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Rigid endoscopy: rhinoscopy

image of Rigid endoscopy: rhinoscopy
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Abstract

Rhinoscopy is minimally invasive, is associated with lower morbidity than rhinotomy, and is the best option for visualizing nasal lesions and taking biopsy samples. Besides being the gold standard for diagnosis of intranasal disease, rhinoscopy is one of the more accessible and easily learned procedures for novice endoscopists.

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Figures

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9.1 (a) Transverse section and (b) longitudinal section showing the anatomy of the nose. These illustrations show the typical anatomy of the canine nose; the anatomy of the feline nose is very similar. Drawn by S. J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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9.6 Intraoral radiograph showing soft tissue opacity in the right caudal nasal cavity of a dog.
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9.7 Radiographic skyline view of the tympanic bullae and frontal sinuses in a cat.
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9.8 Tonsillar inflammation/enlargement in a 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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9.10 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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9.11 (a) Use of an endoscope in the retroflexed ‘J’ position to view the nasopharynx. (b) For visualization of the caudal nasal choanae, the endoscope must be advanced by pulling it towards 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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9.12 Normal retroflexed view of the caudal nasal choanae and retropharynx. (Courtesy of RC Denovo)
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9.13 Normal endoscopic appearance of the dorsal soft palate, the nasal choanae and the dorsal pharyngeal mucosa. (Courtesy of D Levitan)
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9.14 Haemorrhagic discharge from the choanae.
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9.15 Nasopharyngeal lymphoid hyperplasia in a Siamese cat. This is commonly found as the result of chronic inflammation.
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9.16 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 endoscopist.
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9.17 Normal ventral meatus. (a) Cat. (b) Dog: note the smooth pink turbinates, which appear to almost interdigitate.
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9.18 (a) Normal Eustachian tube opening in a dog. (b) Normal dorsal meatus in a dog. Note the smooth vaulted appearance. (c) Normal ethmoid turbinates in a dog. Note the corrugated appearance of the turbinates on the left compared with the nasal septum on the right.
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9.19 Mucus in the anterior nares is always abnormal.
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9.20 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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9.21 CellSafe biopsy capsules are ideal for preserving small biopsy samples collected endoscopically.
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9.22 Position of entry into the frontal sinus. Drawn by S. J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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9.24 A blade of grass lodged in the nasopharynx of a cat dorsal to the soft palate.
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9.25 (a) 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. (b) Posterior rhinoscopic view of nasal lymphosarcoma in a dog (same dog as in Figure 9.31 ). Note the similarity in appearance to (a).
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9.26 (a) A nasopharyngeal polyp seen during examination above the soft palate. A spay hook is being used to pull the soft palate forward so that the nasopharynx can be viewed. (b) The polyp after removal. (Courtesy of RC Denovo)
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9.27 Benign nasal polyps in the dog. (a) At the choanae the appearance may be vascular and erosive, especially in the presence of secondary infection. With anterior rhinoscopy, polyps may be (b) single and confined to a small area or (c) present throughout most of the nasal passage.
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9.28 (a) A piece of stick embedded in the nose of a spaniel (middle of the image). (b) The piece of stick following removal from the dog’s nose.
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9.31 Nasal lymphosarcoma in a Rottweiler. (a) Initial appearance of the lesion. (b) Cut surface of the lesion following biopsy. Note the ‘cotton wool’ appearance.
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9.32 Adenocarcinomas in the dog. (a) Appearance of an adenocarcinoma at the choanae viewed in air. (b) Opaque irregular pale adenocarcinoma with swelling and erythema of the surrounding turbinates. (c) Appearance of an adenocarcinoma under irrigation (same dog as in (a)). The adenocarcinoma is pale and relatively smooth and translucent (compare with (b)), giving the appearance of a polyp.
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9.33 Adenocarcinoma in a cat showing a pale lobulated appearance and vascularity.
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9.34 Nasal adenocarcinoma at the choanae viewed by (a) posterior rhinoscopy and (b) anterior rhinoscopy. Note the difference in appearance when viewed under saline irrigation.
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9.35 (a) Biopsy of an adenocarcinoma at the choanae, using posterior rhinoscopy. The biopsy forceps should be preplaced at the tip of the endoscope before retroflexing the endoscope around the free edge of the soft palate to prevent damage to the biopsy channel. (b) Biopsy of a nasal adenocarcinoma using anterior rhinoscopy.
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9.36 Nasal chondrosarcomas in the dog. Nasal masses can present with a variety of appearances: (a) well delineated and vascular; (b) poorly delineated and invasive; (c) ulcerative; and (d) pale, almost translucent and relatively avascular. Histopathology is always required for diagnosis as the morphology is so varied.
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9.37 Laser debulking of a nasal chondrosarcoma in a dog.
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9.38 Osteosarcomas in the cat: (a) at the choana; (b) well circumscribed vascular nasal mass; and (c) pale, friable, relatively avascular appearance of a nasal mass.
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9.39 Osteosarcomas in the dog: (a) at the choana; and (b) nasal.
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9.41 (a) Swelling and depigmentation of the nasal planum, characteristic of infection, in a German Shepherd Dog. (b) Resolution of swelling and depigmentation 1 month after initial treatment.
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9.42 Nasal aspergillosis in dogs. (a) Classic white plaques. (b) Plaques 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). (c) Close-up view of an colony showing the ‘cotton wool’ appearance of the fungal hyphae.
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9.43 Nasal plaque (a) before and (b) after debridement.
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9.44 Treatment of nasal aspergillosis using an intranasal infusion of enilconazole. After each infusion, the patient is left for 15 minutes and then rotated by 90 degrees for the next infusion, to ensure that as much of the nasal mucosa and sinuses as possible comes into contact with the antifungal solution.
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9.45 Same dog as in Figure 9.42b , 1 month after a single enilconazole treatment. No fungal plaques are visible.

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