Page 36 - Problem-Based Feline Medicine

28 PART 1 CAT WITH UPPER RESPIRATORY TRACT SIGNS

● Often, the tooth is still present, and a deep peri-
FOREIGN BODY
odontal pocket extends into the nasal cavity or
maxillary sinus.
Classical signs
● Occasionally, a periapical abscess from a dental
fracture or caries results in rhinitis. ● Acute onset of sneezing and rubbing face,
● Iatrogenic oronasal fistula may result from poor progressing to chronic signs.
dental extraction technique. ● Unilateral discharge.
● Gagging.
Clinical signs
Chronic sneezing, and mucopurulent nasal dis- Pathogenesis
charge, which may be blood-tinged.
Most foreign bodies are of plant origin, and are either
Presence of an oronasal fistula associated with tooth grass, grass seeds or awns.
loss or advanced periodontal disease, or a tooth fracture
Shotgun or airgun pellets, wood or bone are less fre-
suggesting a periapical abscess.
quent.
● Examination under deep sedation or general anes-
thesia is often required for diagnosis.
Clinical signs
Diagnosis
Signs depend on where the foreign body lodges.
Diagnosis is based on signs of chronic nasal disease Foreign bodies lodging in the nasal cavity cause
and the presence of an oronasal fistula. sneezing and nasal discharge. Blades of grass tend to
lodge in the nasopharynx and produce gagging.
Rarely, a periapical abscess is the cause. This is visible
on radiograph. Typically, there is a sudden onset of:
● Sneezing, which initially is marked and paroxys-
Differential diagnosis mal, and then becomes chronic.
● Rubbing or pawing at the nose.
Visualization of the oronasal fistula is diagnostic. ● Unilateral nasal discharge, which is initially
● Very rarely another disease process is also present, serous or blood-tinged, but progresses to mucopu-
and is responsible for the signs of chronic nasal dis- rulent and may be bloody.
ease, e.g. oronasal fistula with concurrent neoplasia ● Gagging occurs when the foreign body lodges in the
or chronic bacterial infection secondary to viral nasopharynx, or discharge drains into the pharynx
upper respiratory tract disease. from a foreign body in the posterior nasal cavity.
● Radiograph the nose prior to surgery. Evidence
of turbinate lysis suggests tumor, cryptococcosis or
chronic bacterial rhinitis secondary to herpesvirus. Diagnosis
● Failure to respond to surgery suggests another dis-
Diagnosis is based on visualizing the foreign body using:
ease process.
● An otoscope or rhinoscope for foreign bodies in
the anterior nasal cavity.
Treatment ● A dental mirror (warmed and sprayed with
defogging agent) for foreign bodies in the caudal
Seal oronasal fistula surgically using a mucoperiosteal
nasal cavity and nasopharynx. Pull the soft palate
pedicle flap.
rostrally to improve the view.
● A nasal flush may remove all or parts of the foreign
Prognosis body for diagnosis.
● Rhinotomy, when all else fails.
Prognosis is excellent, if the fistula is successfully
closed, but some fistulas may be difficult to close. Radiographs are rarely diagnostic, except for gun pellets.