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1160 Rhinoscopy

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RHINOSCOPY Endoscopic view, retroflexed behind
RHINOSCOPY Karl Storz 2.7-mm, 30° visual field, rigid endoscope: telescope, and outer sheath with cannulas the soft palate to show the choanae. Dog’s right is
for concurrent flushing and introduction of a biopsy instrument. on left side of the image. A fleshy mass is seen in
the right choana.

with waste bucket directly underneath, size (open with destruction as with rhinitis • Blind nasal biopsy: quick, reasonable yield
elevated on folded towels with nose pointed or narrowed with obstruction with edema if biopsy guided by imaging but can miss
down and proliferative neoplasms). region of interest
• Prop mouth open with mouth gag/needle • Biopsy as indicated through endoscope • Nasal flush: minimal tissue disruption, can
cap, and ensure appropriate inflation of biopsy port or blindly after procedure dislodge foreign material, discharge, or with
endotracheal cuff. with cup biopsy forceps. Biopsy may be force, tumor cells
• Enter oral cavity with endoscope in a flexed J delayed until all areas have been visualized • Nasal swab/culture: poor cytologic yield in
position, and rotate the tip of the endoscope to minimize blood obscuring the view. awake animal, superficial culture often shows
at the caudal edge of the soft palate to • Remove gauze sponges (count out), and normal flora
visualize the nasopharynx. Pull endoscopic suction oropharynx. • Rhinotomy: most invasive but can yield
rostrally for closer view of choanae, assessing • Instill phenylephrine (few drops in each definitive diagnosis if other methods fail
for mucosal fragility, discharge, hyperemia, nostril) for voluminous epistaxis.
masses, erosions, or ulcers. Biopsy suspect Pearls
tissue before removing flexible scope. Postprocedure • Pushing the nostril dorsally with a thumb
• Pack oropharynx with gauze; count in and Recover patient with nose tipped down, head and inserting the endoscope next to the nasal
count out to ensure retrieval of all gauze elevated; extubate as late as safely possible with septum eases endoscope entrance.
after the procedure. cuff inflated until last minute. Placing an ice • Rhinoscopy without imaging or biopsy is not
• Measure length from tip of nostril to medial pack on the muzzle may help reduce hemor- a useful diagnostic tool except when remov-
canthus of eye; this is the maximal length rhage. If bleeding continues, phenylephrine ing foreign material. Most causes of rhinitis
of insertion of the endoscope or biopsy can be repeated. cannot be differentiated by gross examination
instruments to prevent penetration of a • Sedation/analgesia to minimize stress but require biopsy and histopathology.
compromised cribriform plate and brain and sneezing (butorphanol or micro dose
trauma. Can mark instrument with tape to acepromazine/dexmedetomidine) SUGGESTED READING
avoid accidental overinsertion. • Discharge same or next day, depending on Saylor DK, et al: Rhinoscopy. In Tams TR, et al,
• Advance endoscope into one nostril, medial bleeding editors: Small animal endoscopy, ed 3, St. Louis,
and ventral and then immediately dorsal, • If bleeding substantial, monitor packed cell 2011, Mosby.
entering alongside the nasal septum. Usually volume/total solids to assess blood loss
begin on the least affected side. AUTHOR: Christine Savidge, DVM, DACVIM
• Begin saline infusion through endoscope for Alternatives and Their EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP
improved visualization and flushing. Relative Merits
• Examine ventral, middle, and dorsal meatus • CT/MRI: can localize lesion, may give
systematically, assessing mucosal changes, indication of neoplasm, foreign body, or
turbinate structure, discharge, and meatal aspergillosis

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