History
fig.2 - lateral skull radiograph. There is a metallic-density foreign body located within the ethmoturbinates.
fig. 1 - preoperative photo showing discrete soft-tissue-swelling over the nasal planum
A 15-year-old male, neutered DSH cat presented with a two-week history of right, unilateral epistaxis with concurrent swelling of the nasal planum (see fig. 1).
The cat had been in the owner’s possession for twelve years, with no known history of trauma during that time. The referring veterinary surgeon’s radiographs revealed a metallic-density foreign body, located within the right side of the nasal cavity, resembling an air-gun pellet (see figs. 2&3) . Clinical examination failed to identify an entry wound, but there was a faint, mature scarring of the skin over the fluctuant, non-painful swelling on the nasal planum..
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Treatment
fig.3 - dorsoventral radiograph of the skull showing a metallic object resembling an air-gun pellet, lodged within the nasal cavity.
fig.4 — intraoperative photograph showing pellet after removal via dorsal rhinotomy.
Surgical exploration of the swelling revealed a small, granulation tract, less than 1mm in diameter, running through the right frontal bone, leading to an area of turbinate necrosis within the nasal cavity rostral to the ostium of the right frontal sinus; this tissue was found to contain the embedded object. The tract was enlarged to facilitate debridement of all non-viable tissue and removal of the air-gun pellet (see fig.4). The nasal cavity was lavaged before primary wound closure; the frontal bone deficit was left unfilled. Overlying soft tissues were closed primarily.
Bacteriology yielded a light growth of Klebsiella ozaenae, sensitive to all antimicrobials tested. The patient made an unremarkable recovery and there has been no recurrence of facial swelling or epistaxis in the two months since surgery..
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Discussion
This case shows that nasal foreign bodies may be asymptomatic for many years before clinical signs become apparent. Dorsal rhinotomy is tolerated relatively well in the feline patient.
