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Rigid endoscopy: rhinoscopy

image of Rigid endoscopy: rhinoscopy
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Abstract

Nasal disease is common in the dog and cat, often presenting as a nasal discharge, with or without sneezing, stertor or stridor. Epistaxis may or may not be a feature, and can be present alone. Access to the rhinarium is difficult, since it is entirely encased in bone apart from at either end, and contains numerous turbinate scrolls forming many blind-ending channels in which foreign bodies or pathological changes can be hidden. There are only a limited number of direct physical approaches to the nasal cavity: dorsal rhinotomy; ventral rhinotomy; and rhinoscopy. Rhinoscopy is minimally invasive, providing reduced morbidity over other surgical options, and affords the best option for visualizing lesions and taking biopsy samples for diagnostic work, either for initial diagnosis or to confirm a suspected diagnosis. This chapter discusses Anatomical considerations; Indications; Preoperative diagnostic work-up; Intraoperative diagnostic work-up (under general anaesthesia); Instrumentation; Premedication and anaesthesia; Procedure; Caudal (posterior, retropharyngeal) rhinoscopy; Anterior (rostral) rhinoscopy; Frontal sinus exploration; Pathological conditions; Fungal rhinitis topical therapy; Postoperative care; and Complications.

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Figures

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8.1 Transverse section to show the anatomy of the canine/feline nose. Longitudinal section to show the anatomy of the canine/feline nose. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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8.6 Intraoral radiograph, showing soft tissue opacity in right caudal nares.
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8.7 Radiographic skyline view of the tympanic bullae and frontal sinuses in the cat.
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8.8 Tonsillar inflammation/enlargement in the dog. The tonsils can be examined in detail with a rigid endoscope. The tonsillar crypt should be explored with forceps under direct visualization to exclude foreign bodies.
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8.10 Anatomy of the retropharynx and posterior nasal cavity. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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8.11 Endoscope in retroflexed ‘J’ position. For visualization of the caudal nasal choanae, the endoscope must be advanced by pulling it toward the endoscopist while keeping it retroflexed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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8.12 Normal retroflexed view of the caudal nasal choanae and retropharynx. (Courtesy of RC Denovo)
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8.13 Normal endoscopic appearance of the dorsal soft palate, the nasal choanae and the dorsal pharyngeal mucosa. (Courtesy of D Levitan)
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8.14 Haemorrhagic discharge from the choana.
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8.15 Nasopharyngeal lymphoid hyperplasia in a Siamese cat. This is commonly found as the result of chronic inflammation.
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8.16 Theatre set up for rhinoscopy. The patient is in ventral recumbency on a gridded table with the chin resting on a rolled up towel. The monitor is positioned at the caudal end of the patient, directly opposite the surgeon.
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8.17 Normal ventral meatus. Cat. Dog: note the smooth pink turbinates, which appear almost to interdigitate.
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8.18 Normal Eustachian tube opening in the dog. Normal dorsal meatus in the dog. Note the smooth vaulted appearance. Normal ethmoid turbinates in the dog. Note the corrugated appearance of the turbinates on the left compared with the nasal septum on the right.
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8.19 Mucus is always abnormal in the anterior nares.
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8.20 Ulcerative/erosive rhinitis with generalized swelling and erythema of the turbinates. Multiple small erosions are evident and bleed easily on contact.
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8.21 ‘Cell-safe’ frames are ideal for preserving small endoscopic samples.
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8.23 A blade of grass lodged in the nasopharynx of a cat dorsal to the soft palate.
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8.24 colonies at the choanae, viewed by posterior rhinoscopy. The endoscope is retroflexed through 180 degrees, giving an inverted image, so this colony is in the right nostril. Posterior rhinoscopic view of nasal lymphosarcoma in a dog (same dog as in Figure 8.28 ). Note the similarity in appearance to (a).
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8.25 A piece of stick embedded in the nose of a spaniel (middle of the image). A piece of stick following removal from the nose of a spaniel.
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8.28 Nasal lymphosarcoma in a Rottweiler. Initial appearance of the lesion. Cut surface of the lesion following biopsy. Note the ‘cotton wool’ appearance.
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8.29 Adenocarcinomas in the dog. Appearance of an adenocarcinoma at the choanae viewed in air. Opaque irregular pale adenocarcinoma with swelling and erythema of the surrounding turbinates. Same dog as in (a) showing the appearance of an adenocarcinoma under irrigation. The adenocarcinoma is pale and relatively smooth and translucent (compare with b), giving the appearance of a polyp.
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8.30 Adenocarcinoma in a cat showing pale lobulated appearance and vascularity.
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8.31 Nasal adenocarcinoma at the choanae viewed by posterior rhinoscopy and anterior rhinoscopy. Note the difference in appearance when viewed under saline irrigation.
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8.32 Biopsy of adenocarcinomas. At the choanae, using posterior rhinoscopy. The biopsy forceps should be preplaced at the tip of the endoscope before retroflexing around the free edge of the soft palate to prevent damage to the biopsy channel. Nasal adenocarcinoma, using anterior rhinoscopy.
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8.33 Nasal chondrosarcomas in the dog. Nasal masses can present with a variety of appearances: well delineated and vascular; poorly delineated and invasive; ulcerative; and pale, almost translucent and relatively avascular. Histopathology is always required for diagnosis as the morphology is so varied.
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8.34 Laser debulking of a nasal chondrosarcoma in a dog.
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8.35 Osteosarcomas in the cat: at the choana; well circumscribed vascular nasal mass; and pale, friable, relatively avascular appearance of a nasal mass.
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8.36 Osteosarcomas in the dog: at the choana; nasal.
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8.37 A nasopharyngeal polyp seen during examination above the soft palate with a spay hook. The polyp after removal. (Courtesy of RC Denovo)
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8.38 Benign nasal polyps in the dog. At the choanae the appearance may be vascular and erosive, especially in the presence of secondary infection. With anterior rhinoscopy, polyps may be single and confined to a small area or present throughout most of the nasal passage.
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8.40 Swelling and depigmentation of the nasal planum, characteristic of infection, in a German Shepherd Dog. Resolution of swelling and depigmentation 1 month after initial treatment.
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8.41 Nasal aspergillosis. Colonies in the noses of two dogs: (a) demonstrating the classic white plaques; and (b) showing a greenish tinge due to secondary infection. Note the extensive turbinate damage, leading to an abnormally large airspace. In (a) turbinate destruction has exposed the frontal sinus and plaques can be seen within the sinus cavity (rear of the image). Close-up view of the colony showing the ‘cotton wool’ appearance of the fungal hyphae.
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8.42 Nasal plaque before and after debridement.
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8.43 Treatment for nasal aspergillosis using an intranasal infusion of enilconazole.
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8.44 Same dog as in Figure 8.42 b, one month after a single enilconazole treatment. No fungal plaques are visible.

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