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Patient Preparation
Sternal recumbency places the patient is in a more ‘natural’ po- sition in relation to the viewing monitor. The head is propped up with either a sandbag, wedge foam protected with an inconti- nence pad, or rolled towel. A cut down needle cap6,7 is used as a speculum to allow for evacuation of infused fluids from the nose, to be directed out of the mouth.
A 1L bag of sterile saline is hung and connected to one of the stopcocks of the endoscope sheath. Another giving set can be attached to the egress stopcock and allowed to drain into the wet table or into a bucket. The endoscope unit is held in a ‘pistol’ position with the light guide cable pointing towards the ground. Continuous irrigation as will help magnify structures as well as remove discharge and haemorrhage that can obscure the view. Control of saline flow is best managed using the con- trol on the ingress port on the sheath.
Biopsy
The operator can collect biopsy using a pair of 3 mm rigid cupped biopsy forceps. These can be placed in a premeasured depth (not to exceed the length measured from the tip of nose to medial canthus of eye). Nasal samples with bone fragments/ spicules represent deep sampling technique which is necessary in many cases for an accurate diagnostic interpretation. Samples should be submitted for histopathology (+/- PARR), bacterial culture & sensitivity and aspergillosis culture if indicated.
Complications
Haemorrhage is the commonest complication of anterior rhinoscopy but is rarely long lasting or significant. Aspiration of fluid can be prevented by fitting an appropriately sized endotracheal tube and leaving adequate space for the free flow of irrigant fluid over the free edge of the soft palate and out through the mouth.
Conclusion
In conclusion, the author’s experience using rigid endoscopy has provided an easy and rewarding minimally invasive alternative to traditional diagnostic and surgical interventions for upper respiratory conditions. Endoscopy can be an extremely valuable and versatile part of clinician’s diagnostic and therapeutic armamentarium.
Suggested Reading:
1. Sobel, D. Upper Respiratory tract endoscopy in the cat: a minimally invasive approach to diagnostics and therapeutics J Feline Med Surg. 2013 Nov;15(11):1007-17.
2. Lhermette, P, Sobel, D. Rigid Endoscopy: Rhinoscopy. In Lher- mette P, Sobel D, editors: BSAVA Manual of Canine and Feline Endoscopy and Endoscurgery, Quedgeley, 2008, British Small Animal Veterinary Association.
3. Johnson, L.R., Foley, J.E., De Cock, H.E.V., Clarke, H.E., Maggs, D.J. Assessment of infectious organisms associat- ed with chronic rhinosinusitis in cats, J Am Vet Med Assoc 227, 2005, 579–585.
4. Michiels, L., Day, M.J., Snaps, M., Hansen, P., Clercx, C. A retrospective study of non-specific rhinitis in 22 cats and the value of nasal cytology and histopathology, J Feline Med Surg 5, 2003, 279–285
5. Caniatti, M., Roccabianca, P., Ghisleni, G., Mortellaro, C.M., Romussi, S., Mandelli, G. Evaluation of brush cytology in the diagnosis of chronic intranasal disease in cats, J Sm Anim Pract 39, 1998, 73–77
6. Barton-Lamb AL, Martin-Flores M, Scrivani PV, Bezuidenhout AJ, Loew E, Erb HN, Ludders JWEvaluation of maxillary arterial blood flow in anesthetized cats with the mouth closed and open.Vet J. 2013 Feb 7.
7. Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: twenty cases. Vet J. 2012;193(2):367-73. Epub 2012/03/03.
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