Abstract
A 16 month old cat presented with a history of acute onset oral pain and hypersalivation. Oral examination revealed a wooden stick that protruded from the right sublingual region. Lateral cervical radiography showed retro pharyngeal gas lucencies. An 11 cm wooden stick was removed per os and the resulting tract was endoscopically explored. There were no post-operative complications and the cat remains disease free four months after presentation. In contrast to dogs, where oropharyngeal stick injuries are an uncommon albeit well recognised condition, there have been no previous case reports of oropharyngeal stick injuries in the cat. This case report describes the presentation, diagnosis and treatment of an oropharyngeal stick injury in a cat.
A16-month-old male neutered. 4.0 kg Bengal cat was presented as an acute emergency with oral pain, hypersalivation and reluctance to close its mouth. Oral examination revealed a wooden stick protruding 2 cm from the right sublingual mucosa. This was the only abnormality to be found on further clinical examination. Preoperative serum biochemistry and haematology were unremarkable. The cat was premedicated with 0.25 mg acepromazine maleate (ACP, C-Vet) and 0.5 mg butorphanol tartrate (Torbugesic, Forte Dodge Animal Health) intramuscularly. Perioperative clavulanate potentiated amoxycillin (Augmentin, Beecham) 80 mg was administered by intravenous injection and 20 mg carprofen (Rimadyl, Pfizer) was injected subcutaneously prior to the induction of anaesthesia. Anaesthesia was induced with 20 mg of intravenous propofol (Rapinovet; Schering-Plough Animal Health) and maintained with isofluorane vapourised, in pure oxygen through a modified Ayres T-piece. Hartmann's solution (Aquapharm No. 11; Animalcare) was administered intravenously at the rate of 20 ml per hour intraoperatively.
Left lateral radiography of the cervical region revealed a retro pharyngeal gas lucency and also caudal displacement of part of the hyoid apparatus (Fig 1). On further examination of the pharyngeal area a solid linear mass was palpable percutaneously passing in ventro-medial direction toward the cervical vertebrae. The oral foreign body was removed using gentle rostral traction and crocodile forceps were used to bluntly dissect away any snagged tissue. A 110 mm long wooden stick was removed (Fig 2). The resulting tract was then investigated using a flexible 4-mm diameter endoscope (Olympus BF 4.0 mm). The vagosympathetic trunk and common carotid artery were visible running parallel to the tissue defect which had been narrowly missed by this penetrating injury. During endoscopic examination of the tract, several remaining splinters of wood seen within the tract at varying depths were retrieved endoscopically using endoscopic forceps. The whole tract was visually assessed without surgical intervention. The tract was flushed with 500 ml of saline and the sublingual defect was left to heal by secondary intention. Further analgesia was provided with a second subcutaneous dose of 8 mg car-profen given 24 h post surgery. The cat was discharged 24 h post endoscopy on a seven-day course of 50 mg clavulanate potentiated amoxycillin (Synulox; Pfizer) twice daily.
Left lateral radiography of the cervical region revealing a retro pharyngeal gas lucency (black arrow) and also displacement of part of the hyoid apparatus (white arrow).
Wooden stick which was removed from the cat's mouth (scale in cm).
The cat was re-examined at 5 and 10 days post surgery. The owner reported that the cat was clinically normal. The oral lesion appeared to be healing well on day five and almost completely granulated on the tenth day post injury. A follow up examination four months after presentation revealed that the cat was clinically normal.
Discussion
Oropharyngeal stick injuries are an uncommon but well recognised event in dogs (White & Lane 1988, Griffiths et al 2000). Although oral foreign bodies such as thread attached to the base of the tongue are well reported in cats (Felts et al 1984), the authors are not aware of any cases reported in the literature that describe the presentation, diagnosis and treatment of an oropharyngeal stick injury in a cat. In dogs, affected animals present with either acute (<7 days) or chronic diseases (>7 days) (White & Lane 1988). In acute cases, the presenting signs are hypersalivation, dysphagia and oral pain, in contrast to chronically affected animals in which abscessation and formation of discharging sinuses are the main symptoms. In this case, the diagnosis was straight forward; in cases where an oropharyngeal foreign body is suspected based on clinical signs but cannot be identified on oral examination, radiography can be a useful additional diagnostic test (Griffiths et al 2000).
The acute and chronic classification is useful as the clinical approach to the two groups differs. In the chronic group, the aim of surgery is to explore all sinus tracts and aggressively debride the associated chronic inflammatory tissue as well as removing any visible foreign bodies. In acute lesions, simple removal of the foreign body in its entirety and aggressively lavaging the sinus tract can be curative. Endoscopic evaluation of the sinus tract was rewarding in this case as further fragments of the wooden foreign body were removed. This technique may reduce the incidence of complications such as chronic sinus formation which can proceed incomplete removal of a oropharyngeal foreign body.
Acknowledgements
The authors would like to thank Lizza Baines for her assistance in the interpretation of the radiographs. R.J. Mellanby residency was kindly supported by the Alice Noakes Trust.