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Rhinoscopy 1159

○ Hook the anconeal process of the ○ Caudoventral luxation • Arthrodesis can provide pain relief for a
ulna between the humeral condyles, and ■ The femur should be abducted and chronically unstable joint. Aside from cost,
carefully extend the elbow. With this
complications include nonunion, stress
externally rotated to seat the femoral
VetBooks.ir part of the maneuver, the joint should ■ Hobbles may be applied for 10-14 days. • Excision glenoid arthroplasty for the shoulder
head in the acetabulum.
fractures, implant failure, and infection.
be reduced.
○ Passive range-of-motion exercises can
begin after bandage removal, but restricted ○ Medially directed pressure can be applied joint. There are few reports of glenoid
arthroplasty, but an abnormal gait is to be
to the reduced proximal femur as the
exercise is essential for 4-6 weeks, followed hip is passively flexed and extended in expected.
by 2 weeks of leash exercise only. an attempt to drive debris from the • Amputation
• Hip acetabulum.
○ Assistant stands on opposite side of animal, RELATED CLIENT EDUCATION
holding the ends of a padded rope or leash Postprocedure
placed in the animal’s groin to provide • Radiograph to evaluate the reduction. SHEETS
counterpressure. • Toes should be accessible or visible to Consent to Perform General Anesthesia
○ Craniodorsal hip luxation (more common): monitor for heat, cold, swelling, or pain. How to Assist a Pet That Is Unable to Rise
The tarsus is grasped and externally • Bandage needs to be protected from moisture Procedures and Techniques
■ and Walk
rotated while the femur is pulled and kept clean and dry. How to Perform Range-of-Motion Exercises
caudally. How to Provide Bandage Care and Upkeep
The head of the femur rides up (moves Alternatives and Their
■ at Home
laterally and then caudally) and over Relative Merits
the dorsal acetabular rim. • Open reduction AUTHOR: Nicholas J. Trout, VetMB, MA, DACVS,
Internal rotation while maintaining ○ Requires surgical intervention DECVS
■
distal traction on the femur, together ○ Greater cost EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
with direct pressure on the greater ○ Carries a higher rate of success than closed Thompson, DVM, DABVP
trochanter, seats the head in the reduction for the shoulder, elbow, and hip
acetabulum. • FHO may be worth considering for cats
Place hip in an Ehmer or modified and small dogs because the possibility of
■
Ehmer sling for 2 weeks. hip reluxation is eliminated.
Rhinoscopy Client Education
Sheet

Difficulty level: ♦♦♦ • Gauze for packing off oropharynx Possible Complications and
• Flexible endoscope (small < 3 mm diam- Common Errors to Avoid
Overview and Goal eter maximum for patients < 10 kg) for • Biopsy sample not representative of disease
Minimally invasive, endoscopic approach to retrograde pharyngoscopy to evaluate the process; risk minimized by advanced
the nasal cavity for visual examination and nasopharynx imaging
biopsy procedures • Flexible or 1.9-2.7 mm, 30° oblique, rigid • Inability to examine caudal conchae if
endoscope for anterograde cranial rhinoscopy endoscope is too big (especially cats and small
Indications • Vacuum source for suction dogs), or to see choanae during nasopha-
• Chronic nasal discharge • Culture container with growth media ryngeal exam (especially in dolichocephalic
• Chronic sneezing • Biopsy forceps (intraendoscopic or separate dogs)
• Epistaxis, after ruling out coagulopathy, clamshell or cup biopsy forceps) • Hemorrhage after biopsy; low risk of serious
hypertension, or ehrlichiosis (p. 305) • Biopsy jar with 10% buffered formalin blood loss. Rarely, hemorrhage warrants a
• Nasal foreign body (identification and • Phenylephrine (e.g., Neo-Synephrine drops) blood transfusion, or if bleeding persists,
removal) for postoperative epistaxis ipsilateral carotid ligation.
• Stertor • Penetration of compromised cribriform plate,
• Maxillary, nasal, or facial deformity Anticipated Time traumatizing the brain. Measure distance
• Sample collection to confirm clinical sus- • 60-90 minutes anesthesia time, 30-60 from tip of the nostril to medial canthus of
picion (biopsy for histopathology or deep minutes for endoscopy the eye. This measured length on endoscope
nasal culture) • Up to 3-4 hours for complex foreign bodies is the maximal length of insertion.
and/or copious flushing • Aspiration of fluid, prevented by a well-fitted
Contraindications endotracheal tube with adequately inflated
Coagulopathy (primary/secondary); severe Preparation: Important cuff and packing the pharynx during the
hypertension Checkpoints procedure plus oropharyngeal suctioning
• Advise owners that epistaxis is expected for and lowering the nose for drainage after
Equipment, Anesthesia 1-3 days after the procedure. the procedure.
• General anesthesia and endotracheal intuba- • Assess coagulation (e.g., platelet count, • Superficial bacterial culture or culture of nasal
tion with optimal endotracheal tube cuff seal coagulation profile [p. 1325]) flush will likely differ from caudal nasal cavity
• Maxillary local block, 2% lidocaine • Measure blood pressure (p. 1065) cultures.
• Mouth gag or cut needle cap for cat/small • Serology for canine ehrlichiosis or fungal
dogs exposure based on geography Procedure
• Sterile, water-soluble lubricant • Advanced imaging (CT/MRI) where • Sternal recumbency with animal facing
• Sterile saline solution for flush available endoscopist; head at edge of table,

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