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RUSVM Small Animal Surgery 1 > Upper Airway > Flashcards

Upper Airway Flashcards

1
Q

History/ clinical signs associated with nasal dz?

A 
Nasal discharge 
Sneezing 
Reverse sneezing 
Stertor 
Epistaxis 
Facial deformation 
Ocular discharge
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2
Q

T/F: rhinoscopy and nasopharngoscopy should be performed prior to imaging

A

False

AFTER

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3
Q

What is the most common indication for nasal planum resection?

A

Neoplasia

  • SCC
  • Lymphoma, maligant histiocytosis, maligant melanoma, basal cell carconoma, mast cell tumor , HAS
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4
Q

What type of surgery would you do to gain access to the nasal cavity and sinuses?

A

Rhinotomy (dorsal)

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5
Q

What type of surgery would you do to access the ventral nasal cavity and choanae?

A

Rhinotomy (ventral)

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6
Q

You have a dog with a sinusitis and you want to drain and infiltrate drugs into the cavity. What type of surgery would you do?

A

Sinusotomy

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7
Q

What are the major risks and complications of nasal surgery?

A

Hemorrhage —> dorsal, lateral, and major palatine arteries

Flap necrosis

Oronasal fistula (surgically made passage between the oral and nasal cavity)

Dehiscence

Stenosis of the airway

Incomplete resection or recurrence (neoplasia)

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8
Q

Brachycephalic breeds have a local chrondrodysplasia that results due to early ankylosis of what bones?

A

Basioccipital

Basisphenoid

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9
Q

What are the brachycephalic dog breeds?

A 
English and French bulldog 
Pug
Shih Tzu 
Pekingese 
Boston Terrier 
Boxer 
Chihuahua 
Cavalier King Charles spaniel 
Maltese 
Chow chow 
Yorkshire terrier 
Miniature pinscher 
Shar pei
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10
Q

What are the primary disease components of brachycephalic airway syndrome?

A

Stenotic nares

Elongated soft palate most important

Everted laryngeal saccules/stage I laryngeal collapse

Hypoplasia trachea

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11
Q

What are some contributing problems to brachycephalic airway syndrome?

A 
Nasopharyngeal turbinates 
Stage 2/3 laryngeal collapse 
Tonsillar eversion 
Tracheal collapse 
Secondary edema 
Macroglossia
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12
Q

What is the pathophysiology of upper airway obstructive disease?

A

Higher neg pressures to overcome obstruction —> secondary soft tissue changes (edema/hyperplasia/collapse) —> decreased air flow with increased obstruction

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13
Q

Normally, the epiglottis should overlap the soft palate by how much?

A

1-2mm at midline

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14
Q

Elongated soft palate causes what respiratory sound/sign??

A

Inspiratory dyspnea (Stertor)

Exentsion of the soft palate into the rima glottis causes obstruction and causes loss of protective laryngeal function

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15
Q

Stage the laryngeal collapse..

Collapse of the cuneiform cartilage

A

Stage 2

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16
Q

Stage the laryngeal collapse..

Everted laryngeal saccules

A

Stage 1

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17
Q

Stage the laryngeal collapse ..

Collapse of the coriculate cartilage

A

Stage 3

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18
Q

Collapse of the larynx results in what respiratory sound?

A

Stridor

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19
Q

What is a hypoplasic trachea?

A

Irregular, thick/firm cartilage rings

Overlap of rings

Increased airflow resistance

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20
Q

T/F: Hypoplastic trachea can be treated by placing a tracheal stent

A

False

No treatment

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21
Q

What gastrointestinal comorbidities are seen with BAS?

A 
Regurgitation 
Vomiting 
Hiatal hernia 
Pyloric hypertrophy 
Ulceration

Risk factor for aspiration pneumonia

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22
Q

Signalment associated with BAS?

A

Brachycephalic
2-3yrs
M>F

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23
Q

What is your DDX for chow chow that presents as..

Exercise intolerance
Increased noise, “snoring”, or “snuffling”
Gastrointestinal signs

A

Brachycephalic airway syndrome

Space occupying mass of the upper airway

  • neoplasia
  • abscess
  • granuloma
  • foreign body
  • epiglottic retroversion
24
Q

What would you look for on radiographs on a dog with BAS?

A

Right heart enlargement

Assess for hypoplastic trachea (tracheal lumen:thoracic inlet ratio)

Non-cardiogenic pulmonary edema

Aspiration pneumonia

Hiatal hernia

Megaesophagus (may be associated with reflex of esophagitis)

25
Q

How should you perform an upper airway exam for BAS ?

A

Avoid drugs that affect laryngeal function
(Eg ketamine, diazepam, large dose pure u, or acepromazine)

Propofol, then can give sedative/opioid after exam

Doxapram improve respiration (general CNS stimulant )

Tonsil -> soft palate -> nasopharynx -> arytenoid cartilages -> nares

26
Q

When is surgery necessary for BAS?

A

When there is presence of any of the components

-early surgical intervention is important to prevent secondary changes

27
Q

You just did surgery on a BAS patient.. what should you do post op?

A

GU protectants and promotility agents (eg famotidine, pantoprazole, metoclopramide)

Anti-inflammatories for soft palate reaction and saccule excision

Anti-emetic at time of pre-med (maripotant)
Preoxygenation

28
Q

What are techniques that can be used in a staphylectomy?

A

Sharp dissection (freehand/ “cut and sew”)
CO2 laser excision
Bipolar sealing device excision

29
Q

What are the advantages to doing a staphylectomy with a laser?

A

Rapid

Very little blood loss

30
Q

What technique is useful for soft palate surgery when the palate is very thick?

A

Folded flap palatoplasty
—> excision of part of the oropharyngeal soft palate and underlying muscle

—> nasopharyngeal side folded forward and sutured to the orophargyneal border resulting in both shortening and thinning of the palate

31
Q

What are common complications to staphylectomy?

A

Acute
- hemorrhage and inflammation

Chronic
-undershortening

Overshortened —> nasal reflux and aspiration

32
Q

What is the surgery done to correct everted laryngeal saccules ?

A

Excision

—> cut with scissors and left to heal by second intention

33
Q

What are methods that can be used to correct stenotic nares?

A

Wedge resection (horizontal/vertical/dorsolatera)

Amputation - alar wing +/- alar fold

Alapexy

34
Q

What is the surgery to correct a stage II laryngeal collapse??

A

Partial arytenoidectomy and ventriculochordectomy

35
Q

What complications can arise from an arytenoidectomy and ventriculochrordectomy?

A

“Webbing” or stricture

-> can be avoided by NOT cutting to the ventral and dorsal extends of the corniculate processes and vocal folds

36
Q

What is the surgical corrections for a stage 3 laryngeal collapse?

A

Permanent tracheostomy

This is an end stage processes —> salvage procedure

37
Q

post-op care for BAS patient?

A 
\+/- nasal O2 
Avoid overheating (decrease panting and labored breathing)

Leave intubate as long as possible

Sternal recumbency with head up

Analgesia - buprenorphine
+/- sedation
Anti-inflammatory

NPO for 24hours
Treatment of GI signs
E-collar

38
Q

What is the medical treatment for BAS?

A 
Weight loss 
Environmental changes 
-cool 
-decreased activity 
-reduce exposure to respiratory irritants

Harness
Treat underlying GI disease

39
Q

What is the outcome for correction of any component of BAS?

A

Success rate 61-95%

Will not resolve snoring

Mortality 3-6% - English bulldogs secondary to aspiration pneumonia

40
Q

Laxity of the hypepiglotticus muscle in the face of extreme inspiratory effort can lead to??

A

Epiglottic retroversion

41
Q

What is the treatment for epiglottic retroversion?

A

Surgical pexy of the ventral aspect of the epiglottis and the dorsal base of the tongue

42
Q

What muscle is responsible for laryngeal abduction?

A

Crycoarytenoidus dorsalis

43
Q

What nerves innervate the muscles of the larynx?

A

Cranial (sensory) and caudal (motor) laryngeal nerves

-> vagus nerve
—> cranial laryngeal
—> recurrent laryngeal —> caudal laryngeal

44
Q

What are the diseases of the larynx?

A

Paralysis
Collapse

Neoplasia 
Cyst 
Trauma 
Foreign bodies 
Laryngeal web formation
45
Q

What are the clinical signs of laryngeal dz?

A 
Stridor 
Exercise intolerance 
Gagging/dysphagia 
Dysphoria 
Coughing

Dyspnea that does not improve with open mouth breathing

46
Q

Etiology of largyneal paralysis ?

A

Dysfuntion/damage to vagus and branches

  • acquired vs congenital
  • unilateral vs bilateral
47
Q

Congenital largyneal paralysis is seen in what breeds??

A

Bouvier de Flanders, huskies, bull terriers, and Dalmatians
—> progressive nerve degeneration

Rottweilers
—> progressive generalized degenerative disease
—> ataxia, paresis, head tremors, neurogenic muscle atrophy

48
Q

Signalment of acquired laryngeal paralysis?

A

Large breed, older dog

Poster children are the overconditioned labs and retrievers

49
Q

What is the cause of acquired laryngeal paralysis ??

A

Part of a generalized neuropathy
—geriatric onset largyneal paralysis polyneuropathy (GOLPP)

Idiopathic is most common 
Hypothyroid 
Trauma 
Immune mediated (myasthenia gravis) 
Infectious 
Toxin (lead or OP)
50
Q

What should you be looking for on radiographs of a dog with suspected laryngeal paralysis ?

A

Thoracic rads

  • Aspiration pneumonia
  • Megaesophagus
  • Cranial mediastinal masses (thymoma)
  • Non cardiogenic pulmonary edema

Cervical rads

  • laryngeal cartilages
  • masses
51
Q

In what case would an acetylcholine receptor antibody titer help to diagnose largyneal paralysis?

A

Thymoma associated with myasthenia gravis

52
Q

What is the treatment for laryngeal paralysis??

A

unilateral arytenoid lateralization
(THE ONLY TREATMENT) —> decrease airway resistance

Medical
-> weight loss, stress reduction, exercise restriction, environmental changes

53
Q

Post-op care for arytenoid lateralization?

A

Maintain ET tube until patient sufficiently awake

Avoid heavy sedation or meds that may cause nausea/vomiting

NPO for 24hrs - small amount of water and food with close monitoring

Monitor for signs of aspiration pneumonia

54
Q

What is the most important complication of unilateral arytenoid lateralization ??

A

Aspiration pneumonia

LIFE long risk

55
Q

Devocalization surgery is AKA?

A

Ventriculocordectomy

56
Q

In a ventricuocordectomy, it is important to leave 1-2mm ventral cord intact. Why?

A

To decrease risk of webbing

RUSVM Small Animal Surgery 1 (39 decks)

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