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Ventral rhinotomy is a surgical procedure, approaching through the roof of the mouth, to gain access to the nasal cavities. This is approach is used to treat aspergillosis or other infections, retrieve nasal foreign bodies, or remove tumors.
An alternative approach from the outside of the nose (dorsal rhinotomy) is more commonly used, but the obvious cosmetic impact often makes it unacceptable to the owner. Research work investigating the effectiveness of ventral rhinotomy found it to give a similar amount of visibility within the nose and with the added benefit of being more cosmetically acceptable.
Rhinotomy is usually undertaken at referral centers. There is often substantial blood loss during surgery and so access to blood transfusion facilities is also recommended.
The patient is blood typed (in case a transfusion is required) and tested for clotting disorders. The dog is then given a general anesthetic, and positioned lying on their back. The mouth is held in an open position such that the surgeon can gain access to the hard palate.
The mucoperiosteum is elevated to expose the bone of the hard palate (the shelf of bone separating the mouth from the nose). An oscillating saw is then used to cut and remove a window of bone, and gain entry to the nasal sinuses. Major blood vessels pass through the nasal cavity and are difficult to avoid, making it necessary to ligate these. Minor bleeds may be controlled with manual pressure.
Once the treatment has been completed, the cavity may be packed with absorbable hemostatic swabs to decrease haemorrhage. The bone is not replaced, but sent for histology. The mucoperiosteum flap is sutured back in position and the patient woken from the anesthetic.
There is some debate about which approach (dorsal or ventral rhinotomy) provides the best access to the nasal sinuses. However, the consensus is that the ventral approach provides at least equal access to the dorsal alternative, and given it is more cosmetically acceptable to owners it is gaining traction as the approach of choice.
There can be considerable intraoperative hemorrhage which necessitates a blood transfusion. The latter requires the patient to be closely monitored for adverse transfusion reactions hours to days following surgery. In addition, the dog is likely to suffer nosebleeds for some days after the procedure. Blood loss should be monitored to ensure it is not excessive.
The patient is also likely to be in discomfort, so the use of strong pain-relieving medications is mandatory.
Surgery often gives superior results to medical therapy alone, since the penetration of antifungals, antibiotics, or chemotherapy drugs from the bloodstream into the nasal sinuses can be limited.
Some procedures, such as packing the nose with antifungal to treat aspergillosis, require repeated treatments.
The cost of ventral rhinotomy varies depending on whether it is undertaken in first opinion practice or at a referral center. An owner should expect a cost of around $1,000 to $2,500 depending on the procedure performed in addition to the rhinotomy.
It may be possible to avoid rhinotomy and instead use an alternative technique such as endoscopy. This is especially relevant for the removal of foreign bodies or the harvesting of biopsy samples for analysis.
All surgery carries a risk, and ventral rhinotomy is no different. In this case, heavy hemorrhage is a recognized complication, and so provision should be in place to cope with such an eventuality.
In the long term, complications can arise such as a failure of the mucoperiosteum to heal, leading to the formation of a fistula between the mouth and the nasal cavity. This then allows food to pass up into the nose where it creates a nidus for infection.
Given a dog's nature drive to sniff, it is difficult to prevent conditions such as aspergillosis or inhaling a foreign body. If you become suspicious your dog has something stuck up their nose, seek help from a veterinary professional. It is often possible to remove grass awns with special forceps, if they are identified before tracking deeply into the nasal cavity.
However, nasal cancer can be a sequelae of inhaling second hand cigarette smoke, so people should refrain from smoking when in the same airspace as the dog.
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My dog presented nasal inflammation, reverse sneezing and discharge from one nostril and was treated with antibiotics and anti inflammatories. It helped but didn't cure. It spread to the other nostril and then eventually to both. Snout is warm but no swelling; another round of antiobiotics seemed to help discharge but pet is beginning to show signs of behaviorial distress. No fever; bloodwork good. Is the next step this procedure or is there a less invasive treatment to find out what's going on in her nasal cavity?
Dec. 16, 2017
Dr. Michele K. DVM
Debra, thank you for contacting us about Bella. I'm sorry that she is going through this. I think the answer to your question depends on the skill level of your veterinarian and the equipment available. A ventral rhinotomy will certainly provide a solid sample of tissue to biopsy, and allows for the nasal passages to be 'cleaned out', and tissue or foreign body debris removed, physically. There are side effects to this procedure, however, post-operatively, and it is a fairly invasive procedure. Other alternatives that might be considered, depending on the severity of the nasal disease, might include an endoscopic biopsy if that equipment is available, or nasal hydro-flushing to collect cell samples. Both of these techniques have the downside of providing a much smaller tissue sample and possibly missing the actual lesion that is causing this problem, but they are less invasive. It seems at this point you need to have a conversation with your veterinarian about risks/benefits of the procedure and alternatives - since I haven't examined Bella, your vet is in the best position to have that conversation. A 2nd opinion is always another alternative. I hope that you are able to get answers, and that Bella is okay.
Dec. 16, 2017
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