Page 62 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 4 · Surgery of the nose and nasopharynx

If substantial haemorrhage has occurred intraopera- For lateralized (nostril) granulomatous/fungal or malig-
tively, fluid replacement therapy should be continued until nant lesions where the central planum can be preserved,
VetBooks.ir independently. Blood products should be used as needed. unilateral nasal rotation flap incorporating dorsal nasal
cosmetic reconstruction of the nostril is possible using a
the deficit is restored and the animal is eating and drinking
plane tissue, with excision of Burow’s triangles (ter Haar
Analgesia is continued until the animal is subjectively
comfortable (usually within 3–5 days). Oral or transdermal
facial distortion, but can be closed with a facial artery axial
opioid analgesics or non-steroidal anti-inflammatory drugs et al., 2013). Larger defects will inevitably cause some
are usually provided during this time. pattern flap or buccal advancement/rotation flaps (Buiks
and ter Haar, 2012).
Nasal planum resection and reconstruction
Resection of the nasal planum is indicated when neoplasia
involves this area, after extensive trauma and sometimes Specific conditions
for fungal disease. Nasal planum resection alone, or in con-
junction with the premaxilla, is performed depending on the Nasal aspergillosis
location and tumour type (Kirpensteijn et al., 1994; Gallegos Aspergillus fumigatus is a ubiquitous saprophyte found in
et al., 2007). The original technique for nasal planum ampu- mouldy hay, wood chips, rotting vegetation and compost.
tation was described by Withrow and Straw (1990), and This fungus easily becomes airborne and, therefore, is
it remains the easiest technique for resection of nasal easily inhaled. Dogs with nasal aspergillosis usually do not
planum tumours in cats. The postoperative appearance of have malignant or immunosuppressive diseases and are
the animal is not always acceptable to the owners. generally in good health, and although some have been
With the animal positioned in sternal recumbency, the demonstrated to have T- and B-cell dysfunction, it is
surgical area is carefully palpated to estimate tumour exten- unclear whether this represents the cause or the effect of
sion into adjacent tissue. The nasal planum is completely the disease. A. fumigatus has been shown to cause lym-
removed with a 360-degree skin incision made with a phocyte transformation in T and B cells in vitro (Sharp et
scalpel. The incision is made so that it transects the under- al., 1991a, 1991b, 1993; Peeters et al., 2005). In contrast to
lying turbinates. The cartilage of the nasal plane and the dogs, cats have been more commonly reported to suffer
turbinates should be cut with an incision angled at about 45 from disseminated aspergillosis associated with an immu-
degrees to the hard palate (Withrow and Straw, 1990). nosuppressive disease or condition (Tomsa et al., 2003).
Haemorrhage can be controlled by direct pressure. A More recently, feline upper respiratory tract aspergillosis
purse-string suture of 2 or 3 metric (3/0 or 2/0 USP) absorb- has been reported more frequently, often in association
able or non-absorbable suture material is placed through with nasal infections (Wilkinson et al., 1982; Kano et al.,
the skin around the incision to cover the exposed nasal con- 2008; Barachetti et al., 2009; Furrow and Groman, 2009;
chae partly with skin. The new nasal orifice is closed to Karnik et al., 2009; Giordano et al., 2010; Smith and
approximately 1 cm in diameter (Withrow and Straw, 1990). Hoffman, 2010; Barrs et al., 2012; Declercq et al., 2012;
Alternatively, for a more cosmetic result, an advance- Kano et al., 2013; Barrs et al; 2014; Barrs and Talbot, 2014).
ment flap can be created from the dorsal aspect of The disease occurs over a wide geographical range,
the nose to reconstruct the dorsal wound. Laterally, the including Australia, the USA, the UK, mainland Europe and
exposed turbinate cartilage can be denuded from the over- Japan. Two anatomical forms have been reported: sino-
lying mucosa and sutured to the lateral cartilage. The nasal and sino-orbital aspergillosis (Barrs et al., 2012;
wound is further closed using interrupted sutures from Barrs and Talbot, 2014). The environmental saprophytic
the skin to the remaining planum cartilage. If wider margins fungi that cause these infections are most commonly from
are required, complete nosectomy with premaxillectomy the A. fumigatus complex, including A. fumigatus and
may be required (Figure 4.9). Postoperative care consists A. felis (Kano et al., 2008, 2013; Barrs et al., 2012; Kano
of an Elizabethan collar, broad-spectrum antibiotics for 1 et al., 2013; Whitney et al., 2013; Barrs and Talbot, 2014).
week and analgesia for 3 days. Diagnosis of nasal aspergillosis in both dogs and cats is
based on imaging, rhinoscopic (Figure 4.10), cytological
and histopathological findings.

(a) (b)
(a, b) Rostral maxillectomy
4.9 with nasal planum resection
was performed for an invasive
squamous cell carcinoma. (c) Owners
should be aware and accepting of their
pet’s altered appearance prior to
selecting this treatment option.

Rhinoscopic view of nasal aspergillosis; atrophy of turbinates
4.10
(c) ith severe inflammation of the mucosal lining of remnant
turbinates is visible ith macroscopically identifiable fungal gro th.

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