Surgical affections of Nose

Surgical affections of Nose in animals are Atheroma, Nasal polyps, Necrosis of the turbinate bone and Parasites in the nasal chambers.

Surgical affections of Nose are-

1. Atheroma or Nasal cyst
2. Nasal polyps or Nasal polypi
3. Necrosis of the turbinate bone
4. Parasites in the nasal chambers
5. Traumatic wound and fracture of the nasal bones
6. Foreign body in Nasal Cavity

Atheroma or Nasal cyst

Atheroma is a sebaceous cyst that mostly occurs in the false nostril in the horse, causing a local swelling and perhaps a nasal respiratory noise due to encroachment on the nasal passage.

The size of the cyst varies from a pigeon egg to a large chicken egg. The content may be like water in the small cyst and the large cyst may be filled with a thick, greasy dark grey material.

The presence of the cyst is easily diagnosed by clinical examination.

Treatment of Atheroma

The skin over the cyst is prepared aseptically by clipping, shaving and painting with povidone iodine for the operation and the tissues may be anaesthetized by infiltration with a local anaesthetic eg. 2% lignocaine hydrochloride.

A stab incision is made over the swelling area and evacuating the contents and swabbing its lining with tincture of iodine or any irritant or stimulating agent such as ammonia or turpentine liniment, constitute an effective method of treatment.

The irritant does not come in contact with the mucous membrane of the nose.

An alternative method of treatment is the dissecting out the cyst. It is the best method of treatment. The incision through the skin exposes the wall of the cyst. The wall should be separated from the surrounding tissues and excised.

It may be desirable to establish drainage into the nasal cavity. The edges of the skin incision may be united with simple interrupted suture with nylon or silk.

Nasal polyps or Nasal polypi

Polyps are generally multiple and of smaller in size. The general appearance of polyps are soft, non-ulcerated that arise from nasal mucosa. Usually they are pedunculated and consist of loosely arranged fibrous tissue covered by epithelium.

The growths are commonly attached to the lateral wall and rarely to the nasal septum.

Polyps cause partial or complete obstruction of the nasal passages show clinical signs like discharge, inspiratory dyspnoea and stertor.

There may be frequent sneezing, the animal may show restlessness and may rub its nostrils against the ground.

In bilateral obstruction, animals exhibit mouth breathing .

Extensive growths produce sufficient pressure to cause atrophy of the turbinates and also facial deformity.

Diagnosis of Nasal polyps

Diagnosis of Nasal polyps in animals is done by-

• Direct visualization
• Endoscopic visualisation of the nasal cavity reveals the presence of growth
• Radiography
• Histopathology
• Microbial culture examination

Treatment of Nasal polyps

Pedunculated growths are removed by excision at the base of the attachment by local infiltration anaesthesia.

When growths are enlarged and inaccessible through external nares, Rhinotomy and excision is indicated.

Rhinotomy

An incision through the skin and cartilage on the dorsolateral aspect of the nostril gives enough space to remove the growth from the nasal cavity. Base of the growth is debrided and cauterized.

Haemorrhage is controlled by temporary plugging of the nasal cavity with gauze impregnated with an antiseptic and intravenous administration of haemo-coagulase, vitamin K, ethamsylate.

Trephining of the nasal bones is indicated when polyps extends upto the caudal aspect of the nasal septum.

Necrosis of the turbinate bone

Necrosis of the turbinate bone occurs occasionally in the horse but rarely in other species.

Etiology of Necrosis of the turbinate bone

The lesion is generally due to strangles, with an accumulation of pus in the folds of the bones.

Wound inflicted directly through the nostril or through the nasal bones followed by infection of the seat of injury.

It may be a complication of the root of a molar tooth in its vicinity.

Symptoms of Necrosis

Foetid purulent discharge, usually unilateral interference with respiration, manifested by a snuffling or roaring noise

Swelling in the nasal chamber, which may or may not be visible or palpable from nostril

Ulceration and discoloration of the bone which may be felt by fingers

Dullness on percussion of the affected region and swelling of the submaxillary lymphatic glands.

Treatment of Necrosis of the turbinate bone

Block the maxillary nerve and sedate the patient if necessary. It is also best to perform a tracheotomy.

Make a trephine opening where the nasal bones start to diverge and far enough from the median line to avoid injury to the nasal septum.

Cut the cartilaginous anterior end of the turbinate loose from its attachments anteriorly and with a nasal septum chisel cut the attachment.

Bleeding can be controlled by tamponing the cavity tightly with gauze. It is impossible to completely remove the ventral turbinate due to its anatomical location.

After operation, the affected region may be insufflated with iodoform powder or a mixture of it and boric acid once daily as a further antiseptic precaution.

Prognosis of Necrosis of the turbinate bone is favourable when the necrotic portion can be entirely removed.

Parasites in the nasal chambers

The only parasite Linguatula taenioides which is almost confined to the dog, being very rarely found in the horse, mule sheep and goat.

It may locate in any part of the nasal chamber but most commonly seen in the convolution of the ethmoid and in the cul-de-sac of the middle meatus.

The dog becomes infested by eating the viscera of herbivore, usually the sheep and rabbit, containing the larvae of the parasite.

Symptoms of Nasal parasites

The usual number of parasites is two that will cause no clinical signs but when they are more in number, they cause agitation of the host, the dog scratching his nose with his paws, sneezing frequently and sometimes showing aberrations simulating rabies.

There may be mucoid discharge from the nose, occasionally streaked with blood.

The parasites remain for months in the nose, eventually die or are expelled.

Diagnosis of Nasal parasites

Diagnosis of Nasal parasites is based on the following examination-

1. Direct finding the parasites and their eggs
2. Microscopic examination of nasal discharge

Differential diagnosis of Nasal parasites with nasal catarrh, distemper and rabies should be carried out.

Treatment of Nasal parasites

There is no successful treatment but supportive measurements are followed.

Snuff may be used to make the dog sneeze, with a view to causing expulsion of the pest.

In alarming condition, trephining the nose and remove the worms

Slightly irritating injections have been used with some success eg. Dilute solutions of ammonia or benzene. This may be introduced through the nostril or through an artificial opening, their object being to dislodge or destroy the parasites.

Traumatic wound and fracture of the nasal bones

Traumatic wound in the nostrils and fracture of the nasal bones are common surgical affections of nose in automobile accidents.

Management of traumatic wound and fracture of the nasal bones

A tracheotomy operation is performed to permit breathing as it is necessary to tamponade the nasal cavity to control haemorrhage.

Anaesthesia is achieved by blocking both maxillary nerves, if necessary sedate the patient with appropriate drugs.

A trephine opening is made on the median line of the face at the point where the nasal bones start to diverge from each other.

This is determined by placing the thumb and finger on either side of the nasal bones and passing them backward over the dorso-lateral surface.

A pair of compression forceps with jaws four inches long is inserted through the trephine opening and astride the nasal septum.

The points of forceps should reach the full width of the nasal septum and are then closed tightly.

The nasal septum is then divided anteriorly by a curved incision, leaving at least two inches of the septum to support the nostril.

Secure the cut end with a pair of forceps, then place a nasal septum chisel astride the septum and push it along the superior border of the nasal septum until the chisel comes in contact with the forceps, withdraw the chisel and insert in the same manner along the floor of the nostril, cutting the septum free from the vomer bone with a narrow chisel placed anterior to and in contact with the forceps, divide the septum transversely and remove the septum through the nostril.

Tamponade the nasal cavity tightly with antiseptic impregnated gauze. It is advisable to suture the nostrils shut to retain the tampon in position.

The tampon and trachea tube may be removed in 48 hours. After operation, nasal cavity may be irrigated with a mild antiseptic solution through the trephine opening.

Foreign body in Nasal Cavity

Rostral turbinate system helps in the filtering of direct entry of small foreign bodies and very rarely they get lodged in the nasal mucosa to cause inflammation.

Clinical signs of Foreign body

Clinical signs of Foreign body in animals are-

• Epistaxis
• Excessive sneezing
• Purulent discharge unilateral

Diagnosis of foreign body

• Direct visualization with magnification
• Otoscopy of the rostarl nasal passage.
• Radiography- plain and with contrast radiography

Treatment of foreign body

Removal of the foreign body depends on the space and location. If Rostral side foreign body, use of a small alligator forceps along with endoscope. if Caudal side foreign body, it may be embedded in the mucosa or free in the passage, use of a flexible endoscope.

Nasopharynx 2-4 mm diameter arthroscope or in large dogs with a bronchoscope can be used.

Surgical approach for foreign body removal

There are two surgical approach for foreign body removal in animals-

1. Dorsal approach
2. Ventral approach

Dorsal approach

Make a dorsal midline skin incision from the caudal aspect of the nasal septum to the medial canthus of the orbit. Explore both the sides of the nasal cavity.

A bone saw can be used to elevate the periosteal flap on the proposed entry.

Gently lavage the nasal passage and remove the foreign body. Bone flaps are sutured by 3-0 or 4-0 wire sutures. close the skin with apposition sutures.

Ventral approach

Make a midline incision in the hard palate. Elevate the muco-periostium, without damaging the palatine vessels and nerves. Extend the incision caudally to the soft palate.

Incise the palatine bone with rongeurs or power driven burr. Explore the nasal cavity. After removing the foreign body Close the nasal mucosa and oral mucosa with simple interrupted sutures.