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!"#$%&&'%("$%) *+,-+./+0%&111
2+3+0++4%5++0%2+67+8
9:;<=%5:>(?
UpperAirway
ObstructioninCats:
;@
A@B%9<;?*
!Fledlctlugthecuse0Iuel
llwy0bstluctl0u-bsed0u
hlst0lyudcllulclslgus-lsless
lellbleluctsthultlslud0gs.
ObstructioninCats:
Pathogenesisand
ClinicalSigns
UniversityofEdinburgh
DominiqueJ.Griffon,DVM,MS,MRCVS
<C*?2<;?D hs0hlyugel0lysudI0lelgub0dleslethem0stc0mm0uus0hlyugel
0bstluctl0uslucts,butg00duudelstudlug0I0thelc0udltl0usll0wsI0lellylec0gultl0u
ud l0llte mugemeut. bscesses, luIectl0u, steu0sls, 0l ue0lsl my 0bstluct the
us0hlyux.Llyugel0bstluctl0umybecusedbyvllety0Ic0udltl0ussuchsgluu-
l0mt0usllyugltls,ue0lsl,cysts,llyug0ssm,udllyugelllysls.Extlmullc0m-
lessl0u 0I the uel llwy sh0uld ls0 be c0usldeled. Cllulcl slgus 0I uel llwy 0b-
stluctl0u l0vlde vluble luI0lmtl0u b0ut the deglee 0I llwy c0ml0mlse ud the
ut0mlcc0mltmeutluv0lvedbutleu0tseclIlcI0luyltlculldlsesel0cess.
U
pperairwayobstructionincatsisacommonandsometimeslife-threat-
eningcondition.Earlyrecognitionofclinicalsigns,combinedwithap-
propriate diagnostic and therapeutic approaches, increases the chances
ofasuccessfuloutcome.Thisrequiresagoodunderstandingofthepathogenesis
ofupperairwayobstructionaswellastheoptionsavailabletotreateachcondi-
tion.Athoroughknowledgeoftheanatomyofthiscomplexregionisalsocru-
cial,especiallyifanysurgicalcorrectionisundertaken.
This article focuses on obstructive diseases affecting the nasopharynx, phar-
ynx,andlarynxin catsandreviewstheanatomy,pathogenesis,andclinicalsigns
associatedwiththeseconditions.Theintentistohelpcliniciansestablishacom-
pletelistofdifferentialsandguidethemthroughthediagnosticapproachofup-
perairwayobstruction.Acompanionarticlewillfamiliarizeclinicianswithun-
usual conditions and provide small animal surgeons with new information
regardingtreatmentoptions.
<(<?:EB
Theupperrespiratorytractincludesthenares,nasalpassages,pharynx,larynx,
andcervicaltrachea.Thepharynxcanbedividedintothreeareas:theorophar-
ynx,nasopharynx,andlaryngopharynx(Figure1).Theoropharynxisventralto
" Chl0ulc,u0ul0glesslvestelt0l
I0ll0wluguuellesllt0ly
tlctluIectl0uluctsls
suggestlve0Ius0hlyugel
steu0sls.
" Ellyslgus0Iuelllwy
0bstluctl0uluctssh0uldbe
lec0gul/edbeI0lecyu0sls
devel0s.
" lth0ughthecllulcleluce
0Igluul0mt0usllyugltlsls
slmlllt0tht0Illyugel
ue0lsl,thesec0udltl0uscu
ledt0dlstlcllydlIIeleut
0utc0mes.
" Tem0llyudelmueut
llyugelllyslsmylesult
Il0mvllety0Ic0udltl0us.

the soft pal ate, extending
from the palatoglossal arches
rostrally to the base of the
epiglottis caudally. Dorsal to
thesoftpalate,thenasophar-
ynx is located between the
choanaeandtheintrapharyn-
gealostium.
1
It connects the
nasal cavity with the larynx
and contains the pharyngeal
openingoftheauditorytubes.
The normal length of these
openings measures 4 mm in
cats.
2
Caudally, the bound-
aries of the intrapharyngeal
opening (or ostium) are the
caudaledgeofthesoftpalate
and the pal atopharyngeal
arches. The laryngopharynx
or caudal pharynx, which is
common to both the diges-
tiveandrespiratorytracts,ex-
tends from the intrapharyngeal opening to the rostral
borderoftheesophagus.
Theanatomyofthecartilagesformingthelarynxdif-
fers slightly between dogs and cats. In both species,
three unpaired cartilages (the epiglottis, cricoid, and
folds ventrally and the ary-
tenoid cartilages dorsally; it
functions mainly in phona-
tionanddividesthelaryngeal
passageintoarostralvestibule
andacaudalinfraglotticcavi-
ty.The aryepiglotticfoldaris-
es from the lateral margin of
the epiglottis on each side of
the vestibule in both species;
itendsatthearytenoidcarti-
lageindogsandatthecricoid
cartilageincats.
The innervation of the lar-
ynxissimilarindogsandcats.
The cranial laryngeal nerves
originatefromthevagusnerve
atthelevelofthenodosegan-
glion and directly supply the
larynx. The internal branches
providesensoryinnervationof
thelaryngealmucosa,whereas
the external branches provide motor innervation to the
cricothyroideusmuscle.Thecaudal(recurrent)laryngeal
nervesoriginatefromthevagusnerveatthethoracicin-
let and loop around the subclavian artery on the right
and the ligamentum arteriosum on the left before re-
!"#$%&'()#* *+,-+./+0 % &111 *.F## % <G7.F#H@I"-7JK
97LM0+%NOAnatomyofthefelineupperrespiratorytract(!
=nasalpassage; "#=nasopharynx; $#=openingoftheaudi-
tory tube; %# = soft palate; &# = oropharynx; '# = laryn-
gopharynx; (#=hyoepiglotticus; )#=epiglotticcartilage; *#
= epiglottis; !+# = thyroid cartilage; !! = vestibular fold;
!"#=depressionrostraltothevocalfold; !$#=vocalfold;
!%# = cricoid arch; !&# = cricoid lamina). (Illustration by
IanLennox,MedicalIllustration,UniversityofEdinburgh,
UnitedKingdom)
three unpaired cartilages (the epiglottis, cricoid, and
thyroid) and one pair of arytenoid cartilages form the
larynx,buttheshapesofthecartilagesdiffer:Thecor-
niculateandcuneiformprocessesofthearytenoidcarti-
lagesfoundindogsareabsentincats.
2
Indogs,thereis
a small interarytenoid cartilage between the two ary-
tenoidcartilages.
2
Incats,however,thearytenoidcarti-
lages are only connected by the transverse interary-
tenoid ligament. Cats also lack a vestibular ligament,
which in dogs extends from the floor of the thyroid
cartilage to the cuneiform process. Consequently, the
feline arytenoid cartilage is connected to the floor of
the larynx by the vocal ligament only.
2
The laryngeal
musclesaresimilarinbothspecies,withtheexception
of the ventricularis muscle, which is present only in
dogs. In both species, the cricoarytenoid muscle is re-
sponsibleforabductionofthearytenoidcartilages.
Thelaryngealcartilagesandligamentsarecoveredby
a mucosa that forms the walls of the larynx. In dogs,
thelateralventriclesopenoneachsideofthelarynxbe-
tween the vestibular fold cranially and the vocal folds
caudally.Thevestibularfoldsorfalsevocalfolds"con-
tain the ventricularis muscle and vestibular ligament.
Catslacklaryngealventricles,andthereisonlyaslight
depression in front of the vocal folds. Vestibular folds
arepresent,however,buttheydonotcontainanymus-
cleorligament.
3,4
Theglottisconsistsofthetwovocal
and the ligamentum arteriosum on the left before re-
turningtothelarynx
2
;theyinnervateallofthelaryngeal
musclesexceptthecricothyroideus.
5<?P:Q@(@*>*
(FK",RF0SGL+F#%5"#S,K
Nasopharyngealpolypsareacommoncauseofupper
airwayobstructionincats.Alsocalledotopharyngealor
inflammatorypolyps,thebenignpedunculatedgrowths
areofuncertainorigin.Polypsmayoriginatefromthe
mucosal lining of the middle ear, auditory tube, and
nasopharynx, all of which are similar histologically.
5,6
Although the exact etiology is unknown, chronic in-
flammation, infection, and congenital anomalies have
beenproposedaspossiblecauses.
7
Polypshavebeenas-
sociated with rhinitis and otitis resulting from various
bacterialandviralagents(e.g.,calicivirus).
8
Itisunclear
whethertheseinfectionsareprimaryorsecondarycon-
ditions.Becausenasopharyngealpolypsaremorecom-
monincatsyoungerthan3yearsofage,
9,10
afamilialor
congenitaloriginhasalsobeensuggested.
11
Nobreedor
sexpredispositionhasbeendescribed.
(FK",RF0SGL+F#%</KJ+KK
Extension of otitis media may also result in a na-
sopharyngealabscessratherthanapolyp.
12
Intheseun-
usual cases, the abscess is located near the opening of
hS0FhRYh/ " RYTEh0 0 CRT LES " \EST BuLR F 0L0S " CL C \ RuS

the auditory tube, obstructing the nasopharynx. Na-
sopharyngealabscessesmayalsoformsecondarytofor-
eignbodymigration.
13
Fungal infection of the nasopharynx is usually sec-
ondarytocryptococcalrhinitis.However,atypicalpre-
sentationsinwhichcatspresentwithsignsofnasopha-
ryngealdiseasewithoutrhinitishavebeenreported.
14
In
these cases, the mycosis arises from the caudal part of
thenasalpassageandformsapolypoidcryptococcoma,
obstructingthenasopharynx.
Myiasis occasionally occurs in the pharynx, most
commonlyintheretropharyngealtissues,butmayalso
involvethesoftpalate.
15
,-./0/102#larvaemaybevisual-
izedthroughabreathinghole"inthemucosalsurface
ormaybefoundfollowingexcisionofthesurrounding
granuloma.
(FK",RF0SGL+F#%*-+G"K7K
Nasopharyngealstenosisisanunusualformofupper
airway obstruction secondary to scar tissue formation
across the nasopharynx. Whereas choanal atresia is a
developmental failure of the posterior nasal cavity to
communicate with the nasopharynx, nasopharyngeal
stenosisisanacquireddisease.Inhumans,nasopharyn-
gealstenosisisthoughttodevelopsecondarytomuco-
salulcerationsassociatedwithinfection,causticburns,
or oropharyngeal surgery.
16
This condition has also
beendescribedincatsfollowingupperrespiratorytract
infection.
17
The location of the stenosis along the na-
sopharynx is variable. Scar tissue may form across the
openingsofthecaudalnaresintothenasopharynx,de-
creasing their diameter from 5 mm to pinpoint size.
Adhesions may also form caudally, attaching the soft
palatetothedorsalwallofthenasopharynx.
C0FJRSJ+,RF#7J%*SG40".+
Brachycephalicsyndromeisarareconditionthathas
been described in brachycephalic cats (e.g., Persian
breeds).
18
The short skull conformation in these ani-
malsisassociatedwithanelongatedsoftpalate,distort-
ednasopharynx,andshortnarrownasalpassageslead-
mouscellcarcinomaisaveryinvasivetumor,common-
lyextendingintothesoftpalateandlaryngopharynx.
20
Primarylaryngealneoplasiaindogsandcatsisrare.
21,22
Benign tumors (e.g., rhabdomyomas) have been de-
scribed in dogs
23
but not in cats. Lymphosarcoma and
squamouscellcarcinomaarethemostcommonlaryn-
gealneoplasmsreportedincats.
24
Lymphosarcoma may
present as a mass or a diffuse thickening of the entire
larynx,
22
whereassquamouscellcarcinomamayspread
fromthelarynxintothepharynxandsoftpalate.Ade-
nocarcinoma,epidermoidcarcinoma,andundifferenti-
atedcarcinomahavealsobeendescribed.
25-27
Laryngeal
adenocarcinomas have been reported to metastasize to
theregionallymphnodes,lung,andspleen.
28
=F0SGL+F#%5F0F#SK7K
Idiopathiclaryngealparalysisislesscommonincats
thanitisindogs.Othercausesoflaryngealparalysisin
cats include congenital defects, generalized neuromus-
cular dysfunction, trauma, and neoplasia.
29
Unilateral
hemiplegiahasalsobeendescribedinonecatwithlym-
phomatousinfiltrationofthevagusnerve.
30
Damageto
therecurrentlaryngealnervesmayresultfromwounds
to the ventrolateral neck and may be associated with
Horner`s syndrome if the cervical sympathetic trunk
hasbeendamagedconcurrently.
31
Mechanicalcompres-
sionoftherecurrentlaryngealnerveresultingfromin-
flammatoryswellingorneoplasiaofadjacentstructures
mayresultinneuropraxia.
32
Laryngealparalysishasalso
beenreportedfollowingsurgeryofthe trachea,thyroid,
andligationofpatentductusarteriosus.
33
Inthesecas-
es, inadvertent transection of the laryngeal recurrent
nerveresultsinpermanentlaryngealparalysis.Howev-
er,postoperativelaryngealparalysiscausedbyexcessive
retractionmaybeonlytemporary.Respiratorydistress
may be noted immediately after surgery, especially if
upperairwayedemaispresent.Inothercases,theonset
ofclinicalsignsmaybedelayedbyseveraldaysoreven
weeks. Although this is difficult to explain, clinical
signsdeveloped38days(median)afterexperimentalbi-
lateralrecurrentnervetransectionindogs.
34
*.F##%<G7.F#H@I"-7JK !"#$%&'()#* *+,-+./+0%&111
ednasopharynx,andshortnarrownasalpassageslead-
ing to stenotic nares. Brachycephalic syndrome may
resultinlaryngealedemaandeventuallycollapseofthe
larynxindogs.Incats,littleisknownabouttheclinical
significance of this syndrome. Because of their seden-
tarynature,catswithstenoticnaresmaynothavesig-
nificantupperrespiratoryproblemsforseveralyears.
15
(+",#FK7F
Neoplasiaofthenasopharynxusuallyoriginatesfrom
the nasal passage or the oral cavity. Adenocarcinoma,
squamous cell carcinoma, and lymphosarcoma are the
most common nasal tumors in cats.
19
Tonsillar squa-
lateralrecurrentnervetransectionindogs.
>G3#F..F-"0S%=F0SGL+F#%T7K+FK+
Inflammatorylaryngealdiseaseindogsandcatstends
tobeacutebutrarelyresultsinlife-threateningrespira-
toryobstruction.
35
Trauma, infectious agents, foreign
bodypenetration,andinsectbitesmaycausetransient
laryngeal inflammation and edema.
24,35,36
However,
granulomatouslaryngitishasbeenreportedtocausese-
vere progressive upper airway obstruction in cats.
35,37
Theclinicalappearanceofthisconditionisverysimilar
tothatoflaryngealneoplasia:Asymmetricnodularle-
sionsobstructtherimaglottidis(Figures2and3).Granu-
MY S S " STEh0T C hRES " h0RhER' S SYh0R0ME " RhuL0MT0uS LRYh T S
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FELNE-Upper airway obstruction in cats FELNE-Upper airway obstruction in cats
pathogenesis and clinical signs pathogenesis and clinical signs
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