Vol. 22, No.
10 October 2000
CE Refereed Peer Review
FOCAL POINT
★ A thorough understanding of
feline upper airway obstructive
diseases and possible therapeutic
alternatives allows diagnosis and
treatment under the same
anesthetic episode, thereby
improving outcome.
KEY FACTS
■ Flexible endoscopy is valuable
for evaluating the choanae,
nasopharynx, and subepiglottic
areas.
■ Middle-ear evaluation is part of
the diagnostic approach for
nasopharyngeal polyps.
■ Nasopharyngeal stenosis is easy
to diagnose and carries a good
prognosis after surgery.
■ Treatment of granulomatous
laryngitis consists of surgery and
long-term antiinflammatory
therapy.
■ Unilateral arytenoid lateralization
provides excellent results in cats
with permanent laryngeal
paralysis.
Upper Airway
Obstruction in Cats:
Diagnosis and
Treatment*
University of Edinburgh
Dominique J. Griffon, DVM, MS, MRCVS
ABSTRACT: Clinical signs of upper airway obstruction provide valuable information regarding
the degree of airway compromise and the anatomic compartment involved but are not specific
to any disease process. The purpose of the diagnostic workup is to determine the extent and
nature of the condition. The extent of the physical examination depends on the degree of up-
per airway obstruction, and complete evaluation may need to be postponed until the patient is
anesthetized. However, rapid assessment of respiratory impairment is crucial because it al-
lows appropriate triage of patients. In cats with mild upper airway obstruction, radiographs of
the thoracic and cervical areas may be obtained with the patient either awake or under seda-
tion. A complete oral and laryngeal examination should be performed with the patient under
anesthesia. Additional tests may also be indicated. Manipulation of the upper airway in a com-
promised patient is likely to exacerbate signs; therefore, diagnostic tests and corrective
surgery should be scheduled under the same anesthetic episode. This article describes the
corrective surgical techniques for obstructive airway diseases. Although these techniques may
be technically demanding, they do not require specialized equipment and, depending on the
nature of the disease, often provide good results.
C
linical signs of upper airway obstruction are variable and not specific to
any disease process. Signs may help to localize disease, but a thorough di-
agnostic approach is needed to diagnose the condition. The severity of
signs will depend on the degree of functional obstruction and will dictate the
initial therapeutic approach. On presentation, triage should be conducted im-
mediately so that patient care can be prioritized accordingly. Cats with severe
upper airway obstruction should be anesthetized and intubated as quickly as
possible.1 Placement of a cricothyrotomy tube or emergency tracheostomy
should be limited to patients that cannot be intubated and that require bypass of
the larynx.
Diagnostic evaluation should be performed after respiratory function has im-
*A companion article entitled “Upper Airway Obstruction in Cats: Pathogenesis and
Clinical Signs” appeared in the September 2000 (Vol. 22 No. 9) issue of Compendium.
Small Animal/Exotics
proved. The physiologic re-
sponse to a stress-induced in-
crease in oxygen requirements
involves an acceleration of the
respiratory rate. This will exac-
erbate any preexisting compro-
mise of the upper airway and
may quickly result in a life-
threatening situation. For that
reason, handling of patients
with compromised airways
should be minimized, and most
diagnostic tests should be per-
formed while the patient is un-
der anesthesia. Routine hema-
tology and blood chemistry
should be performed before
anesthesia if the patient can
safely tolerate blood sampling.
Alternatively, analyses may be
postponed until the cat has
been sedated or anesthetized.
Because examination and intu-
bation of the upper airway may
exacerbate the obstruction and
complicate recovery, diagnostic
evaluation should be scheduled
when treatment of the condi-
tion may be achieved under the
same anesthetic episode. If this
is not possible, clinicians should
be prepared to place a tempo-
rary tracheostomy tube.
DIAGNOSIS
Physical Examination
The purpose of the initial ex-
amination is to assess the degree
of airway compromise. This can
be done from a distance by ob-
serving the attitude, posture,
breathing pattern, respiratory
rate, and color of mucous mem-
branes. A gentle physical exami-
nation and auscultation may
then be performed. Oxygen
therapy should be provided dur-
ing examination, if required.
Any step of the examination
that causes stress should be Figure 2—Otoscopic examination of a cat. (A) Normal
postponed until the cat is anes- transparent appearance of the tympanic membrane.
thetized and intubated.
Various tube types and sizes
HEMATOLOGY ■ AIRWAY COMPROMISE ■ NASOPHARYNGEAL POLYPS ■ OTITIS MEDIA
Figure 1—Intraoperative view of the nasopharynx of an
8-year-old cat with bilateral nasopharyngeal polyps
and nasopharyngeal foreign body. A ventral midline
approach through the soft palate was used.
Figure 2A
Figure 2B
(B) A nasopharyngeal polyp in the middle ear. The
mass can be seen behind the tympanic membrane.
Compendium October 2000
(including urinary catheters)
should be prepared to allow in-
tubation of a narrowed airway.
At this point, intravenous ad-
ministration of an ultra–short-
acting corticosteroid (e.g., 0.25
mg/kg of dexamethasone sodi-
um phosphate) is recommended
to minimize edema. Ideally, la-
ryngeal anatomy and function
should be evaluated before intu-
bation. This examination can be
performed with the patient un-
der light anesthesia, with simul-
taneous observation of the respi-
ratory cycle. After intubation,
the soft palate should be evaluat-
ed for any ventral deviation that
may be associated with nasopha-
ryngeal masses. Nasopharyngeal
polyps present as unilateral or
bilateral gray or pink masses
with a smooth or nodular sur-
face (Figure 1). Although they
often measure 1 to 2 cm in di-
ameter when diagnosed, polyps
may reach up to 5 × 2 cm. A
laryngoscope placed at the base
of the tongue facilitates inspec-
tion of the pharynx and larynx
for any mass, inflammation, or
foreign body. Gentle retraction
of the soft palate with a spay
hook or stay sutures provides ex-
posure of the caudal nasophar-
ynx. Otoscopic examination is
important in cats with nasopha-
ryngeal diseases and/or signs
of auricular disease. Auricular
discharge and rupture of the
tympanic membrane may be as-
sociated with otitis media. Oto-
pharyngeal polyps are some-
times seen through a bulging
tympanic membrane (Figure 2).
Cannulation of the nose with
a 6-Fr nasogastric tube should
be attempted in cats with sus-
pected nasal or nasopharyngeal
obstruction. In cats with na-
sopharyngeal stenosis, a cannu-
la can be advanced through the
nasal passages but stops before
Compendium October 2000 Small Animal/Exotics

reaching the laryngopharynx warranted in cats with nasal or

on both sides. Cannulation of nasopharyngeal disease, with
the nasal passages allows cau- or without auricular signs. Na-
dal displacement of nasopha- sopharyngeal polyps are best
ryngeal masses and, used in visualized on the lateral projec-
combination with cranial re- tion as a soft tissue density in
traction of the soft palate, im- the nasopharynx, displacing
proves their visualization. If the soft palate ventrally (Figure
no abnormality is found on 3). The best radiographic view
clinical and radiographic ex- to evaluate middle-ear disease
amination, further diagnostic is the open-mouth view.3 Ad-
tests (e.g., endoscopic exami- ditional views include oblique
nation of the subepiglottic views of the bullae and a ven-
area and nasopharynx) should Figure 3—Lateral radiograph of the skull of a cat with a trodorsal projection to assess
be considered. nasopharyngeal polyp. Note the soft tissue opacity over the external canal and petrous
the nasopharyngeal area and the ventral deviation of the temporal bone. Soft tissue
Radiography soft palate. opacity within the bulla and
Thoracic radiographs are thickening of the wall suggest
part of the routine evaluation middle-ear involvement. How-
of patients with respiratory ever, radiographic changes are
disease. Indeed, localization of inconsistent, especially early in
respiratory signs is not always the disease course, and false-
accurate. Symptoms of prima- negative radiographic diagnosis
ry lower respiratory tract dis- of otitis media has been report-
ease may be masked if pa- ed in up to 25% of the cases.3
tients suffer concurrent upper Computed tomography of the
airway obstruction. One ven- skull may be considered in the
trodorsal and two lateral pro- absence of radiographic signs
jections should be evaluated of middle-ear disease.4,5 Radio-
for metastases in cats suspect- graphic signs of nasopharyn-
Figure 4—Lateral radiograph of the skull of a cat with na-
ed of having laryngeal neopla- sopharyngeal stenosis. Note the dorsal deviation of the
geal stenosis are inconsistent.6,7
sia. Evaluation of the entire caudal edge of the soft palate. A dorsal deviation of the soft
respiratory tract is warranted palate may occasionally be seen8
to establish a treatment plan (Figure 4).
and prognosis.
Cervical radiographs are also indicated. Radiodense Endoscopy
foreign bodies (e.g., needles, pellets) are occasionally Endoscopic examination of the nasopharynx requires
found in cats. Radiographic signs of laryngeal neoplasia retroflexion of a flexible endoscope over the soft palate,
are variable. Feline laryngeal tumors may appear as a thereby allowing visualization of the entire nasopharynx
generalized thickening of the larynx rather than a dis- and choanae as well as the most caudal portion of the
tinct mass lesion.2 Tumors are best visualized by laryn- nasal cavities. By the time of presentation, nasopharyn-
goscopy. Conversely, radiographs are useful in localizing geal polyps tend to have reached such a significant size
mass lesions causing extramural compression of the lar- that endoscopic evaluation is rarely needed for diagno-
ynx. Soft tissue radiopacities are suggestive of tumors or sis. However, endoscopy is crucial for the diagnosis of
abscesses of the larynx and adjacent structures. Soft tissue nasopharyngeal stenosis, radiolucent foreign bodies, ab-
swelling, subcutaneous emphysema, and displacement of scesses, and neoplasia. In nasopharyngeal stenosis, adhe-
the tracheolaryngeal cartilages may be found in animals sions are occasionally located at the junction of the na-
with laryngeal trauma.1 In these cases, radiographs are sopharynx and laryngopharynx, preventing retroflexion
also helpful in assessing the status of the spine. of an endoscope over the soft palate. Cranial retraction
Whereas cervical and thoracic radiographs may be ob- of the soft palate allows direct visualization of the area.
tained using sedation in some patients, skull radiography The same flexible endoscope may be used to evaluate
is always performed while the patient is anesthetized in subepiglottic disorders. Foreign bodies are occasionally
order to ensure proper positioning. Skull radiography is found caudal to the larynx and may be retrieved endo-

CANNULATION ■ LARYNGOSCOPY ■ OPEN-MOUTH VIEW ■ SOFT PALATE

Small Animal/Exotics Compendium October 2000

COMPENDIUM
ON CONTINUING EDUCATION
scopically. Tracheoscopy will also improve visualization ®
F O R T H E P R A C T I C I N G V E T E R I N A R I A N
of subepiglottic tumors and facilitate biopsy.
Veterinary Technician reprints also available
Histopathology
Histologically, nasopharyngeal polyps consist of a 2001 PRICE SCHEDULE*
core of well-vascularized fibrous connective tissue cov- 2 4 8 12 16
ered by stratified squamous or columnar epithelium.9 Quantity pages pages pages pages pages
Inflammatory cells are especially prominent in the sub- Black & White
mucosa.10 However, a presumptive diagnosis of na- 100 $ 108 $ 204 $ 416 $ 604 $ 784
500 152 296 616 896 1,156
sopharyngeal polyp can usually be made on the basis of 1000 208 412 868 1,260 1,628
signalment, history, and the appearance of the mass. 5000 636 1,264 2,828 4,076 5,160
Preoperative biopsy is, therefore, not essential. Instead, 10,000 1,172 2,332 5,280 7,596 9,572
I recommend immediate surgical treatment and histo- Color
pathology of the excised tissue. Similarly, the gross ap- 100 $ 972 $1,408 $2,856 $4,180 $5,380
500 1,152 1,612 3,112 4,704 6,040
pearance of nasopharyngeal stenosis and abscesses is char- 1000 1,264 1,840 3,428 5,260 6,852
acteristic. 5000 2,328 3,600 7,140 10,672 12,168
Making a diagnosis of laryngeal masses requires 10,000 3,280 5,792 10,640 16,704 18,812
histopathology. Granulomatous laryngitis must be dif- *Price includes UPS Ground Shipping to one location.

ferentiated from neoplasia because the prognoses differ ORDER FORM

significantly. The inflammatory disorder clinically re- Quantity _____________ ❏ Black & White ❏ Color
sembles neoplasia but histopathologic findings consist ❏ With Review Questions ❏ Without Review Questions
of a mixed inflammatory cell infiltrate involving mac-
Author _________________________________________
rophages, lymphocytes, and plasma cells. Ulceration of
the epithelium is a common finding in humans and has Title of Article ___________________________________
also been described in cats.11 ______________________________________________
Histopathologic examination of frozen sections is help- From Vol. _________________ No. ______________
ful in the management of laryngeal masses. The test’s ac-
❏ Compendium ❏ Veterinary Technician
curacy was 93% in a study comparing the diagnoses
based on evaluation of frozen sections compared with tis- ❏ Payment Enclosed (All payments must be in US funds drawn
on a US branch of a US bank.)
sue prepared using conventional methods.12 Establishing
an intraoperative diagnosis provides a rational basis for ❏ Purchase Order Attached
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Phone __________________________________________
Other Tests
Cytologic examination of laryngeal masses may be at- SHIP TO:
tempted if frozen sections are not available. Inflammation NAME
may, however, be difficult to differentiate from neopla-
sia.13 Before recovery from anesthesia, a temporary tra- COMPANY OR PRACTICE

cheostomy should be considered to palliate the obstruc- ADDRESS

tion until a definitive diagnosis can be made. Cytology is
more useful in the diagnosis of fungal infections, where CITY STATE ZIP

organisms may be seen in the specimen. BILL TO:

Results of bacterial cultures should be interpreted in NAME
combination with other diagnostic tests. Although bacte-
rial infections may be clinically significant, they often are COMPANY OR PRACTICE

secondary to upper airway obstruction. ADDRESS

Ultrasonography is often used to evaluate patients that
present with cervical masses, to define the character of CITY STATE ZIP

the mass as well as the organ involved.14 Ultrasonography Detach and Mail to: Reprints Department
may be easier than is radiography to perform on sedated Veterinary Learning Systems
patients and may provide useful preoperative informa- 275 Phillips Boulevard
tion. Assessing the degree of vascularization and invasive- Trenton, NJ 08618
No telephone calls accepted.
ness of cervical masses will help in planning surgical

MACROPHAGES ■ TRACHEOSTOMY
Compendium October 2000 Small Animal/Exotics
Produce the ultimate
treatment and in anticipating complications. The ultra-
sonographic appearance of a laryngeal cyst has recently
in dental x-rays
been reported in a cat.15 Ultrasonographic evaluation
performed without sedation provided a preoperative
Atlas of Canine & Feline
diagnosis. Alternatively, cysts may be diagnosed by fine-
needle aspiration during laryngoscopic examination. Sur-
DENTAL RADIOGRAPHY
gical treatment may be performed under the same anes- Thomas W. Mulligan • Mary Suzanne Aller •
thetic episode. Charles A. Williams
Computed tomography helps delineate the extent of Mary Suzanne Aller, Editor
nasal and nasopharyngeal tumors and may be used to
evaluate middle-ear disease in cats with nasopharyngeal 248 pages, 846 radiographs with arrow
polyps.4,5 Electromyography and muscle biopsies are not overlays to indicate notable features
needed to diagnose laryngeal paralysis. They may, how-
ever, be indicated to evaluate other muscle groups in
cats with suspected generalized neuropathy.

TREATMENT
Nasopharyngeal Polyps
The timing of surgery and the techniques used will
depend on clinical presentation and the extent of dis-
ease. A ventral bulla osteotomy is indicated when evi-
dence of middle-ear disease is found. This may be per- RATED
formed first to remove all attachments of the polyp. ★★★★★
The septum dividing the bulla into a small ventromedi-
al and a large dorsolateral compartment must be re-
moved. 16 Care should be taken when curetting the
promontory to avoid damage to sympathetic fibers and
subsequent postoperative Horner’s syndrome.17 Cul-
$
80
tures can be obtained from the bulla during surgery,
and excised tissue can be submitted for histopathology.
$89
Secondary bacterial infection should be anticipated and
% off! First in the field
a broad-spectrum antibiotic administered intravenously
(e.g., cephazolin, 20 mg/kg). When a bacterium is iso-
0
1 846 reference radiographs
lated, postoperative antibiotherapy should be adjusted
according to sensitivity and continued for 3 weeks. A ■ Practical tips throughout
Penrose drain or a modified butterfly catheter connect- ■ More than 840 real-case images with indicative
ed to a vacutainer tube18 may be placed before closure arrows
of the surgical site to provide drainage and minimize ■ State-of-the-art techniques for the beginning
postoperative swelling. Primary closure has been found practitioner, technician, and specialist
to be as successful as is passive drainage after total ear
■ Precise information on positioning, supplies
canal ablation and lateral bulla osteotomy in dogs.19 Al-
and equipment, processing, safety, film
though no similar study has been performed in cats
with ventral bulla osteotomy, primary closure is an ac- handling, and more
ceptable option.
If a bulla osteotomy is not indicated, traction avul-
sion is used to remove polyps from the ear canal and/or
nasopharynx. A ventral midline approach through the VLS
VE T E R I N A RY
BOOKS
L E A R N I NG SYS T E M S
soft palate may be required if the nasopharyngeal polyp
cannot be retracted caudally (Figure 1).
CALL OR FAX TODAY TO ORDER
Nasopharyngeal Stenosis 800-426-9119 • Fax: 800-556-3288
Nasopharyngeal stenosis can be treated by resecting
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the membrane covering the internal nares; however, web- the Caribbean. Request international pricing.
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LARYNGEAL PARALYSIS ■ VENTRAL BULLA OSTEOTOMY

Small Animal/Exotics Compendium October 2000

bing may recur, especially if pri- Laryngeal Neoplasia

mary closure cannot be achieved Because laryngeal tumors in
and a mucosal defect is left to cats are rare and may not be re-
heal by second intention.20,21 Re- sectable by the time of presenta-
currence after bougienage has tion, information regarding surgi-
also been described.21 In humans, cal treatment is often scarce. Total
various techniques have been de- laryngectomy and permanent tra-
signed to try to prevent this com- cheostomy are techniques used in
mon complication after resection humans that have had limited use
of stenotic webs; surgical laser, in veterinary medicine.25,26 Laryn-
mucosal flaps, and airway stents geal lymphoma may have a better
have been used with variable suc- prognosis than squamous cell car-
cess.22 The use of a braided stain- cinoma and adenocarcinoma be-
less-steel stent did not resolve cause it may respond to chemo-
clinical signs in a cat with recur- therapy and radiation therapy.27–29
rent nasopharyngeal stenosis.21 However, I am not aware of any
This complication should be pre- study reporting treatment proto-
vented by reconstructing the mu- cols and survival times in cats with
cosal surface of the nasopharynx laryngeal neoplasms.
following excision of the stenosis. Even if the laryngeal neo-
If primary closure cannot be ac- Figure 5A plasm cannot be resected, a per-
complished, a nasopharyngeal ad- manent tracheostomy with or
vancement flap can be used.8 The without adjunctive treatment
mucosa and submucosa of the may be considered as palliative
dorsal laryngopharynx should be therapy for upper airway obstruc-
gently elevated (Figure 5). The tion. The technique for perma-
flap should be advanced and su- nent tracheostomy in cats is simi-
tured to the cranial edge of the lar to that in dogs.30,31 However, I
dorsal nasopharyngeal defect would recommend the use of a
(Figure 6). Primary closure of the rectangle rather than an oval tra-
soft palate can then be achieved cheostomy because the mucosa in
in a routine manner. cats is more delicate and difficult
to elevate from the tracheal rings
Granulomatous Laryngitis Figure 5B than that in dogs. Because laryn-
From the limited data avail- geal tumors may extend into the
able, combined medical and sur- Figure 5—(A and B) Surgical treatment of nasopha- trachea, the tracheostomy site
ryngeal stenosis. After excision of the membrane, a
gical treatment may be warranted should be positioned as distal as
mucosal flap is elevated caudal to the dorsal na-
to treat obstructive inflammatory sopharyngeal defect. (From Griffon DJ, Tasker S: possible. An H-shaped incision
laryngeal disease in dogs and Use of a mucosal advancement flap for the treat- should be made over four tra-
cats.23,24 Because no evidence for ment of nasopharyngeal stenosis in a cat. J Small cheal rings to create two full-
bacterial infection has been found, Anim Pract 41:71–73, 2000; with permission.) thickness tracheal flaps at both
the need for antibiotic treatment the cranial and caudal ends of the
in granulomatous laryngitis is incision (Figure 7). The tracheal
questionable.11 Antibiotic and corticosteroid treatment flaps should be raised, and a rectangle of skin and subcu-
alone provide only slight and temporary improvement.11 taneous tissue can be excised. The amount of tissue re-
Surgical excision of the proliferative laryngeal tissue by sected must be determined on an individual basis to allow
partial laryngectomy has been reported, but intermittent tension-free closure without obstruction by redundant
or long-term administration of prednisolone may be re- skin. Two longitudinal skin flaps should be elevated lat-
quired to control clinical signs after surgery.23 Permanent erally to the tracheostomy site. The width of these flaps
tracheostomy may be considered as a last resort. In con- should approximate the thickness of the subcutaneous
trast to laryngeal neoplasia, the long-term prognosis fol- tissue and trachea. The tracheal flaps are sutured to the
lowing treatment of proliferative inflammatory laryngitis skin to seal the cranial and caudal borders of the tra-
is good.11,23,24 cheostomy. Finally, the longitudinal skin flaps should be

STENOTIC WEBS ■ PREDNISOLONE ■ LARYNGECTOMY ■ TRACHEAL RINGS

Compendium October 2000 Small Animal/Exotics

Your comprehensive
brought in apposition with the incised mucosa at the lev-
el of the tracheal lumen. guide to diagnostic
Laryngeal Paralysis ultrasonography
Cats with cervical swelling resulting from trauma,
surgery, or neoplasia of adjacent structures may present Nautrup and Tobias
with neurapraxia of the recurrent laryngeal nerve. In
these cases, laryngeal paralysis can be temporary and sup-
portive treatment may be considered.32,33 Oxygen therapy
and temporary tracheostomy in combination with an an-
tiinflammatory dose of short-acting corticosteroids (e.g.,
dexamethasone sodium phosphate, 0.25 mg/kg twice/
day) are often required. This treatment should be discon-
tinued (within a week) after the swelling has decreased or
if the tracheostomy tube becomes nonfunctional. Cats
tend to produce more mucus than do dogs31 and I have
found maintenance of tracheostomy tubes beyond 3 days
difficult. If palliative treatment becomes impractical be-
fore laryngeal function is recovered, definitive repair is
recommended.
The three surgical procedures most commonly de- New
scribed for the treatment of laryngeal paralysis in dogs
include castellated laryngofissure, ventriculocordectomy
and partial arytenoidectomy, and unilateral or bilateral
arytenoid lateralization.34–36 Castellated laryngofissure is
technically demanding in dogs, and would be even more
so in cats, in which the thyroid cartilage may be too
small to create an adequate central cartilaginous flap.
$
149
Robert E. Cartee, Editor
Partial laryngectomy and vocal fold removal by an oral
approach has been used successfully in a few cats with la-
400 pages, hard cover
ryngeal paralysis.37–39 Although relatively simple, this 1597 illustrations
technique requires placement of a temporary tracheosto-
my tube37; complications, including postoperative ede- ■ Sonographic diagnosis in dogs and cats,
ma, aspiration, and laryngeal stenosis, are well recog- including ultrasound, M-mode, pulsed
nized in dogs.26,35,37
and color Doppler echography
Although unilateral arytenoid lateralization is techni-
cally more demanding, I prefer the procedure described ■ Echocardiography, abdominal and pelvic
by Lahue34 for treating cats with permanent laryngeal sonography, and fetal ultrasonography
paralysis. Unilateral arytenoid lateralization has previ-
ously been described in cats.40,41 Mobilization of the ■ Case illustrations using conventional
arytenoid cartilages seems subjectively easier in cats radiography, computed microfocal
than in dogs, possibly because cats lack an interary-
tomography, specimen photography,
tenoid cartilage. Transection of the interarytenoid liga-
ment is not warranted. Two 3-0 polypropylene sutures and line drawings
should be placed through the dorsocaudal edge of the ■ Recognition of the disease process and
cricoid. Alternatively, sutures may be placed through
the caudal cornu of the thyroid cartilage. In canine ca- courses of treatment
daver larynges, however, cricoarytenoid lateralization
techniques provided a greater increase in the size of the
glottic opening than did thyroid lateralization tech- CALL OR FAX TODAY TO ORDER
niques.40 Each suture passes under the caudal laryngeal 800-426-9119 • Fax: 800-556-3288
nerve and through the cricoarytenoid articular surface
Price valid only in the US, Canada, Mexico, and
or the muscular process of the arytenoid cartilage. The
the Caribbean. Request international pricing.
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OXYGEN THERAPY ■ THYROID CARTILAGE

Small Animal/Exotics
Figure 6A
Figure 6B
Figure 6—(A and B) Surgical treatment of nasopharyn-
geal stenosis. The mucosal flap is advanced cranially to
allow primary closure of the defect. (From Griffon DJ,
Tasker S: Use of a mucosal advancement flap for the
treatment of nasopharyngeal stenosis in a cat. J Small
Anim Pract 41:71–73, 2000; with permission.)
sutures are tied, moving the arytenoid cartilage caudally
and laterally. Based on the few reported cases as well as
my own experience, results have been excellent.40,41
Other Diseases
Nasopharyngeal foreign bodies can be removed using
cranial retraction of the soft palate or endoscopy. If a
nasopharyngeal abscess is present, a ventral midline ap-
proach through the soft palate is required to allow re-
moval of any foreign body, debridement, and lavage. A
ARYTENOID CARTILAGE ■ NASOPHARYNGEAL ABSCESS ■ BACTERIOLOGY
Compendium October 2000
Figure 7—Permanent tracheostomy. (A) Two incisions
are made perpendicular to the midline skin incision
(1) to create two skin flaps (2,3). (B) The trachea is
stabilized in a ventral position by suturing the ster-
nohyoid muscle to its lateral and dorsal wall. An H-
shaped incision is made through the ventral tracheal
rings to create two full-thickness tracheal flaps (1,2)
perpendicular to the skin flaps. (C) An open tra-
cheostomy. (D) The tracheal flaps (1,2) are externally
reflected and sutured to the skin. The free edges of the
skin flaps (3,4) are sutured to the incised mucosa at
the level of the tracheal lumen. (From Nelson AW:
Lower respiratory system, in Slatter D [ed]: Textbook
of Small Animal Surgery, ed 2. Philadelphia, WB Saun-
ders Co, 1993, p 793; with permission.)
ventral bulla osteotomy is indicated if the abscess is an
extension of otitis media. Excised tissue is submitted
for histopathology and bacteriology. Postoperative an-
tibiotherapy is prescribed for 3 weeks after surgery,
based on the sensitivity of the organism isolated.
Treatment of nasopharyngeal cryptococcosis includes
Compendium October 2000 Small Animal/Exotics

immediate physical dislodgment or debulking of the le-

Share Your
sion(s), followed by long-term systemic antifungal thera-
py.43 Cryptococcal granuloma can be flushed from the na-
Knowledge
sopharynx by inserting a cannula in each ventral nasal
meatus and injecting sterile saline under pressure. Gentle We invite you to impart your clinical knowledge
palpation of the mass through the soft palate facilitates by discussing your interesting cases, unusual
caudal mobilization. If the lesion(s) cannot be flushed, a
ventral midline approach through the soft palate allows presentations, or procedures for clinical solutions
surgical debulking. Antifungal therapy is prescribed for a
minimum of 6 months, based on sensitivity results. Of for the following features:
the five cats described by Malik and coworkers,43 four E
IC CHALLENG

were cured, based on resolution of clinical signs and de- DIAGNOST

rn on a Rat Po
isoning
Unexpected Tu
clining latex cryptococcal antigen agglutination titers. DIAGNOSTIC CHALLENGE By Marjory
Brooks, D.V.M
and Jeff Jacobs
on, D.V.M
.
., Dipl. A.C.V.
I.M.,

One cat, in which the nasopharyngeal mass had not been

was exam-
d male Beagle,
r-old, neutere Con-
ugsy, a four-yea n of the rat poison
M ined within one
hour of ingestio l placement

A detailed account of a clini- trac . Initial

®

of apomorphine
treatment consiste
and 30 mL of
d of subconjunctiva
oral hydrogen
therapy, Mugsy
peroxide to induce
vomited a large

removed, died of upper airway obstruction.43

e to this Addi-
vomiting. In
respons the rat bait.
identified as
lue material d charcoal by
gas-
amount of green-b mL of activate
nt included 200 neously (SC).
tional treatme 2.5 mg/kg subcuta

cal dilemma takes readers from

and vitamin K1 supply of
tric intubation with a 10-day
ed to his owners
Mugsy was discharg

Brachycephalic syndrome rarely warrants surgical

hours orally.
mg every 24
vitamin K1 50

SEALING ry
NS BY LES
blood chemist
nation. All
ILLUSTRATIO

for PT determi PT at recheck

specific patient presentation

hours later limits. The
d for 48 hours within normal because cor-
tion was schedule values were ted finding

treatment in cats, probably because of their sedentary na- A recheck examina vitamin K regimen to
confirm , an unexpec K deficiency
was 65.9 seconds al PT due to vitamin
ion of the owners report- initiating an
after complet Although his rection of abnorm 48 hours of
coagulopathy. and Mugsy within 24 to
resolution of K1 as directed should resolve K1. of
had given vitamin re to rat poison, clotting appropriate
dose of vitamin persistent prolongation
ed that they for reexposu y the cause of vitamin
nity was markedl To determi ne al
had no opportu time (PT) assay whether addition for more
prothrombin finding in the PT and
time in the : 9.5-12.5). This clotting time a sample was
sent

ture. The surgical correction of stenotic nares involves re- through the steps leading to the 57 seconds (normal d that his early pre- was needed, was drawn
prolonged at it appeare K therapy . Whole blood
ted because prevented ion analyses 3.8 percent
was unexpec vomiting had detailed coagulat anticoagulant (one part
productive Contrac, how- citrate ged, and the
sentation with of rodenticide. directly into and centrifu
a toxic dose poison. parts blood) cold packs to
a vet-
absorption of iolone, a long-acting K citrate to nine was shipped on tion
s bromad vitamin 1 plasma Coagula
ever, contain at the same supernatant (Comparative
therefore resumed e laboratory University,
Treatment was erinary referenc ory, Cornell

section of a wedge of epithelium and nasal cartilage and

two weeks. completion tic Laborat
dosage for another recheck, 48 hours after Section, Diagnos

ultimate diagnosis in 1000-1500

ed and d
At Mugsy’s next was still markedly prolong York). d of activate
Ithaca, New ion panel consiste
, the PT sample. A thrombin
of vitamin K1 from the previous The initial coagulattime (aPTT), PT, and g
unchanged vita-
essentially d, parenteral partial thrombo
plastin and TCT screenin
ry profile was submitte were (TCT). The aPTT
owners clotting time
blood chemist SC, and the
given 50 mg and recheck
48
min K1 was vitamin K1 August 2000

is similar to the procedure described in dogs. Excellent

resume oral
instructed to
ed
Peer Review

words. 76 Veterinary
Forum

responses have been reported in cats.44 THERAPEUTIC

Episodes of spontaneous laryngospasm may be inter-

CHALLENGE

rupted by injecting 1 to 2 ml of water into the cat’s THERAPEUTIC CHALLENGE

KAREN WILSON
Intussuscep
mouth44 to dislodge secretions accumulated in the lar- While the course of therapy is of- tio
In a Yearlin n
g
ynx and provoke a swallowing reflex, thus interrupting ten clear-cut, some patients pre-
By Linnea Lentz,
D.V.M.

B
the spasm. A short-term course of an antiinflammatory sent true challenges to medical
eau, a 15-mont
when the owners
described as mild,
nixine) administe
h-old colt, had been
called the referring
and Beau was treated
red intravenously
colicky for about
veterinarian. The
four hours

with 10 cc Banamin ®
colic was
e (flu-
and no other
ties. An initial
abnormali-
IV injection
of xylazine appeared

dose of prednisone may also be prescribed, if needed, to

(IV), 10 cc of control the pain to
approximately 1 dipyrone IV, and for only 20
⁄2 gallon of mineral minutes before
tube. Within the oil administered a second
hour, Beau was via nasogastric dose was necessary.
University of Minneso again colicky and Rectal
was referred to the palpation revealed

skills. In 1000-1500 words, these

ta. many
distended loops
of small
testine. After placemen in-
Initial Treatme

treat the associated pharyngitis.

a nasogastric t of
nt on Referra
Clinical signs l reflux were obtained. tube, 6-7 L of
on presentation Abdominocen-
included profuse tesis results were
sweating, numerous normal.
attempts to lie Because of the
down, and a distended severity of the
abdomen. Physical colic, the small
examination re- intestinal distention

cases describe the steps that

vealed a pulse and nasogastr ,
of 84 beats per ic reflux, we
decreased gastrointe minute, recom-

Laryngeal and branchial cysts are best treated by com-

mended explorato
stinal motility ry laparotomy
all four quadrants in diagnose the cause to
, slightly toxic of the colt’s colic.
cous membran mu- The owners quickly
es, a capillary agreed, and pre-
time of 2.5 seconds refill operative antibiotic
(normal: 1-2),
and a normal
temperature. potassium penicillin s, including
work revealed Blood 22,000 units/kg
a packed cell IV and Gentocin
volume (gentamicin) 6.6

eventually lead to case resolu-

of 48 percent mg/kg IV, were

plete surgical excision. An intraoral approach or a ventral

(normal: 32-48), administered before
protein of 7.2 g/dL total preparing the colt
(normal: 5.7-7.9), for surgery. During
surgery, a jejunocec
August 2000 al intussuscep-➔
Peer Reviewed
Veterinary Forum
73

laryngofissure may be used to reach and excise laryngeal tion.

cysts.15,45 The branchial cyst reported in a cat was de- CASE OF THE
MONTH

scribed as a large, cystic mass located in the cervical re- Canine Hemipares
is , D.V.M.

CASE OF THE MONTH

By Donivan Hudgins

gion, displacing the larynx and trachea.46 A ventral mid-

line cervical approach provided enough exposure for Some case presentations are so J asmine, a four-year-
kg, spayed Golden
old, 29-
Retriev-
to the clinic
activity levels
and vaccinations
for distemper,
had been normal,
were current
hepatitis, lep-
nza, par-
er, was presented tosporosis, parainflue

dissection and removal of the mass. Prognosis after exci-

of lameness. irus, Lyme
for sudden onset vovirus, coronoav

confounding that both diagnosis

found a stray
The owner had sus- disease, and rabies.
and given Solu
goat in the backyard The patient was
goat may have ® (prednisolone)
pected that the Delta Cortef
On presenta- usly (IV) and
butted Jasmine. ry 100 mg intraveno 2.5 cc in-
was ambulato
tion, the dog amoxicillin injectable

sion of laryngeal and branchial cysts is excellent.

uncoordi nated, The owner was
but obviously tramuscularly.
n revealed the provide cage rest
and observatio instructed to

and therapy are perplexing. Often,

deficit was in and return
primary walking over the weekend
dog’s condition
the right rear leg. ion re- Monday if the
Physical examinat .
had not improved
re of 101.6˚F, week, Jas-
vealed a temperatu The following

The treatment and prognosis associated with extra-

es, capil- to improve, and
membran
CORBIS

pink mucous mine appeared

of 1 sec (normal: she did have
lary refill time whatever problems
heart and Over the next
1-2 sec), normal seemed subtle.

a patient may return again and

sign of pain. The weeks, her prob-
lungs, and no two to three
did knuckle over, but not as pro-
right rear foot proprio- lems recurred the
indicating decreased indicat- before, and
nounced as dog

mural compression of the upper airway depend on the

toe pinch that the
ception, but owner reported
were intact. to her deficits.
ed sensory nerves seemed to adjust
of the affected next few weeks,
Temperatures Then, over the
no different of coördination
foot and leg were Jasmine’s lack

again with continuously changing

other three feet
than that of the seemed to worsen.
and flexion 21, Jasmine
and legs. Extension were On October

nature and location of the disease. The cat with retro-

and hip joints ted for examina-
of the stifle reflex on was re-presen
on a leash
normal, but patellar tion. When followed appeared
exaggerated,
the right was in the lawn, Jasmine
upper motor ated, with
which suggested to be very uncoördin
Appetite and
neuron disease.

pharyngeal plexiform vasculopathy was cured after exci- signs. Word count: 1000-2000. 66 Veterinary Forum
Peer Reviewed
August 2000

sion of the affected lymph node.47

CONCLUSION
An initial evaluation of cats with upper airway ob-
struction should be used to assess the degree of respira- SEND YOUR ARTICLES TO:
tory impairment and allow appropriate triage. A good
Editor, Veterinary Forum
understanding of the epidemiology and pathophysiolo-
gy of upper respiratory obstructive disease in cats allows 275 Phillips Blvd.
clinicians to establish and prioritize a list of differentials. Trenton, NJ 08618
However, the selection, timing, and sequence of diag-
Fax: (609) 882-6357
nostic tests also depend on the severity of airway com-
promise and the personality of the cat. E-mail: lmiller.vls@medimedia.com

BRACHYCEPHALIC SYNDROME ■ LARYNGOSPASM

Small Animal/Exotics
After the nature, location, and extent of the disease
have been identified, treatment options and prognosis
can be discussed. When possible, diagnostic tests and
corrective surgery should be performed during the same
anesthetic episode to facilitate recovery. Some diseases
(i.e., nasopharyngeal stenosis, abscesses and cryptococ-
cosis, laryngeal cysts, granulomatous laryngitis) are un-
usual but carry a good to excellent prognosis if recog-
nized early and treated appropriately. When surgery is
indicated, successful outcome will depend on appropri-
ate surgical technique as well as anticipation of potential
complications and postoperative monitoring.
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About the Author
Dr. Griffon is affiliated with the Department of Small Ani-
mal Surgery, Hospital for Small Animals, University of Ed-
inburgh, United Kingdom. She is a Diplomate of the Amer-
ican College of Veterinary Surgeons and the European
College of Veterinary Surgeons.