Is this nasal discharge secondary to the dental procedure?

RE: Is this nasal discharge secondary to the dental procedure?

Kate Richardson — Tue, 14 Jul 2020 09:17:48 GMT

You're telling me!!

Previous history from past 2 years just routine but tartar ad mild gingivitis noted and old fracture of 204, dental assessment discussed, no action taken.

beginning of April 2020 owner reported grinding her teeth past when eating large pieces of food/biscuits, then regurgitating (or spitting it out) past 2-3 weeks. No pain apparent when they touched her face, eating mashed up wet food ok, otherwise no changes noted except slight weight loss. Exam revealed upper right dental disease with suspected resorptive lesion predominantly, not many teeth on left upper arcade but some inflammation. Mild watery discharge from R eye. mass on lower neck in thyroid region. Bloods unremarkable including T4. GA/dental assessment performed a week later. That's all I have to give you! O was told 7 teeth removed. Cat appeared to recover uneventfully and was fine for about 2 weeks before sneezing and nasal discharge started. I suspect wasn't brought in sooner as we were in lockdown and was still eating etc.

I just got nasal swabs back and just neutrophilic inflammation and bacteria. Mass on the neck was about size of walnut when I saw her, fluid filled, dark brown fluid aspirated, might be a thyroid cyst but fna results just showed cystic fluid with mixed inflammation. Don't think it's related.

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29222/is-this-nasal-discharge-secondary-to-the-dental-procedure/224202#224202"]So this could be: a) nasal disease cause by the dental procedure; b) intraoral disease caused by the nasal disease; c) two manifestations of the same disease, the intraoral phenomenon having appeared slightly earlier; d) nasal disease not connected at all with any periodontal disease.[/quote]

That's where I was. There was a fragmented 208 in situ but wasn't obviously reactive, but I extracted it anyway. I think it's d) and just a complete coincidence re the timing as it sounds as though the extractions were performed on the Right side other than 204- impossible to say if it could be related to the extraction of this tooth without an xray at the time. The vet who did the procedure is pretty experienced, and I am as sure as I can be that if there had been any complications at the time, they would have told the clients. The clients are not being difficult about this, they have been very understanding and just want to know what is going on.

I think the nasal septum looks slightly deviated as well, it was quite hard to get it 100% straight due to 104 being present, 204 being absent, even with a little cotton wool wedge in place of 204 (any tips on this gratefully received) and there is a loss of the turbinate structure, but I wasn't quite sure if the discharge is just obliterating it on the xray, although one of the views was after flushing (although I doubt I managed to remove all the discharge). Nothing rewarding from flushing sadly.

RE: Is this nasal discharge secondary to the dental procedure?

Evelyn Barbour-Hill — Tue, 14 Jul 2020 00:42:44 GMT

We don't know what dental procedure was done and, really, we don't know why. So that's not very helpful.

So this could be: a) nasal disease cause by the dental procedure; b) intraoral disease caused by the nasal disease; c) two manifestations of the same disease, the intraoral phenomenon having appeared slightly earlier; d) nasal disease not connected at all with any periodontal disease.

So I would forget the dental procedure and concentrate on making a diagnosis of the nasal disease. (Even if the owner is badgering you because they want to sue their veterinary surgeon )

On the left side there's both obscuring (especially rostrally) and complete destruction (especially caudally) of the fine structures of the nasal cavity. The proces does not appear to break through the septum nor through the walls of the nasal cavity. The septum seems to deviate a little to the right but that may be due to slight angulation of the radiograph. There is no detectable foreign body. There is no connection that I can see to any of the tooth alveoli. (and for something so massive to have developed from an extraction site one would expect some very obvious tract). Did you inspect and probe the extraction sites while you were doing the radiography?

If I've got the timescale right, the discharge appeared towards the end of April – at the most, 3 months ago. That doesn't seem very long for such massive changes, and I suspect the process began much earlier; and certainly if what's going on is so severe as to do all that in three months it looks a poor prognosis.

Keeping it simple and ignoring zebras, the differential lies first of all between infection, of type to be determined, and neoplasia, of type to be determined.

Investigation next step – not teaching granny to suck eggs, just saying – needs endoscopy both ortho and retrograde, with copious flushing afterwards (and before and during, if necessary to get clear vision); biopsy of any suspicious tissue via the endoscope (if possible – quite often it isn't) ; with collection of the products of flushing so that any scraps of tissue can be used as biopsies and bacteriology can be done on the mucus.

If you haven't then got the answers you need (but I think you will) then you could go to CT scan. Or if it's available reasonably close the owner might want to go to CT scan straight away. But CT won't iby itself give you a diagnosis – it can't do histopatholgy or bacteriology.

I have to say I think the prognosis is somewhere between poor and hopeless.

RE: Is this nasal discharge secondary to the dental procedure?

Kate Richardson — Mon, 13 Jul 2020 20:29:11 GMT

15 yo FN DSH

presented in April for oral pain. Well for old cat. No notes unfortunately at time of dental. No history of nasal issues previously.

RE: Is this nasal discharge secondary to the dental procedure?

Norman Johnston — Mon, 13 Jul 2020 20:14:35 GMT

Can you give us more information? Signalment and history In particular

RE: Is this nasal discharge secondary to the dental procedure?

Kate Richardson — Mon, 13 Jul 2020 17:22:21 GMT

Second time trying! Minimal info I'm afraid. Dental procedure performed in April due to oral pain. 7 teeth extracted according to owner. Nasal discharge left side 2 weeks post dental. No xrays at time. Xrays taken last week. Has been on amoxyclav for 2 weeks and discharge much improved although not resolved. I'm not convinced is obviously dental procedure related but happy to hear other opinions.Am concerned may be nasal tumour