Diagnosing Feline Rhinitis

A cat infected with feline immunodeficiency virus presented with a history of chronic sneezing and right-sided mucopurulent nasal discharge and underwent a dental cleaning. At that time, a fractured right maxillary canine tooth (104) was extracted. Clinical signs resolved after the procedure. One month later, the unilateral mucopurulent nasal discharge and sneezing recurred. A small fistula was found in the area of 104. Radiography and rhinoscopic examination revealed a large tooth root—likely retropulsed during the extraction of 104—in the right nasal cavity, occluding the meatus. The sneezing and nasal discharge resolved after removal of the root fragment with endoscopic grasping forceps.

Commentary 1: Criticalist’s Perspective

Nasal discharge in cats and dogs can be a frustrating condition, both for clients and medical teams. A definitive underlying cause can be challenging to identify even with advanced, sometimes repetitive, diagnostics. Empirical treatment is often focused on minimizing the clinical signs utilizing antimicrobials and anti-inflammatory medications. Although nasal foreign bodies are a relatively uncommon cause, especially in cats, it is important for clinicians to include this on their list of differentials. Imaging, as noted in this case report, can be beneficial not only diagnostically but also therapeutically. It can lead to a more rapid diagnosis and resolution in cases of foreign bodies that may otherwise be missed for prolonged periods.—Tara J. Fetzer, DVM

Commentary 2: Dental Specialist’s Perspective

This case report emphasizes the fundamental importance and value of dental radiography for both presurgical planning and postextraction confirmation of tooth removal. Perforation into the nasal cavity is a real risk associated with maxillary canine tooth extraction. In dogs and cats, a thin layer of bone separates the nasal side of the canine tooth root from the nasal cavity proper. Ascending periodontal disease or endodontic disease can result in inflammation and resorption of maxillary bone on the nasal side of the tooth root and subsequent drainage into the nasal cavity manifesting as rhinitis. Nasal symptoms can also result from inappropriate placement of the dental elevator along the palatal aspect of the tooth causing perforation into the nasal cavity. A take-home message from this report is that simple imaging (ie, dental radiographs) can be used in cats with chronic nasal clinical signs before more expensive and invasive tests.—Christopher Snyder, DVM, DAVDC