The nose knows - Nasal disease in cats - Article 2

Oliver, a 7 year old male neutered DSH presented with a 12 month history of chronic foul smelling nasal discharge that started shortly after Oliver went missing for a period of several days. Oliver remained tight-lipped about his ordeal, which was suspected to have included some form of trauma. The discharge responded partially to antibiotics, but rather than being through the worst of it, Oliver’s problems were only just starting…

On examination Oliver had a foul smelling bilateral nasal discharge with no airflow through the right nares and reduced airflow through the left nares. Submandibular lymph nodes were moderately enlarged. On ocular examination retinal detachment, lens luxation and scarring was apparent. Oliver was admitted for rhinoscopy/CT of the nasal passage to identify the cause of the chronic nasal discharge.

A nasal flush was also planned. This can be performed with the flush flowing in either a normograde or retrograde direction. For a normograde flush a foley catheter is placed above the junction of the soft and hard palates and the balloon inflated. The head is tipped forward and the flush is injected into the catheter, flowing out of both nostrils (if patent). A retrograde flush is performed by first making sure the pharynx is well packed with gauze and the ET tube cuff is inflated. Saline is then flushed through the nostrils in a retrograde fashion.

A 50ml syringe is used with the tip of the syringe placed into the nostril so a partial seal is formed. Flushing in either direction can on occasion dislodge a foreign body or piece of tissue that can be sent for histopathology, so the exiting flush (either through the nostrils or into the pharynx) should be ‘strained’ through gauze to identify if this is the case. Flushing can also provide good therapeutic results with mucous and inflammatory/necrotic tissue being removed from the nasal tract.

Examination of the posterior nares revealed obstruction of the opening to the nares due to ventral deviation of the palatine bone.

CT was performed revealing a fracture of the maxilla and increased soft tissue opacity within the rostral nasal cavity. There were also small radio-dense opacities within the rostral nasal cavities and these were thought to be fractured pieces of the nasal turbinate bones. These small pathological changes would have been very difficult to identify on nasal radiographs, making me even more grateful for the use of an onsite CT in cases of nasal disease.

CT images of the caudal nasal cavity showed that the perpendicular wings of the palatine bone had become detached and deviated ventrally (thanks to Miller’s Guide for identification of that bone!).

3-D reconstruction of the caudal nasal cavity showed the obstruction caused to the posterior nares by the ventral deviation of the perpendicular wings of the palatine bone and also revealed a fracture of the hard palate.

Normograde nasal flush was performed and biopsies were taken from the rostral nasal passages. On histopathological examination of the biopsies acute suppurative rhinitis was identified with areas of necrotic and focally mineralised tissue. The likely cause of the pathological changes is blunt force trauma that occurred when Oliver went missing. The trauma resulted in sequestration of boney fragments of the nasal turbinates which became necrotic resulting in the chronic nasal discharge and foul smell.

Surgery to remove the necrotic nasal tissue was performed and Oliver is now reported to be doing well. We have seen him recently and he is much improved though is still in recovery.

Back