CASE REPORTS
An Unusual Case of a Nasal Foreign Body in a Cat with Chronic Nasal Discharge Emma Bellei, PhD, DVM, Luciano Pisoni, PhD, DVM, Monika Joechler, PhD, DVM, Marco Pietra, PhD, DVM
ABSTRACT This report describes a cat infected with the feline infectious virus and a 1 yr history of unilateral mucopurulent nasal discharge. Intraoral radiography and endoscopic examination revealed the presence of a large fragment of tooth root in the right nasal cavity. The cat had previously undergone maxillary canine tooth (104) extraction. The root was successfully removed by an endoscopic-assisted procedure, and follow-up examination 1 yr later documented complete disappearance of the respiratory signs. (J Am Anim Hosp Assoc 2015; 51:249–251. DOI 10.5326/JAAHA-MS-6112)
Introduction
Case Report
Chronic nasal discharge is a frequent clinical sign in cats.
An 8 yr old intact male cat presented with a 9 mo history of
Underlying causes include periodontal disease; anatomical defects
unilateral mucopurulent nasal discharge. The owner reported that
(e.g., stenotic nares, cleft palate); viral, bacterial, or fungal
the cat had previously undergone professional dental cleaning.
infections; inflammatory and allergic rhinitis; foreign bodies; nasal
During that procedure, tooth 104 (which had a complicated
neoplasia; and nasopharyngeal polyps.
fracture) was extracted because of chronic sneezing and unilateral
A gold standard diagnostic approach has not been described in the literature. As such, the integration of history, clinical examination, diagnostic imaging (e.g., radiography, computed tomography, MRI, rhinoscopy), and histological evaluation of biopsies are essential to achieve a specific diagnosis. In cats, the most frequent causes of chronic nasal discharge are chronic rhinitis and neoplasia, while nasal foreign bodies are not as common as in dogs.1,2 In particular, the most common foreign bodies described in cats are needles, stones, air gun pellets, and grass blades.2
nasal discharge. Postoperatively, the cat was prescribed amoxicillin trihydrate/clavulanate potassiuma (12.5 mg/kg per os q 12 hr for 3 wk). The owner did not report the use of any pain medication after the procedure. After an initial remission of nasal discharge, the cat began showing the same signs 1 mo later that had originally led to the first clinical examination. The cat was then referred. At the time of referral, the cat had right unilateral mucopurulent nasal discharge and sneezing (Figure 1A). A unilateral obstruction of nasal airflow was assessed using a cotton ball wisp that showed no air movement through the right nostril. Oral examination revealed the absence of 104 and of the right
This case report describes the diagnosis and treatment of a
maxillary second premolar tooth (106). In addition, the left
complication associated with a right maxillary canine tooth (104)
maxillary canine tooth (204) was fractured to the gum line, the
extraction in a cat. Please note throughout the manuscript, first
right maxillary first, second, third incisors (101, 102, and 103) and
mention of the patient’s teeth include both the verbal description
the left maxillary first, second, and third incisors (201, 202, and
with the associated number (based on the modified Triadan
203) were missing, the right mandibular first and third incisors
system) in parentheses. Subsequent reference to the teeth is by
(401 and 403) were absent, the left mandibular second incisor (302)
number only.
was absent, and the right and left mandibular canines (404 and 304,
From the Department of Veterinary Medical Sciences, Bologna University, Bologna, Italy. Correspondence: [email protected] (E.B.)
Q 2015 by American Animal Hospital Association
JAAHA.ORG
249
FIGURE 2
A: Root fragment of the right maxillary canine, (104,
on the left) and root of the left maxillary canine tooth after extraction (204, on the right). B: Intraoral radiograph obtained postoperatively. cavity was mobile, and an attempt to remove the foreign body with flexible grasping forcepsd was successful. A: Photograph of the unilateral nasal discharge from
After removing the root fragment from the nasal cavity,
the right nostril of the cat. B: Intraoral picture of the cat. Note the
standard surgical extraction and mucogingival flap closure of the
persistence of the left maxillary canine (204) root. C: Intraoral
extraction site of 204 was performed (Figure 2). Following the
dorsoventral radiograph of the nasal cavities. D: Fragment of the right
request of the owner, no treatment of the other teeth was
canine root (104) retropulsed in the nasal cavity.
performed. The cat was hospitalized for 2 days until a visible
FIGURE 1
respectively) had complicated fractures (Figure 1B). Gingivitis and a small fistula were detected in the area of tooth 104. Laboratory blood tests showed neutrophilic leukocytosis, increased total protein with a low albumin/globulin ratio, and the cat tested positive for the feline immunodeficiency virus. Under general anesthesia, after orotracheal intubation, a
reduction in nasal discharge was seen. Amoxicillin trihydrate/ clavulanate potassium (12.5 mg/kg per os q 12 hr) was administrated for 10 days. Pain was controlled with a single dose of meloxicame (0.05 mg/kg subcutaneously) and buprenorphinef (0.01 mg/kg sublingually q 8 hr for 3 days) after surgery. The 1 yr follow-up examination documented a complete disappearance of the respiratory signs.
dorsoventral intraoral radiograph was obtained and the area was examined via a retrograde approach through the nasopharynx with
Discussion
a flexible bronchoscope measuring 6 mm in diameter and 1050 mm
Several conditions are associated with nasal discharge in cats,
b
in length . Afterwards, the pharynx was packed with cotton swabs
particularly in cats that are positive for the feline immunodefi-
to prevent fluid aspiration and a rigid endoscope with a 2.7 mm
ciency virus, which is a condition that may promote infections and
diameter, a 08 angle, and a length of 19 cm was used to examine the
neoplasia.1 Rhinitis due to a foreign body, represented by a dental
area via an anterograde approach.
root, possibly retropulsed into the nasal cavity during the
c
The dorsoventral radiograph of the nasal cavities revealed retropulsion of a root fragment of 104 into the nasal cavity; wide pulp chambers of the canine teeth; and the retained roots of 102, 103, 201, and 202. A large periapical radiolucency and widened periodontal ligament was also associated with 204 (Figure 1C). Periapical radiolucency was also associated with 304 and 404. Retrograde endoscopy showed purulent exudate in the nasophar-
extraction attempt, is less frequently reported. Complications associated with tooth extraction have an incidence that has not been established in veterinary dental practices of small animals.3 Only a few cases are well described in the literature, and those cases are mainly reported in dogs.3,4 Usually, dislocation of a root or a root tip in the nasal cavity arises when a periapical lesion is present and/or when excessive apical force is employed during an extraction attempt.5
ynx. The anterograde approach revealed a dilation of the right ventral meatus that appeared to be completely filled by a foreign
Conclusion
body consisting of a fragment of tooth root that was rotated in the
In this case, radiography, one of the most commonly used
transverse direction, occluding the meatus (Figure 1D). The
diagnostic methods in investigation of cats with chronic nasal
mucosa around the foreign body was reddened and showed edema.
signs, was able to demonstrate the presence of the dental structure.
The left nasal cavity was within normal limits. The root in the nasal
Rhinoscopy had excellent sensitivity and proved diagnostic as well
250
JAAHA
|
51:4 Jul/Aug 2015
Nasal Foreign Body in a Cat
as therapeutic. Rhinoscopy also decreased the duration of surgery,
REFERENCES
certain risks associated with surgery (such as excessive hemorrhage
1. Demko JL, Leah A. Chronic nasal discharge in cats: 75 cases (1993– 2004). J Am Vet Med Assoc 2007;230:1032–7. 2. Henderson SM, Bradley K, Day MJ, et al. Investigation of nasal disease in the cat-a retrospective study of 77 cases. J Fel Med Surg 2004;6:245–57. 3. Taylor TN, Smith MM, Snyder L. Nasal displacement of a tooth root in a dog. J Vet Dent 2004;21:222–5. 4. Kang MH, Lim CY, Park HM. Nasopharyngeal tooth foreign body in a dog. J Vet Dent 2011;28:26–9. 5. Lommer MJ. Complications of extractions. In: Verstraete FJM, Lommer MJ, eds. Oral and maxillofacial surgery in dogs and cats. Amsterdam (the Netherlands): Saunders Elsevier; 2012:153–9. 6. Mathews KG. Oral approaches to the nasal cavity and nasopharynx. In: Verstraete FJM, Lommer MJ, eds. Oral and maxillofacial surgery in dogs and cats. Amsterdam (the Netherlands): Saunders Elsevier; 2012:547–51.
and subcutaneous emphysema), and decreased the time of hospitalization.6
FOOTNOTES a
Synulox; Pfizer Italia Srl, Roma, Italy
b
Pentax EG 1840; Pentax Medical, Milano, Italy
c
Telescope 64109 AA; Karl Storz Endoscopia Italia S.r.l., Verona, Italy
d
67161T; Karl Storz Endoscopia Italia S.r.l., Verona, Italy
e
Metacam; Boehringer Ingelheim, Ingelheim am Rhein, Germany
f
Temgesic; Schering-Plough SpA, Milano, Italy
JAAHA.ORG
251
An Unusual Case of a Nasal Foreign Body in a Cat with Chronic Nasal Discharge Emma Bellei, PhD, DVM, Luciano Pisoni, PhD, DVM, Monika Joechler, PhD, DVM, Marco Pietra, PhD, DVM
ABSTRACT This report describes a cat infected with the feline infectious virus and a 1 yr history of unilateral mucopurulent nasal discharge. Intraoral radiography and endoscopic examination revealed the presence of a large fragment of tooth root in the right nasal cavity. The cat had previously undergone maxillary canine tooth (104) extraction. The root was successfully removed by an endoscopic-assisted procedure, and follow-up examination 1 yr later documented complete disappearance of the respiratory signs. (J Am Anim Hosp Assoc 2015; 51:249–251. DOI 10.5326/JAAHA-MS-6112)
Introduction
Case Report
Chronic nasal discharge is a frequent clinical sign in cats.
An 8 yr old intact male cat presented with a 9 mo history of
Underlying causes include periodontal disease; anatomical defects
unilateral mucopurulent nasal discharge. The owner reported that
(e.g., stenotic nares, cleft palate); viral, bacterial, or fungal
the cat had previously undergone professional dental cleaning.
infections; inflammatory and allergic rhinitis; foreign bodies; nasal
During that procedure, tooth 104 (which had a complicated
neoplasia; and nasopharyngeal polyps.
fracture) was extracted because of chronic sneezing and unilateral
A gold standard diagnostic approach has not been described in the literature. As such, the integration of history, clinical examination, diagnostic imaging (e.g., radiography, computed tomography, MRI, rhinoscopy), and histological evaluation of biopsies are essential to achieve a specific diagnosis. In cats, the most frequent causes of chronic nasal discharge are chronic rhinitis and neoplasia, while nasal foreign bodies are not as common as in dogs.1,2 In particular, the most common foreign bodies described in cats are needles, stones, air gun pellets, and grass blades.2
nasal discharge. Postoperatively, the cat was prescribed amoxicillin trihydrate/clavulanate potassiuma (12.5 mg/kg per os q 12 hr for 3 wk). The owner did not report the use of any pain medication after the procedure. After an initial remission of nasal discharge, the cat began showing the same signs 1 mo later that had originally led to the first clinical examination. The cat was then referred. At the time of referral, the cat had right unilateral mucopurulent nasal discharge and sneezing (Figure 1A). A unilateral obstruction of nasal airflow was assessed using a cotton ball wisp that showed no air movement through the right nostril. Oral examination revealed the absence of 104 and of the right
This case report describes the diagnosis and treatment of a
maxillary second premolar tooth (106). In addition, the left
complication associated with a right maxillary canine tooth (104)
maxillary canine tooth (204) was fractured to the gum line, the
extraction in a cat. Please note throughout the manuscript, first
right maxillary first, second, third incisors (101, 102, and 103) and
mention of the patient’s teeth include both the verbal description
the left maxillary first, second, and third incisors (201, 202, and
with the associated number (based on the modified Triadan
203) were missing, the right mandibular first and third incisors
system) in parentheses. Subsequent reference to the teeth is by
(401 and 403) were absent, the left mandibular second incisor (302)
number only.
was absent, and the right and left mandibular canines (404 and 304,
From the Department of Veterinary Medical Sciences, Bologna University, Bologna, Italy. Correspondence: [email protected] (E.B.)
Q 2015 by American Animal Hospital Association
JAAHA.ORG
249
FIGURE 2
A: Root fragment of the right maxillary canine, (104,
on the left) and root of the left maxillary canine tooth after extraction (204, on the right). B: Intraoral radiograph obtained postoperatively. cavity was mobile, and an attempt to remove the foreign body with flexible grasping forcepsd was successful. A: Photograph of the unilateral nasal discharge from
After removing the root fragment from the nasal cavity,
the right nostril of the cat. B: Intraoral picture of the cat. Note the
standard surgical extraction and mucogingival flap closure of the
persistence of the left maxillary canine (204) root. C: Intraoral
extraction site of 204 was performed (Figure 2). Following the
dorsoventral radiograph of the nasal cavities. D: Fragment of the right
request of the owner, no treatment of the other teeth was
canine root (104) retropulsed in the nasal cavity.
performed. The cat was hospitalized for 2 days until a visible
FIGURE 1
respectively) had complicated fractures (Figure 1B). Gingivitis and a small fistula were detected in the area of tooth 104. Laboratory blood tests showed neutrophilic leukocytosis, increased total protein with a low albumin/globulin ratio, and the cat tested positive for the feline immunodeficiency virus. Under general anesthesia, after orotracheal intubation, a
reduction in nasal discharge was seen. Amoxicillin trihydrate/ clavulanate potassium (12.5 mg/kg per os q 12 hr) was administrated for 10 days. Pain was controlled with a single dose of meloxicame (0.05 mg/kg subcutaneously) and buprenorphinef (0.01 mg/kg sublingually q 8 hr for 3 days) after surgery. The 1 yr follow-up examination documented a complete disappearance of the respiratory signs.
dorsoventral intraoral radiograph was obtained and the area was examined via a retrograde approach through the nasopharynx with
Discussion
a flexible bronchoscope measuring 6 mm in diameter and 1050 mm
Several conditions are associated with nasal discharge in cats,
b
in length . Afterwards, the pharynx was packed with cotton swabs
particularly in cats that are positive for the feline immunodefi-
to prevent fluid aspiration and a rigid endoscope with a 2.7 mm
ciency virus, which is a condition that may promote infections and
diameter, a 08 angle, and a length of 19 cm was used to examine the
neoplasia.1 Rhinitis due to a foreign body, represented by a dental
area via an anterograde approach.
root, possibly retropulsed into the nasal cavity during the
c
The dorsoventral radiograph of the nasal cavities revealed retropulsion of a root fragment of 104 into the nasal cavity; wide pulp chambers of the canine teeth; and the retained roots of 102, 103, 201, and 202. A large periapical radiolucency and widened periodontal ligament was also associated with 204 (Figure 1C). Periapical radiolucency was also associated with 304 and 404. Retrograde endoscopy showed purulent exudate in the nasophar-
extraction attempt, is less frequently reported. Complications associated with tooth extraction have an incidence that has not been established in veterinary dental practices of small animals.3 Only a few cases are well described in the literature, and those cases are mainly reported in dogs.3,4 Usually, dislocation of a root or a root tip in the nasal cavity arises when a periapical lesion is present and/or when excessive apical force is employed during an extraction attempt.5
ynx. The anterograde approach revealed a dilation of the right ventral meatus that appeared to be completely filled by a foreign
Conclusion
body consisting of a fragment of tooth root that was rotated in the
In this case, radiography, one of the most commonly used
transverse direction, occluding the meatus (Figure 1D). The
diagnostic methods in investigation of cats with chronic nasal
mucosa around the foreign body was reddened and showed edema.
signs, was able to demonstrate the presence of the dental structure.
The left nasal cavity was within normal limits. The root in the nasal
Rhinoscopy had excellent sensitivity and proved diagnostic as well
250
JAAHA
|
51:4 Jul/Aug 2015
Nasal Foreign Body in a Cat
as therapeutic. Rhinoscopy also decreased the duration of surgery,
REFERENCES
certain risks associated with surgery (such as excessive hemorrhage
1. Demko JL, Leah A. Chronic nasal discharge in cats: 75 cases (1993– 2004). J Am Vet Med Assoc 2007;230:1032–7. 2. Henderson SM, Bradley K, Day MJ, et al. Investigation of nasal disease in the cat-a retrospective study of 77 cases. J Fel Med Surg 2004;6:245–57. 3. Taylor TN, Smith MM, Snyder L. Nasal displacement of a tooth root in a dog. J Vet Dent 2004;21:222–5. 4. Kang MH, Lim CY, Park HM. Nasopharyngeal tooth foreign body in a dog. J Vet Dent 2011;28:26–9. 5. Lommer MJ. Complications of extractions. In: Verstraete FJM, Lommer MJ, eds. Oral and maxillofacial surgery in dogs and cats. Amsterdam (the Netherlands): Saunders Elsevier; 2012:153–9. 6. Mathews KG. Oral approaches to the nasal cavity and nasopharynx. In: Verstraete FJM, Lommer MJ, eds. Oral and maxillofacial surgery in dogs and cats. Amsterdam (the Netherlands): Saunders Elsevier; 2012:547–51.
and subcutaneous emphysema), and decreased the time of hospitalization.6
FOOTNOTES a
Synulox; Pfizer Italia Srl, Roma, Italy
b
Pentax EG 1840; Pentax Medical, Milano, Italy
c
Telescope 64109 AA; Karl Storz Endoscopia Italia S.r.l., Verona, Italy
d
67161T; Karl Storz Endoscopia Italia S.r.l., Verona, Italy
e
Metacam; Boehringer Ingelheim, Ingelheim am Rhein, Germany
f
Temgesic; Schering-Plough SpA, Milano, Italy
JAAHA.ORG
251
