 15 months. Eight of the ten horses developed associated complications, some of which affected performance. Airway obstruction and impedance of passage of a fiberoptic endoscope due to nasal mucosal edema occurred in five horses. Facial paralysis (4/10) and laryngeal hemiplegia (2/10), which are not direct features of Horner's syndrome, were also observed.