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FELİNE-Upper Airway Obstruction in Cats Pathogenesis and Clinical Signs
FELİNE-Upper Airway Obstruction in Cats Pathogenesis and Clinical Signs
FELİNE-Upper Airway Obstruction in Cats Pathogenesis and Clinical Signs
9 September 2000
Upper Airway
FOCAL POINT
★ Predicting the cause of upper
Obstruction in Cats:
airway obstruction—based on
history and clinical signs—is less
reliable in cats than it is in dogs.
Pathogenesis and
KEY FACTS
Clinical Signs
University of Edinburgh
■ Chronic, nonprogressive stertor
following an upper respiratory Dominique J. Griffon, DVM, MS, MRCVS
tract infection in cats is
suggestive of nasopharyngeal
ABSTRACT: Nasopharyngeal polyps and foreign bodies are the most common nasopharyngeal
stenosis.
obstructions in cats, but a good understanding of other conditions allows for early recognition
and appropriate management. Abscesses, infection, stenosis, or neoplasia may obstruct the
■ Early signs of upper airway nasopharynx. Laryngeal obstruction may be caused by a variety of conditions such as granu-
obstruction in cats should be lomatous laryngitis, neoplasia, cysts, laryngospasm, and laryngeal paralysis. Extramural com-
recognized before cyanosis pression of the upper airway should also be considered. Clinical signs of upper airway ob-
develops. struction provide valuable information about the degree of airway compromise and the
anatomic compartment involved but are not specific for any particular disease process.
■ Although the clinical appearance
of granulomatous laryngitis is
U
similar to that of laryngeal pper airway obstruction in cats is a common and sometimes life-threat-
neoplasia, these conditions can ening condition. Early recognition of clinical signs, combined with ap-
lead to drastically different propriate diagnostic and therapeutic approaches, increases the chances
outcomes. of a successful outcome. This requires a good understanding of the pathogenesis
of upper airway obstruction as well as the options available to treat each condi-
■ Temporary and permanent tion. A thorough knowledge of the anatomy of this complex region is also cru-
laryngeal paralysis may result cial, especially if any surgical correction is undertaken.
from a variety of conditions. This article focuses on obstructive diseases affecting the nasopharynx, phar-
ynx, and larynx in cats and reviews the anatomy, pathogenesis, and clinical signs
associated with these conditions. The intent is to help clinicians establish a com-
plete list of differentials and guide them through the diagnostic approach of up-
per airway obstruction. A companion article will familiarize clinicians with un-
usual conditions and provide small animal surgeons with new information
regarding treatment options.
ANATOMY
The upper respiratory tract includes the nares, nasal passages, pharynx, larynx,
and cervical trachea. The pharynx can be divided into three areas: the orophar-
ynx, nasopharynx, and laryngopharynx (Figure 1). The oropharynx is ventral to
Compendium September 2000 Small Animal/Exotics
the auditory tube, obstructing the nasopharynx. Na- mous cell carcinoma is a very invasive tumor, common-
sopharyngeal abscesses may also form secondary to for- ly extending into the soft palate and laryngopharynx.20
eign body migration.13 Primary laryngeal neoplasia in dogs and cats is rare.21,22
Fungal infection of the nasopharynx is usually sec- Benign tumors (e.g., rhabdomyomas) have been de-
ondary to cryptococcal rhinitis. However, atypical pre- scribed in dogs23 but not in cats. Lymphosarcoma and
sentations in which cats present with signs of nasopha- squamous cell carcinoma are the most common laryn-
ryngeal disease without rhinitis have been reported.14 In geal neoplasms reported in cats.24 Lymphosarcoma may
these cases, the mycosis arises from the caudal part of present as a mass or a diffuse thickening of the entire
the nasal passage and forms a polypoid cryptococcoma, larynx,22 whereas squamous cell carcinoma may spread
obstructing the nasopharynx. from the larynx into the pharynx and soft palate. Ade-
Myiasis occasionally occurs in the pharynx, most nocarcinoma, epidermoid carcinoma, and undifferenti-
commonly in the retropharyngeal tissues, but may also ated carcinoma have also been described.25–27 Laryngeal
involve the soft palate.15 Cuterebra larvae may be visual- adenocarcinomas have been reported to metastasize to
ized through a “breathing hole” in the mucosal surface the regional lymph nodes, lung, and spleen.28
or may be found following excision of the surrounding
granuloma. Laryngeal Paralysis
Idiopathic laryngeal paralysis is less common in cats
Nasopharyngeal Stenosis than it is in dogs. Other causes of laryngeal paralysis in
Nasopharyngeal stenosis is an unusual form of upper cats include congenital defects, generalized neuromus-
airway obstruction secondary to scar tissue formation cular dysfunction, trauma, and neoplasia.29 Unilateral
across the nasopharynx. Whereas choanal atresia is a hemiplegia has also been described in one cat with lym-
developmental failure of the posterior nasal cavity to phomatous infiltration of the vagus nerve.30 Damage to
communicate with the nasopharynx, nasopharyngeal the recurrent laryngeal nerves may result from wounds
stenosis is an acquired disease. In humans, nasopharyn- to the ventrolateral neck and may be associated with
geal stenosis is thought to develop secondary to muco- Horner’s syndrome if the cervical sympathetic trunk
sal ulcerations associated with infection, caustic burns, has been damaged concurrently.31 Mechanical compres-
or oropharyngeal surgery.16 This condition has also sion of the recurrent laryngeal nerve resulting from in-
been described in cats following upper respiratory tract flammatory swelling or neoplasia of adjacent structures
infection.17 The location of the stenosis along the na- may result in neuropraxia.32 Laryngeal paralysis has also
sopharynx is variable. Scar tissue may form across the been reported following surgery of the trachea, thyroid,
openings of the caudal nares into the nasopharynx, de- and ligation of patent ductus arteriosus.33 In these cas-
creasing their diameter from 5 mm to pinpoint size. es, inadvertent transection of the laryngeal recurrent
Adhesions may also form caudally, attaching the soft nerve results in permanent laryngeal paralysis. Howev-
palate to the dorsal wall of the nasopharynx. er, postoperative laryngeal paralysis caused by excessive
retraction may be only temporary. Respiratory distress
Brachycephalic Syndrome may be noted immediately after surgery, especially if
Brachycephalic syndrome is a rare condition that has upper airway edema is present. In other cases, the onset
been described in brachycephalic cats (e.g., Persian of clinical signs may be delayed by several days or even
breeds).18 The short skull conformation in these ani- weeks. Although this is difficult to explain, clinical
mals is associated with an elongated soft palate, distort- signs developed 38 days (median) after experimental bi-
ed nasopharynx, and short narrow nasal passages lead- lateral recurrent nerve transection in dogs.34
ing to stenotic nares. Brachycephalic syndrome may
result in laryngeal edema and eventually collapse of the Inflammatory Laryngeal Disease
larynx in dogs. In cats, little is known about the clinical Inflammatory laryngeal disease in dogs and cats tends
significance of this syndrome. Because of their seden- to be acute but rarely results in life-threatening respira-
tary nature, cats with stenotic nares may not have sig- tory obstruction.35 Trauma, infectious agents, foreign
nificant upper respiratory problems for several years.15 body penetration, and insect bites may cause transient
laryngeal inflammation and edema. 24,35,36 However,
Neoplasia granulomatous laryngitis has been reported to cause se-
Neoplasia of the nasopharynx usually originates from vere progressive upper airway obstruction in cats.35,37
the nasal passage or the oral cavity. Adenocarcinoma, The clinical appearance of this condition is very similar
squamous cell carcinoma, and lymphosarcoma are the to that of laryngeal neoplasia: Asymmetric nodular le-
most common nasal tumors in cats.19 Tonsillar squa- sions obstruct the rima glottidis (Figures 2 and 3). Granu-
and middle ear polypoid masses in five cats. Vet Surg 18. Willoughby K, Coutts A: Differential diagnosis of throat
14(2):141–144, 1985. and ear disease in cats. Practitioner 17(5):206–214, 1995.
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Current Techniques in Small Animal Surgery, ed 4. Baltimore, frontal sinuses. Probl Vet Med 3(2):170–187, 1991.
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Emergency Medicine • 364 Pages 1996.
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✶ Cardiac Emergencies 34. White RN: Unilateral arytenoid lateralisation for the treat-
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and much more 36. Harvey CE, O’Brien JA: Surgical treatment of miscellaneous
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ff! 1982.
10% o $
61 in Small A
nimal Prac
37. Holt D, Brockman D: Diagnosis and management of laryn-
tice geal diseases in the dog and cat. Vet Clin North Am Small
00
$
68 The
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COLLECTION
Anim Pract 24:855–871, 1994.
38. Tasker S, Foster DJ, Corcoran BM, et al: Obstructive in-
flammatory laryngeal disease in three cats. J Feline Med Surg
1:53–59, 1999.
CALL
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cess granulomata. J Laryngol Otol 108:216–220, 1994.
NOW 40. Spaulding GL: Medical management considerations for up-
per airway disease. Probl Vet Med 4(2):419–428, 1992.
Email: books.vls@medimedia.com 41. Newman BH, Taxy JB, Laker H: Laryngeal cysts in adults:
to order your copy or request a catalog of the
VLS BOOKS A clinicopathologic study of 20 cases. Am J Clin Pathol
complete line of VLS books, journals, and videos. VE T E R I N A RY L E A R N I N G SYS T E M S
81:715–720, 1984.
42. Koch DB, Tate LP: Pharyngeal cysts in horses. JAVMA
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