Nasal sx is uncommon nasal trauma most common - bite wounds; bloody, edema, heals well b/c good vascular supply teeth went in just behind nasal platum will heal, suture in place - don't forget to place stents in nostrils! will develop stenosis! keep stents in as long as possible all tissues - once stent removed, lumen will become smaller, so place largest possible (treat as traumatic wound, often will not need to do more than debride) nasal planum resection usually for cancer SCC is actinic caused by sunlight! kept indoors, no cancer; given sunscreen, no cancer will become large locally invasive unoperable CT/MRI to find extent of tumor margins, don't cut off more nose than necessary complete nasal planum resection is more cosmetic than unilateral "cinch" - simple continuous suture that goes around something post op, can see septum, NBD less pretty in dogs, esp extensive resection take of nasal planum, remeasure dorsally, anchor skin to periosteum ventrally, soft tissue closure stents (if tolerated) complications (both pictured) (only really in dogs): dehiscence & stenosis reop only if mouth-breathing nonsurgical dzz: rhinitis/sinusitis in cats - not treated surgically fungal diseases in dogs - antifungal drugs nasal FB can usually be removed without sx IF removed right away - deep plane of anx to overcome sneezing reflex - look with otoscope, extract with alligator forceps - make sure you have FB and not nasal mucosa! profuse bleeding, have to wake up and try again later - granulomatous tissue surrounding FB, cannot viddy on scope, req sx choana can only be seen with scope neoplasia - most are radiation sensitive - one of the few "long nosed" dog diseases (poodles) - may cause epistaxis, uni or bilateral (if crossing septum) - tend to be Cd in nasal cavity - most do better without sx, just irradiation - can debulk then irradiate - usually not so big how to get in there (3 ways) "dorsal" - incise dorsal midline of muzzle, skin flap, cut bone so it stays attached rostrally; best to bevel to outside is bigger & won't fall through, if not secure drill holes and secure with wire - access most of nasal cavity & sinuses "ventral" - through hard palate "rostral" - easy but few applications; thing rostral in nasal cavity - "oral approach to nasal cavity" brachycephalic airway syndrome congenital problems -> turbulence -> 2ry problems stenotic nares - most significant nasal cavity not long enough soft palate probs congenital (too long) and acquired (edema) hypoplastic trachea - bulldog prob (small trachea on palpation) everted laryngeal saccules = end stage larynx stertor is snoring noise associated with elongated soft palate NEVER put a muzzle on a bulldog - can die acutely stenotic nares esp cause incr turbulence; can prevent devestating 2ry abnormalities, but cannot show watch nares as dog breathes, easy dx ruleout neoplasia, can cause some of these clinical signs light anex, mouth gag for next step no treatment for hypoplastic bronchi severe edema tonsils - otomy complete tracheostomy - bulldogs are poor candidates start with primary problems anesthesia difficult - esp bulldog that has already collapsed - restore condition first nares normal: alar wing and fold drawn laterally with exercise (alar fold is tissue just inside alar wing) stenotic nares handled better by cats; squisher dogs tend to be excitable opening nostrils, go a long way in helping thing don't need to wait! 3-6 months

sx: open nostrils wedge resection dorsolateral - pin alar fold to face alapexy - similar, different pin location horizontal wedge depending on shape, dorsal would not work not superficial - go all the way back (most common mistake!) lateralize alar fold quick and easy, use #11 scalpel blade, will bleed dorsolateral wedge resection surgeon's choice cut out slice, suture back alar wing amputation entire alar wing; best done with laser alapexy salvage procedure, once other techniques fail "attaching something by permanent adhesion" suture to face itself, lateral (lil ventral); not dorsal where some structure looks like it would work soft palate function: prevents aspiration when swallowing excess covers glottis/epiglottis when trying to breathe muscles relax during anx, can see always extubate before cutting palate, prevent aspiration must evaluate length before tube in place 1. clamp & cut where clamped; reduce hemorrhage, holds in place 2. freehand with scalpel 3. freehand with laser (use ETT designed to be used with a laser!) too short on sides -> aspiration problems (better to err on the conservative side) palatectomy clamp (crush) technique grasp tissue from side to center make cut, bite suture (control hemorrage) freehand grasp center of soft palate (tissue to be removed, normally would not handle tissue this way) any suture no smaller then (3) laser freehand no blood loss (no need to suture) must go more slowly than with scalpel less inflammation, probably less postop discomfort "secondary changes" L: edema R: everted saccules! ....more stenosis everted laryngeal saccules/laryngeal collapse stage II: no moving arytenoid out of the way stage III: collapse in DV direction; not enough intrgrity of cartilage to ___, nothing wrong with muscles or nerve, but cartilage becomes weak after years of turbulence arytenoidectomy, ventriculocordectomy biopsy clamp thing - good hemostasis leave several mm of tissue at the base on each side permanent tracheostomy always salvage procedure, done when no other choice bulldogs poor candidates 1. (hypoplastic trachea) 2. lots of skin folds on neck laryngeal paralysis NAVLE trivia: which laryngeal mm is not innervated by recurrent laryngeal n? most important: crico dorsalis b/c motors __ most common: idiopathic, probably b/c generalized NM dz (laryngeal paralysis often first presenting problem) (watch for megaesophagus!) neck sx always risks traumatizing nerve most always bilateral in dogs, silent (stridor on inspiration, may req exercise) "bark sounds different" "cough while eating/drinking" => already aspiration, probably has progressed, more likely to apiration pneumonia with sx

change in temperature (gets hot) -> labs SOB, collapse crisis: temp & O2! icepacks in groin and axilla (vessels closest to skin here), will continue to drop in temp after ice removed! larynx don't close completely/seal off; oxygen mask works good sedative? ace - why? vasodilation of peripheral vessels (a2 blockage!) last resort: tracheostomy! easy to do, difficult to monitor and remove cats: congenital, with brain lesion, age-related change aspiration probs more difficult to mng in cats "respiratory noises on inspiration & exercise intolerance" thoracic rads! 10yo labs also have cancer ("stridor not dyspnea") standard of dx: laryngoscopy - watch larynx - req anesthesia w/o ETT not as critical anx patients as bulldogs, but usually geriatric (neurologist competancy: EMG, NCV) other things mimic LP - resp stridor, L side arytenoid not contracting, chondroma of larynx preventing contraction laryngoscopy doxapram if dog not breathing well normally cartilages drawn apart on inspiration see vibrating movements of cartilage edema of soft tissue b/c trouble breathing img: appreciated edema, is full inspiration no medical treatment unilateral arytenoid lateralization sx: arytenoid lateralization or "tieback" not bilateral!!! keep cuff inflated in case of hemorrage to prevent aspiration lateral approach b/c that's what everyone does cartilage covered by mm - must know anatomy well ... retract thyroid cartilage to see arytenoid process need to cut crico dorsalis, but leave stump attached to arytenoid cartilage suture ...past dorsal border of crocoid cartilage... what suture? nonabsorbable (prosthesis! nothing healing) proline: strong, noninflammatory, good needle for this procedure don't break cartilage! artenoids already spread by ETT; do not suture as far as possible or will aspirate - tie as is - close thyropharyngeal mm img "1" what it should look like - no wider left handed - do right side - easier to pass suture same img as before - (postop relaxed soft palate) double size from resting position (lower right - too wide) feel meatballs - soft not sloppy 1/4 aspirate; can happen at any time; v treatable detected immediately develop neuro problems -> aspiration very likely bite cartilage well, not at the edge stridor afterwards => not wide enough good neuro exam ahead of time, PE partial laryngectomy why ... stage 3 larygngeal collapse? => cartilage is not healthy, is soft, (tie lateral-ventral, not dorsal) evalulate cartilage carefully combo stage II collapse without stage I (b/c no everted laryngeal saccules) cuneiform cartilages moved ventral normally with collapse (see drawing on R)