Abstract
We enjoyed reading the paper on endoscopic removal of nasal polyps in a cat using a novel surgical approach by Esterline and colleagues in the last edition of the Journal of Feline Medicine and Surgery. Without doubt, these veterinarians are capable of thinking outside the square! We would agree that the approach to the choanae using a flexible endoscope introduced via a gastronomy incision was novel, affording excellent access to the nasopharyngeal region. Furthermore, there was a successful outcome, at least in the short term.
May we suggest, however, that similar access could have been obtained more easily, quickly, and inexpensively by way of an incision through the soft palate. If required, this could be extended cranially into a ventral rhinotomy. In our experience (Beatty et al 2000, Hunt et al 2002) and that of others (Mitten 1988, Holmberg et al 1989), most disease conditions of the feline nasopharynx (including nasopharyngeal polyps, cryptococcomas, nasopharyngeal lymphoma, other tumours and foreign bodies) can be adequately visualised and resected through an incision in the soft palate. Indeed, many of these conditions can be debulked even less invasively using digital manipulation, traction or pulsion using an embolectomy catheter, and a vigorous nasal flush technique (Hunt et al 2002).
Figure 1(A), for example, shows the surgical approach to a cryptococcal granuloma via an incision in the soft palate. The appearance of the incision after surgical closure using a single continuous suture pattern is shown in Fig 1(B), while the resected inflammatory lesion is shown in Fig 2. Such an approach is likely to be less time consuming to perform and less painful to the patient than a standard ventral midline laparotomy. Costs associated with theatre fees and cleaning of endoscopic gear are also likely to be less.
(A) The surgical approach to a cryptococcal granuloma (CG) via an incision into the soft palate. The appearance of the incision after surgical closure using a single continuous suture pattern is shown in (B). For orientation, the cat's body is away from the viewer and to the right, whereas the canine teeth are to the left, in both photographs.
The inflammatory cryptococcal lesion resected from the nasopharynx.
Although Dr Esterline and colleagues state ‘rhinotomy was recommended…but declined by the owners’, it may well be that a dorsal rhinotomy was offered, rather than an incision through the soft palate. It is our considered opinion, based on experience, that an incision through the soft palate (Hunt et al 2002) or a ventral rhinotomy (Holmberg et al 1989, Holmberg 1996) is likely to be superior, in the majority of cases, to the more complicated approach used by Esterline et al 2005.