This YouTube video features Dr. Lera Clone presenting a clinical case of a senior small-breed dog (Rhys) with nasal discharge. She discusses differential diagnoses (especially periodontal disease causing an oral–nasal fistula), recommends dental X‑rays and CT for diagnosis, describes surgical repair and expected short-term post-op bleeding, and warns that deep infections typically require surgery rather than antibiotics alone.
Hey guys. Dr. Lara, today I'm here with Rhys. Reese is a 13 year old female spade, I want to say probably min pin. And so Reese was coming to me for a second opinion for discharge from the nose. And that's really what the video is about today. And so when Reese initially came into me, usually what I did was I did my physical exam, I noticed that Reese had some teeth missing. And so I spoke to mom about whether or not she had had oral surgery before. She said she had recently had oral surgery maybe about four to six months before. And I asked if they had had dental X rays done. And so when we went ahead and did some research, there were no dental X rays performed. Now that is not to say that, you know, they're bad or whatever. It's just something for me when I go ahead and I have a 13 year old small breed dog. Regardless of whether it's a min pin, a Yorkie, a chihuahua, whatever that is having discharge from the nose, the first thing that comes to my mind is periodontal leaves. Now dogs can have what's called an oral nasal fistula. What that is is when you have the tooth or any of these teeth up here, the ceiling of where the root sits is the top on the flip side of that is the nasal sinus or the nasal cavity. And so what if the infection gets bad enough? What will happen is the infection will eat through that ceiling of where the tooth root sits and it'll start going into the nasal cav. And so then you can start having discharge, whether it's blood, whether it's pus, whether it's the dog is sneezing a lot. Those are some symptoms for what we call an oral nasal fistula. Now when we have discharge coming out of the nose, there are also some other things that we take into consideration. So could have a mass in the nose. And that's something that is possibility. We could potentially go ahead and have what we call a foreign body. So let's say a dog is, you know, sniffing something and they get something stuck in there. That's a possibility. You know, those are probably the most common possibilities of what could potentially be going on with the nose. And so if your dog is having discharge from the nose, then one of the. And it could also be a virus. You know, for me, with this particular case, I imagined that it was periodontal disease. And so that was something that I had to go based on a scientific guess. If we don't have any exposure to other dogs, that goes ahead and limits the virus possibility. Distemper virus is a possibility that could, if we're talking about viruses, Bordetella or chemical is a possibility of what could potentially be going on that could be causing some nasal discharge. And so if we're looking to, for the cause of what's going on, especially in smaller breed dogs, you want to go ahead and you want to get dental X rays done. That is something that is most likely going to be the case, especially in an older dog. Now, in an ideal scenario, you would have a CT scan performed, and the CT scan is going to go ahead and provide you the, the most aboundant of information looking at the nasal cavity as well as the skull. We'll also provide you information about what's going on with the teeth as well. So you'll be able to figure out is there a periodontal disease going on that could potentially be causing this. Now, even if you see that there is periodontal disease going on based on the CT scans, it doesn't necessarily mean that the oral surgeon is not going to do dental X rays. They're still going to have to do the dental X rays. So. So don't think, oh, yeah, I'll just get out of that. That would be a terrible thing to do. I know, girl. So what we ended up doing today was we were in a situation where we weren't able to do the CT scan. So we went based on the most common things and it ended up being when we did the oral evaluation with the dental X rays, Rhys definitely had an oral nasal fistula. So much so there was so much infection going on there that the discharge had almost formed like a big chunk. And so as the oral surgeon was in there, it was, it was that much more obvious as to what was going on and why we were seeing this discharge. Now, when they do have oral surgery and they have an oral nasal fistula, it is something that you do want to go ahead and keep in mind they will most likely bleed. Other than those for the next two or three days. It's not something that you need to be freaked out about. It is something. I know, kiddo. You want to get going? That's okay. We're wrapping up shortly. It is something that will be common, so don't freak out. You know, that's just part of the healing process. It'll usually take about two or three days for the, for the sutures and the skin to heal and all that kind of stuff. But that is most likely going to be the case. You want to make sure, especially in these Older patients that you do want to have somebody who really knows what they're doing so that they can get in, they can get out. They. And when we end up having to take these major teeth out, like we ended up taking out the fangs on this particular patient, you want to make sure that it's somebody who knows what they're doing, because if they don't, there's a possibility that they might end up leaving a gap between where the tooth, where the tissue is for the where we're closing. And that honestly has happened to me in the past. And that's one of the reasons why I stopped doing oral surgery myself, because that's just not my lane. That's why I work with a group of experts who, hey, when something gets outside my lane, hey, you know what? This is your lane. This is something that you do several times a week, several times a month. And so my patients are able to get, you know, some of the best care, if not the best care possible. So if you guys have any questions about this particular video, please leave it in the comment box. If you found this video helpful, please give us a thumbs up. Heads up. By the way, we did have surgery today. We did have anesthesia, so we are kind of drunk. So that is one of the reasons why you see Reese looking the way that Reese looks. And even if you put your dog. Because this may be a question that may come up at the end, even if you put your dog on antibiotics, it will not resolve the infection. The infection is too deep seated at that point to go ahead and have antibiotics resolve it. It is something that will require surgery. And unless you're okay and your veterinarian is okay with constantly putting your dog on antibiotics, which could potentially create a resistant organism, then you're not going to do that. Otherwise, give us a thumbs up if you found this video helpful. Subscribe and please share it. Thanks for watching. Have a great day and be safe. Oh, I know, I know, I know. Sat.
