Page 1420 - Cote clinical veterinary advisor dogs and cats 4th

720 Oronasal Fistula

Client Education SUGGESTED READING AUTHOR: Camille DeClementi, VMD, DABT, DABVT
• Pet owners should use insecticides according Means C: Organophosphate and carbamate insecti- EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
VetBooks.ir • Safer flea and tick treatments are now avail- toxicology, ed 3, St. Louis, 2013, Saunders, pp
to label directions and keep all insecticides
cides. In Peterson ME, et al, editors: Small animal
away from pets.
715-724.
able for use on pets.

Oronasal Fistula Client Education
Sheet

BASIC INFORMATION • Severe plaque and calculus accumulation, raise the possibility of metastatic disease or
tooth mobility, and deep periodontal pocket- pneumonia
Definition ing if tooth is still present
An abnormal connection forms between Advanced or Confirmatory Testing
oral and nasal cavities, usually due to severe Etiology and Pathophysiology • Periodontal probing and dental radiographs
periodontal disease or after tooth extraction. Periodontitis results in alveolar bone loss and under general anesthesia can reveal the extent
It typically results from oral disease extending loss of the oral and nasal epithelium that of alveolar bone loss.
dorsally and is virtually never caused by nasal normally separates the oral and nasal cavities. • Injection of water into the oral defect (and
disease extending ventrally. while the head is positioned lower than the
DIAGNOSIS neck) shows water flowing from the ipsilateral
Synonym nostril.
Oronasal communication Diagnostic Overview • Other areas of the mouth should be evaluated
The diagnosis is purely visual and made on because periodontal disease is likely general-
Epidemiology physical exam. If uncertainty exists, oronasal ized and severe in patients with oronasal
SPECIES, AGE, SEX communication can be demonstrated by irriga- fistula.
• Older dogs, typically small breeds/mixes with tion (see below).
narrow muzzles (dolichocephalic) TREATMENT
• Older cats concurrently affected by tooth Differential Diagnosis
resorption, alveolar bone expansion, and • Oronasal communications not related to Treatment Overview
abnormal tooth extrusion periodontitis Surgical repair prevents continued entry of food
• Other causes of chronic nasal discharge or fluid into the nasal cavity.
GENETICS, BREED PREDISPOSITION (p. 678). Clinicians should always thoroughly
• Conformation of skull and predisposition examine the mouth and teeth of animals Acute General Treatment
to development of periodontal disease with nasal discharge. • After tooth extraction in the area of the
• Miniature poodles, Chihuahuas, Yorkshire oronasal fistula (if the tooth is still present),
terriers, miniature schnauzers, dachshunds Initial Database the first step is careful tissue debridement
• CBC, serum chemistry profile, uri- and irrigation to remove the epithelial lining
RISK FACTORS nalysis (before anesthesia): results generally and debris.
Periodontal disease (p. 776) unremarkable • Single-flap technique: two divergent releas-
• Thoracic radiographs if the chief com- ing incisions are made, extending from the
ASSOCIATED DISORDERS plaint, history, and physical exam findings gingiva over the mucogingival junction.
Halitosis, nasal discharge
Clinical Presentation
DISEASE FORMS/SUBTYPES
• Area of the maxillary canine tooth is most
often affected
• Occasionally seen in the premolar tooth area;
may be present although the tooth is still
in place (e.g., palatal aspect of a maxillary
canine tooth)
HISTORY, CHIEF COMPLAINT *
• Acute: epistaxis after tooth extraction
• Chronic: history of tooth loss or extraction,
nasal discharge, sneezing, halitosis

PHYSICAL EXAM FINDINGS
• Mucopurulent nasal discharge
• Round or oval defect at junction of palatal
and gingival/alveolar mucosa if tooth is ORONASAL FISTULA Chronic oronasal fistula (arrowheads) in the area of a missing right maxillary canine
missing (oral epithelium in continuity with tooth in a dog. The incisors and most cheek teeth also are missing. The left canine (arrow) and right fourth
nasal epithelium) premolar (asterisk) are affected by severe periodontal disease. (Copyright Dr. Lenin A. Villamizar.)

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