Surgical management of a sinonasal angiomatous polyp and associated cyst involving the paranasal sinuses and nasal cavity via standing axial rhinotomy

This case report describes the successful surgical management of a sinonasal angiomatous polyp involving the dorsal conchal bullae, dorsal conchal sinus, ventral conchal sinus, ventral conchal bullae and ventral conchal recess of the left nasal cavity resulting in a secondary sinusitis and compression of the nasal passage.     

Nasal polyps in dogs: five cases (2005 to 2011)

This series describes five dogs with nasal polyps diagnosed between 2000 and 2011. Clinical signs included reverse sneezing, nasal discharge, epistaxsis, and stertor when breathing. Computerised tomographic findings included soft tissue mass, turbinate destruction, extension through the bony nasal septum and partial lysis of bones surrounding the nasal cavity. Three dogs were treated by dorsal rhinotomy, one dog was treated by ventral rhinotomy, and in one dog the polyp tissue was removed during nasal flushing. Three dogs have no clinical signs of nasal disease. One dog had confirmed recurrence of nasal polyps and was successfully treated with megavoltage radiation. One dog had recurrent nasal disease eight months after dorsal rhinotomy. Nasal polyps are a possible cause of nasal disease in dogs with nasal discharge, epistaxsis and stertor, and a differential diagnosis for dogs with extensive soft tissue lesions of the nasal cavities on computerised tomography. Nasal polyps can be treated successfully by rhinotomy in some cases but may reoccur.     

Extensive nasal septum resection in horses using a 3-wire method

OBJECTIVE: To describe a surgical technique for, and report outcome after, extensive nasal septum resection in horses with congenital or acquired septal diseases. STUDY DESIGN: Retrospective study. ANIMALS: Horses (5) with nasal septal deformity. METHODS: Under general anesthesia, obstetrical wires were preplaced around the ventral, caudal, and dorsal aspects of the nasal septum by combinations of manual guidance (ventral and caudal wires) and use of a trephine hole on the dorsal mid-line (dorsal and caudal wires). The rostral part of the septum was incised with a scalpel and the ventral, dorsal, and caudal septal incisions were made with the preplaced wires. After septum removal, the nasal cavity packed with a tampon and a temporary tracheotomy was performed. RESULTS: The diseased nasal septum was completely removed in all horses. It was possible to direct the caudal cut at a sufficient angle so that the remaining stump was in a wide part of the nasal passage, where it would have minimal effect on airflow. Four horses healed, and returned to intended use but continued to make a slight respiratory noise during exercise. At 13 months after surgery, 1 horse with a concurrent wry nose was retired from race training after 2 additional surgeries failed to relieve exercise intolerance at high speed. CONCLUSIONS: The 3 wire-cut method of nasal septum resection was technically easy to perform and safe, allowed return to function in most horses, and produced an excellent cosmetic appearance. CLINICAL RELEVANCE: This technique for nasal septum resection allows removal of a large portion of the nasal septum and provides a safe alternative to conventional techniques of nasal septum resection in the horse.     

Nasal vascular hamartoma in a Domestic Shorthair cat

A nasal mass in a Domestic Shorthair cat was causing facial deformity, sneezing and intermittent epistaxis. Biopsy samples obtained previously had been non-diagnostic. Computed tomography images revealed an irregular, contrast-enhancing mass occupying a large portion of the righthand side of the nasal cavity. Previously described criteria for malignancy were not present. A ventral surgical approach combined with temporary, ipsilateral, common carotid arterial occlusion provided excellent access for debulking the lesion and collecting samples for histopathology. A nasal vascular hamartoma was diagnosed and clinical signs resolved postoperatively. This is the first documentation of this abnormality in the cat. Hamartomatous abnormalities should be included on the list of differential diagnoses for feline nasal mass lesions. The prognosis for hamartomatous lesions postoperatively is good, in keeping with their limited propensity for growth after maturity.     

Recurrence analysis of intraoperative acridine orange-photodynamic therapy for dogs with intranasal tumors

Intraoperative acridine orange-photodynamic therapy (AO-PDT) and cribriform plate irradiation are used to treat canine intranasal tumors. The purpose of this study was to evaluate the effects of AO-PDT on intranasal tumors and the recurrence rate of tumors after this treatment. Treatments with AO-PDT were performed on 38 dogs through a narrow window of the dorsal nasal cavity. The median progression-free interval was 12 mo and recurrence was detected in 21 dogs. Based on computed tomography, recurrence in 16 dogs was biased to the following areas: lateral (n = 10), medial (n = 2), ventral (n = 0), rostral (n = 0), and caudal (n = 8). Side effects were mild and included subcutaneous emphysema and rhinitis. The median survival time was 24 mo. Although AO-PDT with cribriform irradiation is an effective treatment for intranasal tumors, AO-PDT techniques should be improved to treat the nasal cavity more uniformly and thoroughly.     

Anatomical Features and Histology of the Nasal Cavity of One Humped Camel (Camelus dromedarius)

This study was conducted on nine heads of normal adult one-humped camels. The specimens were collected from Cairo slaughterhouse. The nasal cavity in the freshly collected samples were dissected and photographed. The specimens for microscopic studies were fixed in different fixatives and prepared to examine by light and scanning electron microscope (SEM). The nasal cavity of the camel was studied grossly and by using of light and scanning electron microscope. Specimens from different regions of this cavity were subjected to different histological stains and also demonstrated by the acid and alkaline phosphatases. Gross morphological examination of this cavity showed its three parts: rostral part (the nasal vestibule) covered with skin of usual structure then it lined with smooth mucosa. The middle part (respiratory) had dorsal, middle and ventral nasal conchae, but the caudal part (olfactory) contained the ethmoidal concha. The lining mucosa of the camel nasal cavity was similar to that of other mammals, but there were some differences: the respiratory epithelium showed a small number of goblet cells and there were a mixture of acidic and neutral mucins inside the epithelial and glandular mucous cells. Strong acid and alkaline phosphatase reaction was observed in the lining epithelium of the nasal cavity. By SEM, it showed the surface epithelial layer of the nasal cavity mucosa in three regions (vestibule, respiratory and olfactory) and resulted that it was stratified cuboidal to columnar epithelium, ciliated pseudostratified columnar epithelium with few goblet cells or olfactory mucosa containing neurosensory olfactory cells. This study aimed to investigate the anatomical features, the histological and histochemical structures of the nasal cavity in one humped camel. The findings of this study were discussed with the previous works in this field with the other domestic animals.     

Effect of commercially available nasal strips on airway resistance in exercising horses

OBJECTIVE: To determine the effect of a commercially available nasal strip on airway mechanics in exercising horses. ANIMALS: 6 horses (5 Standardbreds and 1 Thoroughbred). PROCEDURE: Horses exercised on a treadmill at speeds corresponding to 100 and 120% of maximal heart rate with and without application of a commercially available nasal strip. Concurrently, tracheal pressures, airflow, and heart rate were measured. Peak inspiratory and expiratory tracheal pressures, airflow, respiratory frequency, and tidal volume were recorded. Inspiratory and expiratory airway resistances were calculated by dividing peak pressures by peak flows. Endoscopic examination of the narrowest point of the nasal cavity (ie, nasal valve) was performed in 1 resting horse before, during, and after application of a nasal strip. RESULTS: During exercise on a treadmill, peak tracheal inspiratory pressure and inspiratory airway resistance were significantly less when nasal strips were applied to horses exercising at speeds corresponding to 100 and 120% of maximal heart rate. Application of the nasal strip pulled the dorsal conchal fold laterally, expanding the dorsal meatus. CONCLUSIONS AND CLINICAL RELEVANCE: The commercially available nasal strip tented the skin over the nasal valve and dilated that section of the nasal passage, resulting in decreased airway resistance during inspiration. The nasal strip probably decreases the amount of work required for respiratory muscles in horses during intense exercise and may reduce the energy required for breathing in these horses.     

Clinical and magnetic resonance imaging features of nasopharyngeal lymphoma in two cats with concurrent intracranial mass

Lymphoma is reported to be the most common nasal and second most common intracranial neoplasm in cats. Intracranial lymphoma may occur as a primary central nervous system lymphoma or as part of multi-centric disease. Two cats were presented with histopathologically confirmed nasopharyngeal lymphoma and concurrent mass within the middle fossa of the cranial cavity, with magnetic resonance imaging suggestive of direct communication. Both cats demonstrated evidence of bilateral oculomotor nerve deficits and upper respiratory tract noise. In one cat, bilateral optic nerve deficits were also present. The magnetic resonance imaging features were similar in both cases and demonstrated a contrast-enhancing intracranial mass on the ventral aspect of the middle fossa of the cranial cavity and an adjacent mass arising from the dorsal aspect of the nasopharynx. Lymphoma should be included as an important differential diagnosis in cats presented with middle cranial fossa syndrome (in particular ophthalmoplegia) and stertor.     

Nasal obstruction caused by cystic nasal conchae in cattle

Four Holstein heifers were found to have partial nasal obstruction caused by bilateral cystic conchae. Three of the heifers (age range, 4 to 6 months) had a history of progressive nasal obstruction since near birth, were affected severely, and required surgical management. Each of 2 surgical procedures, a bilateral dorsolateral nasal flap approach and a dorsal nasal flap approach, was used successfully. The fourth heifer, which was 15 months old, had signs of nasal obstruction since shortly after birth, but was affected only mildly and was not treated. Follow-up information obtained 10 to 37 months later revealed that all cattle were considered normal and had no signs of nasal obstruction. In each case, a developmental problem or malformation of the ventral nasal concha resulting in cystic enlargement was suspected. The onset of clinical signs early in life and the bilateral nature suggested that the defect was of congenital origin.     

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.     

Ventral rhinotomy in the dog and cat

The nasal cavities of 14 dogs and three cats were explored surgically using a ventral rhinotomy. The exposure achieved through this approach was considered to be equal to a dorsal rhinotomy. One animal died during the immediate postoperative period from perforation of a gastric ulcer. The other animals recovered well and had no significant complications. The long-term survival of the animals was consistent with previous reports for their diseases. Ventral rhinotomy is no more difficult than dorsal rhinotomy, has less patient morbidity and fewer postoperative complications, and is more cosmetically acceptable.     

Ventral Rhinotomy in the Dog and Cat

The nasal cavities of 14 dogs and three cats were explored surgically using a ventral rhinotomy. The exposure achieved through this approach was considered to be equal to a dorsal rhinotomy. One animal died during the immediate postoperative period from perforation of a gastric ulcer. The other animals recovered well and had no significant complications. The long-term survival of the animals was consistent with previous reports for their diseases. Ventral rhinotomy is no more difficult than dorsal rhinotomy, has less patient morbidity and fewer postoperative complications, and is more cosmetically acceptable.     

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.     

Nasopharyngeal cryptococcosis

Naturally occurring cryptococcosis in five cats, a dog and a koala is described. Involvement of the nasopharynx was documented in all patients, and nasopharyngeal mass lesions accounted for the major presenting complaints in four. Signs referable to nasopharyngeal disease included snoring, stertor, inspiratory dyspnoea and aerophagia. Diagnoses were made by caudal rhinoscopy using a retroverted flexible endoscope, vigorous orthograde flushing with saline, or at necropsy. Concurrent cryptococcal rhinitis was present in all cases, although involvement appeared limited to the caudal nasal cavity in most cases. Typical signs of nasal cavity disease, such as sneezing and nasal discharge, were often absent. Treatment of nasopharyngeal cryptococcosis should include physical dislodgement or debulking of lesion(s) to provide immediate alleviation of upper airway obstruction, followed by systemic antifungal therapy to eliminate residual infection from the nasal cavity. Infections caused by Cryptococcus neoformans var gattii accounted for a disproportionately large number of these cases.     

Rhinotomy to access lesions within the nasal cavity of two horses

Most lesions that affect the nasal cavity of the horse can be accessed via the nostril or via a frontonasal sinus flap but occasionally, surgical access to the mid‐portion of the nasal cavity is necessary. This case report describes the use of a centrally based, 3‐sided rhinotomy which provided good access to the ipsilateral nasal cavity and allowed for removal of abnormal tissue/foreign material in two horses. The nasal bone flap was preserved and only relatively mild intraoperative haemorrhage occurred which was controlled with nasal packing. Horses recovered well from surgery with an excellent long‐term cosmetic result.     

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.     

DISTINGUISHING RHINITIS AND NASAL NEOPLASIA BY RADIOGRAPHY

To compare the incidence of radiographic signs in dogs with rhinitis and primary nasal neoplasia and to assess the performance of observers for distinguishing these conditions, the nasal radiographs of 72 dogs with either rhinitis (n = 42) or primary nasal neoplasia (n = 30) were examined by two independent observers using custom-designed forms to record their interpretations. Rhinitis was associated with a higher incidence of focal or multifocal lesions, localised soft tissue opacities, lucent foci, and a lack of frontal sinus involvement. Neoplasia was associated with soft tissue opacities and loss of turbinate detail that affected the entire ipsilateral nasal cavity, signs of invasion of the bones surrounding the nasal cavity, and soft tissue/fluid opacities within the ipsilateral frontal sinus. The signs with the highest positive predictive value (PPV) for rhinitis were absence of frontal sinus lesions and lucent foci in nasal cavity (PPV of each 82%), and invasion of surrounding bones for neoplasia (PPV 88%). There were no significant differences in the position of the lesion within the nasal cavity, incidence of unilateral versus bilateral lesions, calcified lesions, or absence of teeth. There was moderate agreement between observers about the diagnosis (kappa 0.59). Areas (SE) under ROC curves were 0.94 (0.03) and 0.96 (0.03) for observers A and B, respectively (not significantly different; P = 0.68). These results indicate a high accuracy for radiologists examining dogs with nasal diseases. Differentiation of rhinitis and nasal neoplasia should be based on finding combinations of radiologic signs that together have a high PPV. Differences in interpretation between experienced observers in this study suggest that certain signs are potential sources of error.     

A Large Frontonasal Bone Flap for Sinus Surgery in the Horse

A large frontonasal bone flap was created to treat diseases of the paranasal sinuses in 14 horses. The bone flap was made as wide as possible within the confines of the nasolacrimal duct so the floor of the frontal sinus and the dorsal and ventral conchae could be opened. These openings exposed the nasal passages, maxillary sinuses, and ventral conchal sinus thereby facilitating removal of diffuse and localized lesions from these sites. Diseases treated were ethmoid hematomas (4 horses), sinus cysts (5 horses), cryptococcal granuloma, osteoma, hemangiosarcoma, pus in the ventral conchal sinus, and periapical infection of a second molar. Four horses were euthanatized during or after surgery, one because of postsurgical pleuritis and pneumonia (horse with osteoma) and three because of their primary problems (cryptococcal granuloma, hemangiosarcoma, pus in the ventral conchal sinus). Skin suture abscesses that responded to treatment developed in four horses. Ten horses returned to their intended uses, the sinus flaps healed without blemish, and the original problems did not recur. The frontonasal flap technique provided greater access to all paranasal sinuses than methods described previously.     

Infections and some other conditions affecting the skin and subcutis of the naso-ocular region of cats--clinical experience 1987-2003

Infections of the skin or subcutis of the naso-ocular region develop through two mechanisms. Cases with lesions but without concomitant signs of nasal disease probably result from cat scratch injuries. Under certain circumstances, such lacerations result in the introduction of saprophytic microorganisms in such large numbers that host defence mechanisms are overwhelmed. This results in localised, variably invasive, disease in an otherwise immunocompetent host. An unpredictable range of organisms can give rise to such infections including a variety of fungal and bacterial genera. Causal organisms will likely vary from one geography to another as a result of differences in soil type and related environmental factors. Accordingly, procurement of appropriate tissue specimens for culture and susceptibility testing is essential to guide therapy, as these cases require medical and sometimes surgical intervention in order to effect a favourable outcome. In contrast, patients with naso-ocular lesions and concurrent signs of nasal disease have a different pathogenesis. Primary infection of the sinonasal region likely results from the inhalation of infectious propagules, with the infection subsequently penetrating overlying bones to invade the subcutaneous space. These lesions are typically the result of cryptococcosis or aspergillosis and must be distinguished from invasive nasal malignancies. An approach to the investigation and treatment of these patients is presented together with photographs of representative cases.     

Laser Vaporization of the Dorsal Turbinate as an Alternative Method of Accessing and Evaluating the Paranasal Sinuses

Objective: To report a technique for stoma creation into the conchofrontal sinus (CFS) through the dorsal turbinate and to evaluate stoma as a site for sinoscopy. Study Design: Prospective experimental study. Animals: Cadaveric equine heads (n=2) and normal adult horses (5). Methods: Technique feasibility was established on 2 cadaver heads. A diode laser fiber with a contact probe was passed into the nasal passage through a custom built, laser introducer rod (LIR). A videoendoscope was passed ventral to the LIR. A site on the caudal, medial aspect of the turbinate overlying the dorsal conchal sinus (DCS) was identified. A stoma to facilitate endoscope passage was created through the turbinate and sinoscopy performed to identify structures within the CFS and caudal maxillary sinus (CMS) and to evaluate the quality of the approach. The procedure was then performed in standing, sedated horses. Time required, laser energy used and complications were recorded. Endoscopy was performed ≥5 weeks postoperatively to assess stoma size and long‐term effects of the procedure. Results: A stoma was successfully created through the turbinate in both cadaveric skulls and in 4 horses; the stoma persisted for ≥5 weeks. The location of the stoma in 1 horse precluded sinoscopy. Conclusions: Laser vaporization of the dorsal turbinate through the nasal passage creates a stoma that lasts for at least 5 weeks providing a portal to the paranasal sinuses. Based on experience in 1 horse stoma location is critical to ensure adequate endoscope manipulation and sinoscopy. Clinical Relevance: Standing endoscopic sinusotomy within the nasal cavity through the DCS is an alternative to more invasive sinusotomy techniques with fewer potential complications and a cosmetic result.