Nasal Aspergillosis

RE: Nasal Aspergillosis

Alasdair Hotston Moore — Sun, 05 Sep 2021 17:47:48 GMT

Thanks fir the update Mark

RE: Nasal Aspergillosis

Mark Holmes — Sun, 05 Sep 2021 14:30:57 GMT

Cleared up just fine with flushing and canesten. I only needed a single application. The bone flap healed without complications. There was a small amount of emphysema which resolved in 2-3 days. Recovery uneventful.

RE: Nasal Aspergillosis

Alasdair Hotston Moore — Fri, 05 Feb 2021 16:54:12 GMT

Yes the saw is a good option. It’s what I use except in small dogs and cats. Cosmesis is fine without the bone. Genuinely interested to hear the results. Bye for now

RE: Nasal Aspergillosis

Mark Holmes — Fri, 05 Feb 2021 16:49:44 GMT

Yes I rarely remove anything without histology these days. there was certainly the typical grey fungal plaque material in the centre of the tissue.

I’ll bear in mind what you said about the bone flap. Hi n the past I’ve made the rhinotomy with rongeurs so there hasn’t been much to replace. I used an oscillating saw which made a tidier job and I figured it would be less disfiguring to put it back.

it’s a bit late to worry about it now but should be easy to resolve if it causes a problem. Assuming the histology doesn’t address the issue first.

Thanks for your help.

RE: Nasal Aspergillosis

Alasdair Hotston Moore — Fri, 05 Feb 2021 15:55:42 GMT

sadly a large mass is very atypical. Much more likely to be a tumour, I trust you have some histology pending. Do let me know. Turbinate loss with cavitation is much more typical.

On a side note, most of us do not replace the bone flap. Chuck it and close the soft tissues only. There is a risk of necrosis or fungal infection on the flap if you keep it

RE: Nasal Aspergillosis

Mark Holmes — Fri, 05 Feb 2021 15:51:41 GMT

Thanks for getting back to me.

CT confirmed large obstructing mass in the left nasal cavity with fluid retained in the left frontal sinus. Turbinate destruction. Assumed fungal granuloma. Accessed via dorsal rhinotomy. Flushed cleared out and biopsies/culture taken.

Bone flap replaced and sutured in place with pds.

Flushed nasal cavity and sinuses with canesten. Catheters placed into frontal sinuses and nose. Flushed 1 hour and rotated 360 degrees.

This is what I came up with. Opted for rhinotomy as nasal cavity was obstructed. (Fluid retained in sinus) Wasn’t confident that canesten would penetrate the granuloma adequately with flushing alone.

Sound reasonable? I have treated these before and it’s been successful - it’s just been a few years since I needed to.

RE: Nasal Aspergillosis

Alasdair Hotston Moore — Fri, 05 Feb 2021 14:23:44 GMT

You can't rely ion serology alone so the Xrays (or CT) are important to confirm. Try and get a frontal sinus skyline view if you can

Canestan infusion remains the treatment of choice, preferably (IMO) via frontal sinus access

You are welcome to contact me to share x-rays (or on here) and I will tell you more about my protocol

Alasdair HM