Surgery of the Upper Airways in Small Animals

Transcription

1 Upper airways Surgery of the Upper Airways in Small Animals T. Németh, DVM, PhD Major Surgical Procedures on Upper Airways Rhinotomy Frontal Sinus Drainage Brachycephalic Upper Airway Obstructive Syndrome Major Surgical Procedures on Upper Airways Rhinotomy Frontal Sinus Drainage Brachycephalic Upper Airway Obstructive Syndrome Rhinotomy/anatomy Rhinotomy / turbinectomy Indikáció Gradualy narrowing indication area (Rad/CT, rhinoscopy / microbiol. / biopsy / histopath, chemotherapy, radiotherapy) In dogs and cats chronic nasal discharge chronic rhinitis (foreign body!!!, aspergillosis???) nasopharyngeal polyp (cat) ((neoplasm: just cytoreductive, not radical)) Salvage! 1

2 Rhinotomia / turbinectomia Rhinotomy Prerequisites Precise diagnosis (diagnostic imaging, microbiology, histopath!) anesthesia (intubation, anesth. machine, monitoring, analgesia) Surgery (instrumentation, suction unit, electrocautery) preoperative antibiotics (?) Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy Rhinotomy Rhinotomy Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy Rhinotomy Rhinotomy Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy 2

3 Rhinotomy Rhinotomy Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy Rhinotomy Rhinotomy / turbinectomy dorsal Obstructive upper respiratory signs Non-responsiveness to conservative treatment Cytology / Biopsy Rhinotomy / turbinectomy Rhinotomy/dorsal Midline skin incision Dorsal bone-flap Turbinectomy (maxilloturbinates, ethmoturbinates) Curettage / Biopsy Drainage Closure 3

4 Rhinotomy/dorsal Rhinotomy/dorsal Midline skin incision Dorsal bone-flap Turbinectomy (maxilloturbinates, ethmoturbinates) Curettage / Biopsy Drainage Closure Midline skin incision Dorsal bone-flap Turbinectomy (maxilloturbinates, ethmoturbinates) Curettage / Biopsy Drainage Closure Rhinotomy/dorsal Rhinotomy/dorsal Midline skin incision Dorsal bone-flap Turbinectomy (maxilloturbinates, ethmoturbinates) Curettage / Biopsy Drainage Closure Midline skin incision Dorsal bone-flap Turbinectomy (maxilloturbinates, ethmoturbinates) Curettage / Biopsy Drainage Closure Rhinotomy /dorsal Aspergillus-rhinitis Rhinotomy/dorsal Midline skin incision Dorsal bone-flap Turbinectomy (maxilloturbinates, ethmoturbinates) Curettage / Biopsy Drainage Closure 4

5 Rhinotomy / turbinectomy Rhinotomy / turbinectomy ventral Feline nasopharyngeal polyp Rhinotomy / ventral Feline nasopharyngeal polyp Rhinotomy / ventral Non-Hodgkin lymphoma / cat Rhinotomy / ventral Closure 5

6 Rhinotomy / ventral Closure Rhinotomy / turbinectomy Post-operatve treatment analgesia (NSAID, opiates) drain removal in 1 to 2 days Histopathology/microbiology results (!) Discussion on prognosis with owner Major Surgical Procedures on Upper Airways Rhinotomy Frontal Sinus Drainage Brachycephalic Upper Airway Obstructive Syndrome Frontal Sinus Drainage Indication Mainly in cats (dogs) Chronic Sinusitis (CS) Fungal disease (Cryptococcosis) Bacteria Neoplasia / Polyps Frontal Sinus Drainage Chronic nasal discharge Obstructive upper respiratory signs Frontal Sinus Drainage Chronic nasal discharge Obstructive upper respiratory signs 6

7 Frontal Sinus Drainage Midline skin incision Frontal sinus osteotomy Curettage Biopsy Drainage Closure Frontal Sinus Drainage Midline skin incision Frontal sinus osteotomy Curettage Biopsy Drainage Closure Frontal Sinus Drainage Midline skin incision Frontal sinus osteotomy Curettage Biopsy Drainage Closure Nasal irrigation + sinus trepination Indication Chronic fungal rhinitis/sinusitis Aspergillosis Nasal irrigation + sinus trepination Nasal irrigation + sinus trepination Clotrimazol solution 7

8 Nasal irrigation + sinus trepination Major Surgical Procedures on Upper Airways Rhinotomy Frontal Sinus Drainage Brachycephalic Upper Airway Obstructive Syndrome Clotrimazol ointment Brachycephalic-evolution in the English bulldog Brachycephal-evolúció in cats Conditions based on breed predispostion in brachycephalic dogs I. Respiratory disorders - brachycephalic upper airway obstructive syndrome - congenital palatoschisis II. Digestive disorders - Congenital Pyloric Stenosis III. Neurologic - orthopedic disorders - hydrocephalus - vertebral defects IV. Obstetrical disorders - dystocia V. Ophthalmic disorders - cyclopia - entropion - ectropion 8

9 Conditions based on breed predispostion in brachycephalic dogs I. Respiratory disorders - brachycephalic upper airway obstructive syndrome - congenital palatoschisis II. Digestive disorders - Congenital Pyloric Stenosis III. Neurologic - orthopedic disorders - hydrocephalus - vertebral defects IV. Obstetrical disorders - dystocia Brachycephalic respiratory obstructive syndrome 1. Stenotic nares Laryngeal collapse 4. Tracheal hypoplasia V. Ophthalmic disorders - cyclopia - entropion - ectropion Brachycephalic respiratory obstructive syndrome Common consequences: Brachycephalic respiratory obstructive syndrome 1. Stenotic nares Dicreased respiratory capacity Decreased heat tolerance Increased susceptibility for airway diseases Brachycephalic respiratory obstructive syndrome 1. Stenotic nares 2. Radiology of brachycephalic respiratory syndrome 9

10 Brachycephalic respiratory obstructive syndrome Normal 1. Stenotic nares Laryngeal collapse Brachycephalic respiratory obstructive syndrome 1. Stenotic nares Laryngeal collapse (grade I: everted laryngeal sacuculus) Brachycephalic respiratory obstructive syndrome 1. Stenotic nares Laryngeal collapse (grade II (grade II-III: III: collapse of proc. cuneiformis, proc. corniculatus) Brachycephalic respiratory obstructive syndrome Tracheal hypoplasia Tracheal collapse 1. Stenotic nares Laryngeal collapse 4. Tracheal hypoplasia - Congenital malformation - Along the entire trachea - Brachycephalic breeds - No surgery - Older age, degenerative - Segmental - Toy breeds (yorkshire, poodle, maltese) - Surgically treatable 10

11 Diagnosis of tracheal hypoplasia 1. Tracheal diameter > laryngeal diameter 2 Diagnosis of tracheal hypoplasia 1. Tracheal diameter > laryngeal diameter 2 2. Tracheal diameter > diameter of upper third of 3. rib x 3 Tracheal diameter > laryngeal diameter 2 Tracheal diameter > 3 x (diameter of upper third of 3rd rib) 11

12 Diagnosis of tracheal hypoplasia 1. Tracheal diameter > laryngeal diameter 2 2. Tracheal diameter > diameter of upper third of 3. rib x 3 3. Tracheal diameter diameter of thoracic inlet Diagnosis of tracheal hypoplasia Tracheal diameter diameter of thoracic inlet Non-brachycephalic dogs:>0.20 Brachycephalic dogs: >0.16 Bulldogs: > Tracheal diameter > laryngeal diameter 2 2. Tracheal diameter > diameter of upper third of 3. rib x 3 3. Tracheal diameter diameter of thoracic inlet 4. Tracheal diameter = 0.47 x bodyweight 0.39 (cm) Decision making of the surgery of Brachycephalic Airway Obstruction Syndrome Owners complaint (anamnesis): Severity of clinical signs of airway obstruction in general after exercise in certain seasons (hot summer) Response to previous medical treatment X-ray Endoscopy (rhinoscopy, laryngoscopy, tracheobronchoscopy) Possibilities of surgical treatment Stenotic nares: wedge resection : soft palate plasty Laryngeal collapse: - laryngotomy excision of everted laryngeal sacculus - partial laryngectomy Tracheal hypoplasia: no surgery! 12

13 Possibilities of surgical treatment Stenotic nares wedge resection Stenotic nares: wedge resection : soft palate plasty Laryngeal collapse: - laryngotomy excision of everted laryngeal sacculus - partial laryngectomy Tracheal hypoplasia: no surgery! Stenotic nares wedge resection Stenotic nares wedge resection Stenotic nares wedge resection Possibilities of surgical treatment Stenotic nares: wedge resection : soft palate plasty Laryngeal collapse: - laryngotomy excision of everted laryngeal sacculus - partial laryngectomy Tracheal hypoplasia: no surgery! 13

14 Possibilities of surgical treatment Soft palate resection : soft palate plasty Soft palate resection Folded Flap Palatoplasty Soft palate resection Soft palate resection Soft palate resection Soft palate plasty II. VIDEO 14

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16 Possibilities of surgical treatment Stenotic nares: wedge resection VIDEO : soft palate plasty Laryngeal collapse: - laryngotomy excision of everted laryngeal sacculus - partial laryngectomy Tracheal hypoplasia: no surgery! Brachycephalic Airway Obstruction Syndrome Excision of everted laryngeal sacculus Brachycephalic Airway Obstruction Syndrome Excision of everted laryngeal sacculus 16

17 Brachycephalic Airway Obstruction Syndrome Excision of everted laryngeal sacculus Brachycephalic Airway Obstruction Syndrome Excision of everted laryngeal sacculus Possibilities of surgical treatment Stenotic nares: wedge resection : soft palate plasty Laryngeal collapse: Tracheotomy / Tracheostomy - laryngotomy excision of everted laryngeal sacculus - partial laryngectomy Tracheal hypoplasia: no surgery! Surgical anatomy Tracheostomy Indication Curative (partial or complete tracheal obstruction) Palliative (laryngeal obstrucion) 17

18 Tracheostomy Tracheostomy Tracheotomy Temporary tracheostomy (tube) Permanent tracheostomy (stoma) X X X Tracheotomy Temporary tracheostomy (tube) Permanent tracheostomy (stoma) Temporary tracheostomy Tracheostomy VIDEO Tracheotomy Temporary tracheostomy (tube) Permanent tracheostomy (stoma) Tracheostomy Tracheotomy Temporary tracheostomy (tube) Permanent tracheostomy (stoma) Thank You Very Much for Your Attention! 18