Page 68 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 4 · Surgery of the nose and nasopharynx
Chapter 4 · Surger y of the nose and nasophar ynx

➜ OPERATIVE TECHNIQUE 4.1 CONTINUED
VetBooks.ir 3 With an osteotome and mallet the bone flap is outlined first, by not cutting completely full thickness. Once this

has been done, the incisions can be quickly deepened and the nasal cavity opened to immediately address any
bleeding associated with the osteotomy itself. Alternatively, a sagittal saw can be used.
4 The nasal cavity is then systematically explored gently for foreign body removal or if biopsy specimens of specific
areas are to be taken. Material is also harvested for culture and sensitivity testing.
5 Complete turbinectomy or nasal exenteration is then performed using a large bone or uterine curette that should
follow the inside of the maxillary bone ventrally and scoop back a large amount of turbinate material. As
haemorrhage will occur at this stage, curettage should be as swift and targeted as possible.
6 Once haemorrhage has reduced to minimal oozing, the rhinotomy site can be closed.

A midline The incision is A rectangular
incision is deepened to the flap of bone
created over level of the bone in is outlined
the nose the midline and the with
through the periosteum is rongeurs
skin and elevated over the prior to
subcutis. nasal bone of the full-thickness
side that requires resection.
exploration and
turbinectomy.

PRACTICAL TIP

Care should be taken to avoid damaging the cribriform plate caudomedially. Specific attention needs to be paid to
removal of the rostral parts of the dorsal and maxillary turbinates within the nasal vestibule and in ensuring a
patent nasopharyngeal meatus

The flap of bone is discarded.

Samples are taken from the Abnormal tissue is removed Bleeding associated with
nasal cavity for cytology, with the associated turbinates turbinectomy stops once all
culture and sensitivity using a large curette. abnormal tissue and turbinates
testing. have been removed.
PRACTICAL TIP

Bleeding usually stops once turbinectomy is complete, but any ongoing haemorrhage is best controlled by
direct pressure from gauze packing. After removal of the gauzes, active bleeding can usually be controlled
with direct electrocautery, using metal Frazier or Adson suction cannulae as the conductor whilst ‘fixating’
the end of the vessel with the tip of the suction tube and clearing the surgical area of blood at the same time

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