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Soft Tissue

The Soft Tissue Surgery Service at Hamilton Specialist Referrals works hard to ensure a holistic approach to all cases. We pride ourselves on meeting the needs of referring vets, patients and their owners. We can offer a comprehensive approach to a range of different cases; from the simple, to those that require a multi-disciplinary approach. We are more than happy to offer advice to referring vets about management of cases. Please send through an email and we will get back to you to discuss any questions you may have about the referral process or in working up your own cases in-house.

The service works closely with our team of anaesthesia specialists, imaging specialists and nurses to ensure the patient has a smooth journey through the treatment process. We can offer a comprehensive surgical referral service, including:

  • Hepatobiliary surgery: Portosystemic shunts, liver tumours, extrahepatic biliary obstruction, liver biopsies

  • Gastrointestinal surgery: Intestinal Foreign bodies, septic peritonitis, tumour resection, pancreatic surgery

  • ENT Surgery; BOAS surgery, stick injuries, salivary mucocoeles, TECA/LBO, rhinoscopy, aural and ocular surgery

  • Genitourinary Surgery; Urethral trauma, minimally invasive cystotomy, SUBs, urogenital neoplasia

  • Oncological Surgery

  • Thoracic Surgery; pyothorax, PDAs, lung lobectomies, chylothorax

  • Skin and reconstruction Surgery; wound management, VAC wound dressings and wound clinics

With COVID restrictions lifting we will be opening our hospital to regular evening CPD events. Keep up to date with your RCVS CPD requirements and come meet the team to discuss management options for simple and complex cases – we even offer a delicious pizza dinner to attendees. Please keep an eye on our social media pages for update or contact us for a list of upcoming events.


If you have a complex case or just need to discuss your decision making, please get in touch.

Our Soft Tissue Team

Dr Michael Hamilton

Dr Michael Hamilton

Dr Michael Hamilton BVM&S, CertSAS, DipECVS, MRCVS EBVS Recognised Diplomat in Small Animal Surgery
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Dr Karla Lee

Dr Karla Lee

Dr Karla Lee VetMB MA PhD CertSAS DipECVS MRCVS RCVS Recognised and European Specialist in Small Animal Surgery
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Dr Tige Witsberger

Dr Tige Witsberger

Dr Tige Witsberger DVM, MRCVS, DACVS (SA) ABVS Recognised Diplomat in Small Animal Surgery
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Karen Weston - Senior Soft Tissue Nurse

Karen Weston

Karen Weston AVN (Anaes) RVN Senior Soft Tissue Nurse
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Nicole Pollard - Soft Tissue Nurse Team Leader

Nicole Pollard

Nicole Pollard RVN Soft Tissue Nurse Team Leader
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  • BOAS - Brachycephalic Obstructive Airway Syndrome
  • Perineal Hernia
  • Portosystemic Shunts (PSS)
  • Total Ear Canal Ablation (TECA) and Lateral Bulla Osteotomy (LBO)
  • Wound Management
  • Anal Sac Adenocarcinoma
  • Laryngeal Paralysis
  • Surgical Management of the Jaundiced Patient
  • Fungal Infections - Nasal Aspergillosis
  • Salivary Mucocoele

BOAS - Brachycephalic Obstructive Airway Syndrome

Hamilton Specialist Referrals offers a specialist clinic for brachycephalic dog breeds, also known as short-muzzled or short-nosed dogs. Brachycephalic dogs can suffer from long-term health problems that affect their breathing, eyes, bones and gait, heart, skin and ears.

These dogs have compressed skulls that result in overcrowding of the soft tissue within the skull and are at risk of developing respiratory problems such as brachycephalic obstructive airway syndrome (BOAS). We see this condition more commonly in certain breeds, with Pugs, English Bulldogs and French Bulldog over-represented.

What are the signs of BOAS?

The most common clinical signs include:

  • breathing difficulties
  • noise whilst breathing
  • regurgitation
  • gagging
  • reduced exercise tolerance

Some of our patients will have periods of sleep apnoea and associated restlessness at night – owners may note their dog sleeping with a toy or object in their mouth

When to refer a case for BOAS assessment?

If you are concerned about a patient with the clinical signs above please contact us to arrange a referral. Research has shown that early intervention is likely to result in a better outcome for the patient.

Our approach:

We will perform an initial assessment of these patients which includes a full historical assessment, exercise tolerance test, airway assessment and diagnostic imaging.

Rhinoscopic view of the nasopharynx   

Alar fold (inner nostril)

Image of a Laryngeal collapse  

CT evaluation of the airway

We use this information to decide the best surgical and post-surgical management strategy. Typically, surgery will involve a palatoplasty (reducing the length and thickness of the soft palate), laryngeal sacculectomy and rhinoplasty (widening of the nostrils).

Modified folding flap. Palatoplasty end of surgery (soft palate resection)

Palate surgery healed, 6 weeks post op

In some cases we may need to perform more advanced surgery to open the airway within the nostrils. This procedure (turbinectomy) uses a laser to remove some of the tissue within the nasal passageway.

 Rhinoplasty (widening of the nostrils) to improve airflow

One of our patients wearing their protective eyewear essential for laser treatment.

What are the potential complications of Surgery?

Surgery is aimed to improve the flow of air through a restricted airway. Because of the nature of this condition it is not always possible to completely resolve the underlying airway compromise. For these patients a degree of airway compromise will remain despite appropriate surgery.

Patients with respiratory compromise do have an increased risk of anaesthetic complications – as such we work closely with our Anaesthesia specialists to make any intervention as safe as possible.

BOAS recovery pug

One of our pug patients recovering after his treatment.

Our team will develop a specific recovery plan for each patient. The team have found good success witjh BOAS patients recovering in a nurses arms in order to keep them nice and relaxed and comforted as they wake from the anaesthesia. Often less affected patients will go home the same day as the key with BOAS recovery is reducing stress to the patients.

Patients will spend time in their owners car and a specialist will go out and check on them after some time to ensure that they are happy that they are settled before sending them home.

If you would like more information on how to check if your dog is affected with BOAS please find our Respiratory Function Grading Scheme download by clicking below.

Download RFG Scheme PDF 

Perineal Hernia

Perineal Rupture or Perineal Hernia

A perineal hernia is a result of weakness or separation of the muscles of the pelvic diaphragm. These muscles are situated around the rectum, pelvis and the base of the tail. An abnormal hole in or between these muscle allows fat or sometimes abdominal organs to bulge into the perineal area.

This is a condition commonly seen in older, male, entire dogs but other animals may also be affected. In male dogs, male hormone levels can result in weakness in the muscle diaphragm. Couple with conditions that cause straining when toileting or conditions that increase the pressure in the abdomen and failure of the pelvic diaphragm muscles can occur.

Common risk factors for this condition include:

  • Entire (uncastrated) males
  • Disease of the reproductive system (eg. Tumour of the testes)
  • Enlargement of the prostate (benign enlargement, tumours, cystic swellings)
  • Straining due to colitis or pregnancy

Clinical signs of perineal hernia include:

  • Swelling of the perineum
  • Bruising of the perineum
  • Difficulty passing urine – cases that present unable to urinate may be considered a surgical emergency and will need urgent referral for stabilisation and surgery
  • Constipation, pain or straining to pass stool

What happens when a case is referred for treatment of a perineal hernia?

Because there are a range of reasons an animal may present with a perineal hernia we will aim to identify any underlying conditions. Common investigation for these patients includes:

  • Blood tests
  • Urinalysis
  • Abdominal imaging (ultrasound scan of the urogenital system, prostate, etc)
  • Rectal examination

How are perineal hernias treated?

Repair of a perineal hernia requires a surgery. This involves repair of the muscle of the diaphragm, in addition to moving some local muscles to stabilise the repair. In severe or recurrent hernias it may involve mobilisation of muscles from a hindleg or use of a synthetic mesh.

Further support for the repair can be given by fixing the bladder and colon (large intestine) into the abdomen but this is not necessary in all cases.

In male dogs we will typically recommend castration.

What can I expect following surgery?

Most cases will recover uneventfully after surgical treatment. Despite this, complications can occasionally occur. The common complications we see after perineal hernia surgery include:

  • Recurrence of the rupture; stool softeners may be advised long term to reduce the straining during defaecation and therefore protect the repair
  • Rupture of the other side
  • Infection: the surgical site is in the perineal region, near to the anus which is a source of bacteria
  • Faecal incontinence; uncommon and usually temporary

Portosystemic Shunts (PSS)

Portosystemic Shunts

A portosystemic shunt (PSS) is an abnormal connection between the portal vascular system and systemic circulation. Blood from the abdominal organs which should be drained by the portal vein into the liver is instead shunted to the systemic circulation by the PSS. This means that a portion of the toxins, proteins and nutrients absorbed by the intestines bypass the liver and are shunted directly into the systemic circulation.

There are two categories of congenital shunts, extrahepatic (outside the liver) and intrahepatic (inside the liver). While most portosystemic shunts are congenital (the dog or cat is born with the shunt), under certain circumstances portosystemic shunts may be acquired secondary to another problem with the liver (acquired shunts).

The genetic basis of PSS in dogs is unknown, but it is considered congenital and breeds affected include:

  • Miniature schnauzers
  • Yorkshire terriers
  • Irish wolfhounds
  • Cairn terriers
  • Maltese

Single extrahepatic shunts are typically congenital and affect small and toy breeds whereas single intrahepatic shunts affect large breeds. Cats nearly always have extrahepatic shunts.

Presenting Features:

Animals with congenital portosystemic shunts may present for:

  • anaesthetic intolerance - prolonged recovery following an anaesthetic event
  • small body stature
  • behavioural abnormalities

The signs are often episodic and may be more noticeable after eating. These neurological signs are due to the hepatic encephalopathy syndrome.

Signs of abnormal neurologic function include:

  • ataxia (swaying as if intoxicated)
  • seizures
  • blindness
  • head pressing

Other signs may include:

  • anorexia (loss of appetite)
  • vomiting
  • diarrhoea
  • constipation
  • ptyalism (hypersalivation) – most frequently seen in cats
  • polyuria/polydipsia (excessive urination/drinking)
  • stranguria (difficulty urinating)
  • haematuria (blood in the urine)

If your primary care veterinarian suspects that your pet has a portosystemic shunt, a full diagnostic work-up is advised. Some of these diagnostics may be completed by your primary care veterinarian, but you may also be referred to an ECVS board-certified veterinary surgeon or veterinary specialty center for additional diagnostics. A full work-up may include:

  • blood work
  • urinalysis
  • ultrasound
  • portography (an x-ray dye study that specifically highlights the portal system
  • liver function tests (bile acids and ammonia) Bile acids are measured after an overnight fast ("preprandial" or fasting) and then 2 hours after eating ("postprandial"). In dogs with PSS, one or both sets of bile acids are increased. Bile acids can increase with any liver disease, so high bile acids are not specific to congenital portosystemic shunts
  • CT scan with intravenous contrast

We recommend that any patient that is diagnosed with a portosystemic shunt is referred for a discussion on surgical management. Preoperatively we recommend that patients are treated with:

  • Lactulose
  • Purina HA Diet

At HSR surgery will depend on the exact nature of the shunt and the vascular development of the liver. We will typically encounter several common scenarios:

  • Partial attenuation – When you cannot completely ligate the shunting vessel we will typically perform a partial attenuation (narrowing of the shunt). Narrowing of the shunt encourages development of blood vessels within the liver and growth of the liver itself. These cases may also be treated with a cellophane band wrapped around the shunting vessel. This encourages gradual occlusion of the shunt by inducing a fibrous reaction around the vessel. Alternatively we would plan for a second surgical procedure at 3 months post-operatively. The majority of patients that did not tolerate initial complete ligation will go on to have a successful second surgery
  • Complete ligation possible – Complete ligation (tie off or closure) of the shunt vessel is desirable as it can result in complete resolution of the underlying condition

Please let us know if you have any additional questions or would like to speak to one of the specialists regarding a case.

Total Ear Canal Ablation (TECA) and Lateral Bulla Osteotomy (LBO)

What is a Total Ear Canal Ablation and lateral bulla osteotomy Surgery (TECA-LBO)?

Total Ear Canal Ablation (TECA) is a procedure performed to manage severe canal or middle ear disease in dogs.

Canine ear disease is a result of inflammation of the skin that lines the ear canal and can progress to infection within the middle ear. This skin inflammation may be part of a more generalised skin condition – some dogs may historically have issue with itching elsewhere in their body.

When to refer a case for TECA-LBO?

We typically reserve TECA-LBO surgery for patients that have severe “end-stage” ear disease that is no longer treatable with topical or systemic medical therapy.

Our approach:

To assess the extent of ear disease and middle ear involvement we will typically perform advanced imaging (CT or MRI) of the ears. If the extent of disease does not warrant surgery we will perform an ear flush, cytology, culture and otoscopy and review the underlying management strategies.

A TECA involves the removal of the diseased external ear canal. The middle ear or tympanic bulla is then entered by a lateral bulla osteotomy (LBO). This allows us to inspect the middle ear and remove abnormal tissue and the lining of the chamber.

What are the potential complications of surgery?

  • Hearing loss: Whilst TECA surgery does not involve the removal of the inner ear/hearing organ we do expect hearing loss for patient following surgery
  • Bleeding: There are some major blood vessels around the ear canal. All possible steps are taken to avoid these during surgery
  • Nerve Damage: The facial nerve runs very close to the ear canal. Surgery can occasionally (10-20% of cases) result in temporary paralysis of this nerve resulting in drooping of the eyelids and reduced ability to blink. The majority of these cases resolve in 1-2 months. Patients may also experience Horner’s syndrome or vestibular signs post-operatively. We have to closely monitor patients that develop neurological complications
  • Infection/abscess: Some cases can develop infections at the surgery site. Referral of cases for TECA-LBO surgery reduces this risk but in cases where infection occurs, further surgery may be warranted

Wound Management

Wound Management

All cases with complicated or problematic wounds referred to Hamilton Specialist Referrals are assessed by a Specialist in Soft Tissue Surgery. We work closely with our nursing team to create a plan for ongoing management of bandages and review this, as necessary.

When assessing wounds, we will assess the entire history of the patient and pay particular attention to any concurrent medical conditions that may affect the pet’s ability to heal or fight infection.

Assessment of the wound will allow us to tailor the management strategy for individual patients based on:

  • Extent and location of the wound/wounds
  • Chronicity of the wound
  • Presence of infection or neoplasia – sample (biopsies) may be taken for culture and histopathology if necessary
  • Previous treatments made prior to referral

There are various treatment options for wounds dependent on the information above but will often involve a combination of bandaging, second intention healing (natural healing that occurs when a wound is left without stitching it up), direct closure (suturing the wound closed), skin flaps (mobilization of local skin to cover the wound) or skin grafts.

In some cases we may elect to use a Negative Pressure Wound Therapy by placing a vacuum dressing over a wound. This specialized bandage can improve the healing of complicated wounds, whilst also protecting them from environmental contaminants. We will often utilize NPWT for skin grafts and large complicated wounds.

Complete healing and resolution can take time and become quite challenging. We often manage these cases closely with our referring vet colleagues. If you have a case that you would like to discuss please let us know – we would be happy to provide recommendations for management of difficult cases.

Anal Sac Adenocarcinoma

Anal sac adenocarcinoma is a malignant tumour or cancer of the anal sacs of the dog. 

The anal sacs are found on either side of the anus (at 4 and 8 o’clock). These structures play a role in scent marking of faeces. The tumour arises as a primary mass from the anal sacs. In some situations, tumour cells may spread to the lymph nodes (particularly those under the spine – sublumbar lymph nodes) or via the bloodstream to distant organs like the liver, spleen and lungs. 

These tumours may be incidentally noted during routine health check-ups. In some situations, you may notice difficulty passing stool or change in the shape of faeces due to the tumour size causing obstruction or narrowing of the faecal passageway. This tumour is also known to produce a hormone (parathyroid hormone related peptide – PTH-rp) that plays a role in calcium metabolism and can cause excessive drinking and urination. 

How do we diagnose and evaluate for metastasis?

Cases presented for evaluation of an anal sac mass will undergo a series of tests. The most important thing for us to know is the type of anal sac mass and if the mass has spread to other organs or lymph nodes. This evaluation will involve a combination of a CT scan, ultrasound and needle samples from areas of concern and is typically performed under sedation or anaesthesia.

Treatment options and prognosis

The treatment approach to these tumours depends on the results from the tests described above. 

For small tumours of the anal sac (<2.5-3cm) and no evidence of tumour spread, local surgical excision is the most appropriate treatment. For these patients the prognosis is typically considered very good. 

For patients where local excision of the tumour is difficult or there is a concern about the completeness of the excision, radiotherapy may be discussed as an adjunctive therapy following surgery. In other cases, we may discuss a course of chemotherapy to shrink the tumour before surgical excision in combination with post-operative radiotherapy. 

Some patients will have tumour spread to the lymph nodes under the spine. We will evaluate the location of these lymph nodes and determine what the most appropriate treatment is – typically this will involve an abdominal surgery to remove the lymph nodes and a discussion about ongoing chemotherapy or radiation therapy. For patients with tumour spread to the lymph nodes the prognosis is between 11-16 months depending on the tumour size.

In the worst-case scenario, there will be evidence of tumour spread throughout the body. The aim with these patients shifts from an aggressive surgical approach to one that provides a normal quality of life for as long as possible.  

Despite a diagnosis of cancer in these patients we expect that some dogs will enjoy a long period of completely normal and excellent quality life when we treat them appropriately and take a holistic approach to their care and well-being.

Laryngeal Paralysis

Laryngeal paralysis occurs when the larynx (opening to the trachea) is unable to open during normal breathing and particularly when there is increased demand on the respiratory system with exercise.

The muscle responsible for opening the larynx, the cricoarytenoideus dorsalis, is innervated by the longest nerve in the body – the recurrent laryngeal nerve.

What is laryngeal paralysis?

There are two major categories for laryngeal paralysis; congenital and acquired.

Congenital laryngeal paralysis is the result of a progressive degenerative process of the neurons that provide the signals to the muscle of larynx. This condition is seen in certain breeds; Bouvier des Flandres, Bull Terriers, Dalmatians, Rottweilers, Alaskan Malamute and Schnauzers. Animals with congenital laryngeal paralysis may also present with generalized weakness or other neurological signs. 

Acquired laryngeal paralysis is more commonly seen in older dogs (median of 9 years) and common breeds include Labrador and Golden Retrievers, St Bernards and Irish Setters. Recently we have begun to recognize that the disease in these patients may be part of a generalized neurological disorder and the term GOLPP or geriatric onset laryngeal paralysis polyneuropathy is frequently used to describe these patients. 

Laryngeal paralysis may also be caused by trauma of the recurrent laryngeal nerve, a mass or neoplasia in the neck or be part of an endocrine disease process. Although more frequent in large breed dogs, this condition is also recognized in small breed dogs and cats. 

What are the clinical signs of laryngeal paralysis?

Laryngeal paralysis results in clinical signs of gradual exercise intolerance, increased noise when breathing, change or loss of voice, gagging and coughing. Many of these patients are asymptomatic at rest but become symptomatic when stressed, when exercising or during warmer weather. In some cases, this can result in a rapid deterioration in patients due to severe difficulty breathing and inability to appropriately compensate.

How do you diagnose laryngeal paralysis?

The diagnosis of laryngeal paralysis involves a combination of clinical history, and physical examination noting the characteristic breathing sounds associated with laryngeal disease. Patients that have suspected laryngeal paralysis will then undergo further investigation; bloods (to identify any underlying endocrine or systemic disease), laryngeal examination under anaesthesia (to assess if there is normal laryngeal movement) and imaging of the head, neck and thorax (to assess for any structural changes or masses that may be contributing to clinical signs and to assess if there is any signs of pneumonia). For most cases, the only finding from these tests will be the inability to abduct or open the larynx. 

How do you treat laryngeal paralysis?

Our approach to laryngeal paralysis will depend on several patient factors and the severity of disease. For patients that are clinically affected by laryngeal paralysis we will typically recommend a surgical procedure (laryngeal tie-back or unilateral cricoarytenoid lateralization). This procedure involves placing a suture between two of the cartilage structures in the throat to hold the larynx in an open position. This surgical procedure is associated with a very good clinical outcome for patients with 90% of patients having an immediate improvement in ability to breath. 

The most significant complication following this procedure is aspiration pneumonia or a chest infection. Patients that have a laryngeal tie-back procedure will have a lifetime increased risk for development of this condition and careful monitoring and a change in feeding strategy is discussed at the time of hospital discharge.

If you have any questions about laryngeal paralysis or would like to discuss further please speak to your veterinary surgeon or our soft tissue surgery team.

Surgical Management of the Jaundiced Patient

Patients presenting to the surgeon for management of jaundice as a presenting sign have a very specific group of conditions. This group of conditions centered around the hepato-biliary system, the proximal gastrointestinal system (stomach and duodenum), and the pancreas. Because of the complexity of managing cases with conditions involving this area we adopt a multi-disciplinary approach with several specialist team members; anaesthesia, internal medicine, surgery and diagnostic imaging.

Anatomy of the hepatobiliary system

Bile is produced by the liver and then drains through a series of tributaries; canaliculi into inter-lobular ducts, which unite to from the hepatic ducts (2-8 in dogs) from each lobe of the liver, draining into the bile duct, with bile collecting into the gall bladder via the cystic duct. The bile duct travels within the wall of the duodenum for 1-2cm. The bile duct empties into the duodenum at the major duodenal sphincter, which is located 1.5-6.0 cm distal to the pylorus. 

Peri-operative management of hepatobiliary patient

The most common causes of extrahepatic biliary obstruction and therefore the most common comorbidities to consider when operating on a jaundiced patient include pancreatitis (inflammation of the pancreas), cholangitis/cholangiohepatitis (inflammation or infection of the biliary tree), neoplasia (cancer) and cholelithiasis (stones in the biliary system). Other less common comorbidities or causes that have been reported include diaphragmatic hernia causing gall bladder entrapment, migrating foreign body or parasitic infection.

An obstruction of the biliary system can result in profound systemic disease, including hypertension (low blood pressure), coagulopathy (bleeding abnormalities), reduced ability of heart to pump blood gastrointestinal ulceration and a delay in wound healing.

Patients are therefore carefully assessed for any changes in vital clinical parameters and stabilised accordingly prior to surgery. Assessment for coagulation abnormalities and pretreatment with fresh whole blood, fresh frozen plasma or Vitamin K may be prudent and should be considered.

Common surgical techniques for the hepatobiliary system

When to take a patient with an extrahepatic biliary obstruction and jaundice to surgery is a difficult decision.

Typically, we proceed to surgery if there is evidence of an obstruction to the bile ducts and/or worsening blood work suggestive of an obstruction.

The most common surgical procedures of hepatobiliary system are:

Cholecystectomy – removal of the gall bladder
Choledochotomy – opening of the common bile duct
Choledochal tube stenting – placement of a stent in the common bile duct
Cholecystoenterostomy – creation of permanent stoma between the gall bladder and the small intestine (typically duodenum or jejunum)

Deciding which procedure to perform relies on some clinical judgement, the pre-surgical imaging findings and clinical presentation. We try to answer the questions below to determine the most appropriate surgical procedure - this is a joint decision making process between the surgeon, internal medicine consultant and the diagnostic imaging specialist.

Can we demonstrate patency of the common bile duct by catheterization?

If patency of the common bile duct cannot be demonstrated by catheterisation a cholecystoenterostomy should be considered. Cholecystectomy is not indicated in this situation.

If we can catheterize the common bile duct, does the patient have clinical evidence of a functional obstruction (ie pancreatitis)?

Biliary stenting is an option for management of cases that have potentially reversible disease process (i.e feline triaditis/pancreatitis) or as a palliative procure for neoplastic processes.

Is the common bile duct intact or ruptured?

Following traumatic rupture of the common bile duct, the surgical repair site can be supported by placement of a choledochal stent.

Prognosis associated with surgery

Prognosis following surgery depends on the exact condition and procedure being performed. We will discuss the expected outcome and prognosis with you before we proceed with any intervention. Surgery should be considered as part of the entire management of the jaundiced patient. As such, we take a team approach and any discussion about management will involve several members of the team.

Fungal Infections - Nasal Aspergillosis

Fungal infections of the nose and sinuses can cause significant discomfort to pets. It is a common cause for chronic, mucopurulent nasal discharge in the dog.

What causes fungal infections or mycotic rhinitis?

The most common cause for fungal infections in the nose of dogs is either Aspergillus or Penicillium spp. In cats the most common fungal rhinitis is caused by Cryptococcus spp. These fungal organisms are ubiquitous in the environment – they are commonly found in warm, wet areas throughout the world. 

Infection of the nasal passages causes a destructive rhinitis with loss of the turbinate structures (scroll-like bones within the nasal cavity) and the common clinical presentation of chronic, purulent nasal discharge and in some cases bleeding from the nose (epistaxis). 

Young, male, large breed dogs are most commonly affected by this condition, but older dogs have been reported – the German Shepherds and Golden Retriever breeds seem to be particularly susceptible. There is no seasonal incidence of infection, but anecdotal evidence suggests that dogs in rural area or those that go for regularly walks in the countryside may be at a greater risk.

What are the common clinical signs of fungal infection?

Dogs will commonly present with profuse mucopurulent nasal discharge, sneezing, and sometime facial pain or discomfort. There may be ulceration of depigmentation of the nostrils but this is not always seen. In cases with significant destruction of the nasal passageway or severe inflammation bleeding from the nose may be noted. 

How do we diagnose a fungal infection?

Diagnosis typically relies on a combination of clinical examination findings, advanced imaging of the skull (CT scan), rhinoscopy to identify fungal plaques and obtain samples and serological testing. These tests are important to ensure that other causes of nasal disease, like a tumour, are not causing the clinical signs as treated for these problems will be very different.

How do we treat fungal infections of the nose?

Fungal infections have been treated with many different approaches and these have been met with mixed success. 

1. Rhinoscopy, fungal plaque removal and instillation of topical anti-fungal treatment. 

The approach at HSR is to treat fungal infections under anaesthesia with a combination of debridement (removal of) the fungal plaques and instillation of anti-fungal treatment. This is sometimes combined with a surgical approach to the sinuses, the nasal cavity or both. 

2. Oral medication.

Oral tablets/medication do not consistently resolve disease and has been associated with an increased risk of side effects. We may elect to prescribe oral anti-fungal medication for cases that have systemic fungal infection or those refractory to initial treatment.

How successful is this treatment?

Treatment is usually successful in about 65% of patients after an initial round of treatment. Some patients will require multiple rounds of nasal flushing and instillation of anti-fungal agents. These patients will require repeat anaesthesia and rhinoscopy. Approximately 1 in 10 dogs will not respond to this treatment approach and we may recommend more aggressive surgical debridement or the additional of oral anti-fungal medication.

It is common for dogs to have continued serous/watery nasal discharge after treatment. This is because the disease causes destruction to the normal anatomy and changes the normal physiology of the nasal passages

If your pet has recently been diagnosed a fungal infection or you would like to discuss referral, please contact us and we will be more than happy to discuss options.

Salivary Mucocoele

A salivary mucocoele is a collection of saliva within the subcutaneous tissue around the salivary gland or the ducts leading to the mouth. A mucocoele may develop from any of the salivary glands but the mandibular and sublingual salivary gland complex are most affected. 

Poodles, German Shepherds and Dachshunds may have a predilection to this condition. 

Saliva accumulation results in swelling anywhere along the length of the duct so dogs may present with swelling under the chin, neck, back of the throat, side of the face or under the tongue. Saliva accumulation under the tongue is often referred to as a salivary ranula.

What is the cause of a salivary mucocoele?

The exact cause of this condition is not usually found. Blunt trauma, injuries to the mouths, sialoliths or salivary stones have all been implicated. Diagnosis of a salivary mucocoele relies on a clinical examination findings, sampling of the swelling and utilization of special stains for saliva and further diagnostic imaging (often a CT scan).

How do you treat a salivary mucocoele?

The recommended approach for management of a salivary mucocoele is removal of the entire salivary gland and duct of the gland – this procedure is referred to as a sialodenectomy. Recovery from this procedure is usually very quick but it can take several days for the swelling of the neck to completely resolve. Patients are usually kept hospitalised for several days to ensure they receive appropriate pain relief and allow time for any swelling to subside. 

Animals that present with a salivary ranula may undergo an additional procedure referred to as marsupialization. This involves creating an opening between the lining of the mouth and the saliva accumulation to allow continued drainage. This opening will gradually heal without further intervention.

Does removal of the salivary gland cause any problems?

Removal of a salivary gland does not cause any long-term problems for dogs – they have multiple salivary glands that will be able to produce saliva.

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