Page 55 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 4
VetBooks.ir

Surgery of the nose and

nasopharynx

Gert ter Haar and Cheryl S. Hedlund

Investigation of nasal likely to be dyspnoeic and have haemorrhagic and/or uni-
lateral nasal disease than other cats with chronic rhinitis
discharge (Henderson et al., 2004). Lymphosarcoma is the most
common tumour in cats. Viral infection with or without
Nasal disease in dogs and cats is relatively common. secondary bacterial infection is an extremely common
Sneezing, reverse sneezing and unilateral or bilateral nasal cause of nasal disease and discharge in young cats.
discharge (from mucopurulent to frank blood: epistaxis) are Lymphoplasmacytic rhinitis, foreign body, mycotic rhinitis,
indicators of nasal disease. Nasal discharge is a cardinal nasopharyngeal polyps and periapical tooth abscessation
sign of disease and is often the impetus for clients to seek are less common causes of nasal disease in cats.
veterinary attention, but other signs can predominate The animal’s age, environment and history may provide
(Figure 4.1). The aetiology, treatment, and prognosis vary clues to the aetiology of nasal discharge. Congenital abnor-
widely among patients with nasal disease. In a study of 42 malities, viral infections or polyps are common in young
dogs with chronic persistent nasal discharge, neoplasia was animals, whereas older animals are more prone to neo-
the most common cause (33%), followed by inflammatory
rhinitis (24%), periodontal disease (10%), fungal rhinitis plastic disease. Older small-breed dogs are more prone to
the development of acquired oronasal fistulas from tooth
(7%) and foreign body reaction (7%) (Tasker et al., 1999).
Adenocarcinoma was the most common nasal tumour diag- root abscesses. Certain parasitic infections, such as
nosed. The type of nasal discharge does not appear to pre- Pneumo nyssoides caninum (nasal mite), are reported in very
dict aetiology (Bissett et al., 2007). Seventy-eight percent of specific areas (Scandinavian countries: Movassaghi and
176 dogs in the latter study had local disease, with a similar Mohri, 1998; Gunnarsson et al., 2004). Hunting dogs often
distribution (neoplasia 39%, trauma 37%, idio pathic rhinitis inhale foreign bodies, whilst urban pets or show dogs and
22% and periapical abscess 2%). Twenty-two percent of cats may be more likely to inhale a toxin or be exposed to
an infectious agent.
dogs with epistaxis suffered from systemic disease (thrombo -
cytopenia 48%, thrombocytopathia 28%, coagulopathy The duration of the problem may not be apparent to
12%, hypertension 0.08% and vasculitis 0.04%) (Bissett the owners because fastidious animals often continu-
et al., 2007). Chronic inflammatory or idiopathic lympho- ously remove the nasal discharge. The owner should be
plasmacytic rhinitis was diagnosed in 37 dogs with no iden- questioned regarding whether the nasal discharge
tified cause in another study, suggesting that this may be occurred acutely or had a chronic onset, has changed in
a specific contributor to chronic nasal disease in dogs volume or character over time, if there were other clinical
(Windsor et al., 2004); however, every effort should be made signs and the animal’s response to any medications.
to exclude other causes before settling for this diagnosis.
In a study of 37 dogs with a primary nasopharyngeal Physical examination
condition, 54% had a neoplastic process, 11% had non-
infectious inflammatory disease and the remainder had Careful physical examination of the dog or cat with nasal
foreign bodies, benign cystic structures or cryptococcosis discharge is important (Schmiedt and Creevy, 2012).
(Hunt et al., 2002). Studies in cats with nasal disease have Sneezing may or may not be present. Reverse sneezing is a
shown that nasal neoplasia (39–49%) and chronic rhinitis violent paroxysmal inspiratory effort made in an attempt to
(23–35%) are far more common than nasopharyngeal move material from the nasopharynx to the oropharynx and
stenosis, polyps or trauma (Allen et al., 1999; Henderson may accompany caudal nasal or nasopharyngeal disease
et al., 2004; Demko and Cohn, 2007). Cats with neoplasia (Venker-van Haagen, 2005). The animal may paw at the
are older than other cats with nasal disease, and are more face or nose because of discomfort or to remove dis-
charge. Facial deformity may be present if there is swelling
• Nasal discharge – mucoid, mucopurulent, haemorrhagic, serous or bony destruction from neoplasia, cryptococcosis in cats
• Sneezing or reverse sneezing
• Facial deformity or occasionally severe dental disease. Facial symmetry
• Pawing at the face or nose should be carefully assessed, and ocular retropulsion
• Planum ulceration or depigmentation should be performed to evaluate the retrobulbar space.
• Airway obstruction – stridor, stertor, open-mouth breathing Cats with nasal disease have clinical findings similar to
those in dogs but may also have concurrent vomiting (69%)
4.1 Frequent clinical signs associated with nasal disease.
(Demko and Cohn, 2007).

46 BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, second edition. Edited by Daniel J. Brockman, David E. Holt and Gert ter Haar. ©BSAVA 2018

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