Gross Anatomy II

Head 2 and 3: Guttural Pouch, Nasal Cavity, and Paranasal Sinuses Guide pages 157-167 157Jan 29 and Jan 31, 2007 Klimek

"To teach is to learn twice" - Joseph Joubert

Please select a Team.
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I remember canine anatomy ± bring it on! Canine anatomy comes back to me if I review often. We dissected a dog????
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Which of these instruments is a trephine?
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Objectives 
   

 

Review some canine anatomy. Discuss lymphatic drainage of the head in the horse. Discuss in greater detail the structures in close proximity to the guttural pouch. Visualize the opening of the guttural pouch into the nasopharynx relative to external landmarks. Review the arrangement of the turbinates and meati of the nasal cavity. Discuss the equine paranasal sinuses. Discuss the unique arrangement of the soft palate and epiglottis in the horse.

Dissection Announcements 
 

Read the shaded paragraphs (all assignments) even if they are small print ± they have clinical relevance. We do not have nasogastric tubes as mentioned on p. 162, but you can visualize the path. You will NOT have to open the sinuses as directed on pp. 166-167. Use dried specimens, and we will 166cut one half of your head to attempt to demonstrate the nasomaxillary opening and the oblique septum of the sinus.
± The young horses will have under-developed sinuses. under- 



Read the shaded paragraph on page 164. Stop at ³larynx´ on page 167 for Wednesday¶s assignment.

Lymph Nodes of the Head   

Medial (3) and lateral (4) retropharyngeal drain most of upper half of head. They then drain to cranial deep cervical. Mandibular (1) drains skin and masticatory, pharyngeal, hyoid and tongue muscles, and then efferents go to either medial retropharyngeal or cranial deep cervical. Cranial deep cervical (5) drains larynx, esophagus, trachea, mandible and neck, and receives the lymph from other nodes.

How many nasal turbinates (conchi) are there in a dog?
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Two: dorsal and ventral Three: dorsal, ventral, and ethmoidal. Four: dorsal, middle, ventral and ethmoidal.

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How many nasal meati are there in a dog?
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Two: dorsal and ventral Three: dorsal, middle, and ventral. Four: dorsal, middle, ventral and common.

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Terminology Review 

Ethmoturbinate: a turbinate attached to the ethmoid bone (in whole or in part).
± Ectoturbinate: an ethmoturbinate that is in the frontal sinus (i.e., not in the nasal cavity). ± Endoturbinate: an ethmoturbinate that is in the nasal cavity. 

Meatus: an air passageway in the nasal cavity.

Folds in the Nasal Vestibule 

Folds are associated with the dorsal and ventral conchae in the equine nasal vestibule.
± Dorsal concha: straight fold (mentioned but not named in Miller¶s text) ± Ventral concha: alar fold and basal fold (not present in the dog).

dorsal ethmoid meatus ventral meatus ventral turbinate middle meatus dorsal turbinate dorsal meatus ethmoturbinates ventral ethmoid meatus

23 straight fold 24 alar fold

intrapharyngeal ostium

25 basal fold

The term for ³nosebleed´ is«
1. 2. 3. 4.

Dyspnea Epistaxis Hemoptysis Nasohemorrhea

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Equine Paranasal Sinuses   



Paranasal sinuses are air-filled spaces that aircommunicate with the nasal cavity. Illustrations on page 31 of Budras atlas, or pp. 485-488 of Dyce; 485schematic illustration p. 166 in guide; cross sections p. 164. All natural drainage of the sinuses to the nasal cavity occurs through the maxillary sinus, via the nasomaxillary opening into the middle meatus. The other sinuses communicate with portions of the maxillary sinus, but not directly with the nasal cavity. The horse¶s head needs to be in the grazing position for effective drainage. In young horses the sinuses are not fully developed. See Dyce p. 488 for an illustration of age-related agechanges to maxillary sinus.

Maxillary Sinus   

There are rostral and caudal compartments, separated by an oblique septum usually located (in an adult, full-sized horse) 5cm caudal to the rostral fullend of the facial crest. The caudal compartment is also subdivided into medial and lateral portions by the infraorbital canal. The nasomaxillary opening is the natural opening of the sinuses to the nasal cavity. It opens to the middle meatus. The opening is shared at the top of the oblique septum by both the rostral and caudal compartments of the maxillary sinus. The roots of the last 3-4 cheek teeth project into the 3maxillary sinuses, and can be accessed through the sinus.

In the dog, the maxillary sinus«
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Communicates with the frontal sinus. Has no natural opening. Is a recess located at the level of the upper 4th premolar.
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Is the largest of the paranasal sinuses.

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Other Paranasal Sinuses 

Frontal sinus
± Communicates with caudal maxillary sinus through frontomaxillary opening. ± No direct communication to the nasal cavity. 

Dorsal, middle, and ventral conchal sinuses
± Dorsal conchal communicates with frontal sinus; together these form the conchofrontal sinus. ± Ventral conchal communicates with rostral maxillary sinus 

Sphenopalatine sinus
± Communicates with the caudal maxillary sinus

Surgical Limits of Frontal and Maxillary Sinuses
medial

D

Note: line ³D´ should incline more medially. Add a line for medial.

Group Activity: visualize the location of the following on this horse:
opening of the auditory tube into the nasopharynx; larynx; soft palate Refer back to prev. slide«

Identify the breed
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Arabian Morgan Mustang Quarter Horse Trakehner

http://www.ansi.okstate.edu/breeds/
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Relationship of the Epiglottis and Soft Palate   

The palatopharyngeal arch on each side forms the intrapharyngeal ostium, through which the larynx projects The epiglottis normally sits above the soft palate. The epiglottis is normally visible through a nasal endoscope. During swallowing, the soft palate is elevated, Similar to Fig. 7-13 in your guide. and the epiglottis is http://ocw.tufts.edu/Content/27/imagegallery/367 pushed backwards. http://ocw.tufts.edu/Content/27/imagegallery/367 409/ 409/367431

Soft palate Epiglottis http://ocw.tufts.edu/Content/27/imagegallery/367409/367432

Clinical Application 

Duggan VE, MacAllister CG, Davis MS.Xylazine induced attenuation of dorsal displacement of the soft palate associated with epiglottic dysfunction in a horse. JAVMA 2002; 221: 3992002; 221: 399402. 402.
18-month± Article discusses a case of an 18-month-old QH with dorsal displacement of the soft palate that was attenuated with xylazine.
» Epiglottis appeared small and flaccid on endoscopy. Soft palate would go to normal position after swallowing, but epiglottis would slip off end of soft palate. » Xylazine effect was discovered serendipitously because they sedated the horse to facilitate further endoscopy, and the DDSP disappeared for the remainder of the examination. » DDSP returned the following day. » Xylazine is a sedative-analgesic with muscle relaxant sedativeproperties, and varying effects on the equine respiratory tract. Postulated that muscle relaxant properties persist after sedation wears off.

What is the guttural pouch?
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A pocket of the frontal sinus. A recess next to the larynx. An air-filled airdiverticulum of the auditory tube. An out-growth of the outoral cavity.
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Guttural Pouch   

The guttural pouch is an air-filled space airlargely medial to the mandible in a normal horse. There is one associated with each auditory tube. The right and left pouches oppose each other on the midline, and a thin septum of mucosa separates them from each other. The auditory tube/guttural pouch opens to the nasopharynx. The opening is dorsal to most of pouch ± does not provide a good drainage route, except for when the head is lowered.

Guttural Pouches  

The guttural pouches can be ³scoped´ through the nasal cavity by entering the nasopharyngeal opening. This is located at the level of lateral canthus (for estimating from the outside of the head). Diseases of the guttural pouches include empyema (filling with pus); chondroids (when the pus forms concretions; fungal infection; tympany (swelling with air); hemorrhage from the arteries near its wall (due eg. to fungal infections; fracture of the stylohyoid bone).

Guttural Pouch 

Many structures are intimately associated with the pouch:
± Nerves: VII (facial), IX (glossopharyngeal), X (vagus), XI (accessory), XII (hypoglossal), as well as cranial cervical ganglion ± Arteries: external carotid, linguofacial, superficial temporal, maxillary and internal carotid ± Medial retropharyngeal lymph node (lateral as well). ± Stylohyoid bone. 



Many of these structures can be seen through the mucosa on your cadaver, or with an endoscope. Study the vessels and nerves visible in the wall of the guttural pouch on your cadaver.
497± Dyce 497-501 should help you with this. The pictures in Budras pp. 43-45 are also excellent. 43-

Guttural Pouch 

Divisions of the right and left pouches:
± Medial & lateral compartments, separated by stylohyoid bone (identify this in your cadaver) ± Medial and lateral compartments on each side are continuous with each other. 

Boundaries of the pouches if they are normal size:
± ± ± ± ± Dorsally: into condylar fossa Ventrally: to wall of pharynx Medially; to midline Laterally: to parotid salivary gland Caudally: into atlantal fossa

What is your opinion? The guttural pouch in a normal horse is in Viborg¶s triangle.
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Nerves and Vessels Associated with the Guttural Pouch
glossopharyngeal n. hypoglossal n. ext. carotid brs.

facial n.

stylohyoid bone

Lateral side of the medial compartment of the guttural pouch, D498; see p. 43 Budras occipital art., int. carotid more dorsal

Probe is passing through the nasopharyngeal opening of the auditory tube/guttural pouch, simulating an endoscope.

Medial view of the left guttural pouch. Nose is to the left. The ridge is the stylohyoid bone.

Group Activity
1? 4? 6? 8?

Dyce p. 500: cross section looking caudally.

Endoscopic view of dorsocaudal portion of left guttural pouch.

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