DERMATOLOGY up the area . This can be performed in a simple interrupted fashion of a purse string like continuous fashion . Generally 5-0 polydioxone should be used . A small section of buccal mucosa and skin should be left ventral to the philtrum if possible . However if this it not possible due to invasion of the SCC this can be easily reconstructed .
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Tip 6 . I will generally cut one half of the nasal planum then apply a few simple interrupted sutures between skin and nasal mucosa . This limits the haemorrhage and the nasal mucosa slipping into the nasal cavity . I will then remove the other half in similar fashion .
A collar should be placed post surgery , this should be left on for 2 weeks till complete healing . I will generally continue IV fluids for 12 hours at maintenance . A single dose of antibiotics 30 minutes prior to surgery is all that is needed in these patients . Prolonged courses of antibiotics only lead to resistance and should not be given . Good pain control is essential to get these patients eating , buprenorphine is generally sufficient every 6 to 8 hours parentally . These patients need to be encouraged to eat , as smell is a large part of the feline appetite . Warmed tinned food is often a good option .
Figure 1 . Nasal SCC surgery – this patient had an extensive lesion requiring reconstruction of the philtrum as well . They need to be hospitalised for 3 – 4 days post op for wound care and pain control for an ideal response . The excised tissue is always sent for margin evaluation by a histopathologist . Photo Courtesey - Inanda Vets
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Tip 3 . Thoracic radiographs are often unrewarding in detecting metastasis . Lymph node aspirates are generally more worthwhile to detect metastasis .
Tip 4 . This is generally a disease of older cats and serum biochemistry and haematology are usually a good idea in determining any concurrent illnesses . It can however be seen in young cats and this is still recommended .
The patient is anaesthetised ; the rostal maxilla is shaved and prepared for surgery . The patient is then placed in dorsal recumbency with a rigid foam block under the mandible to elevate the head . Patients should always be intubated . The junction between the cartilage and bone is determined .
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Tip 5 . Masses in the T4 category generally will not respond to a simple planum resection and will require osteotomy of the maxilla . These patients are not candidates for planum resection . If there is any doubt a CT should be performed to determine bone involvement .
Ideally 5mm margins should be taken between healthy and malignant tissue . A 15-scalpel blade should be used and a single cut performed to limit the haemorrhage . The cut is deep through the entire nasal cartilage and the underlying nasal turbinates to the incisive bone of the maxilla . All of this tissue needs to be removed . Once the tissue has been removed fine absorbable suture material is used to suture
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Tip 7 . I will generally send them home with oral Buprenorphine ( injectable formulation dosed orally ). This will be absorbed through the mucous membranes of the oral cavity . I will administer a single injection the day after surgery of a NSAID once the patient is fully hydrated post surgery . There may be a small amount of bleeding post surgery and there can be increased sneezing in some patients associated with bleeding . This will resolve with time .
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Tip 8 . The removed section of nasal planum should ALWAYS be sent for histopathological examination even if you are 100 % sure your margins are clear .
Prognosis With clear surgical margins the prognosis is fair to good . Average survival time is around 600 days in the reported cases . 2 Generally recurrence is uncommon with surgical treated cases with clear margins . In cases where margins are not clear radiation therapy is recommended as an adjuvant therapy . However patients need environmental management to prevent further exposure to harmful UV radiation and formation of new SCC on non-pigmented areas .
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Tip 9 . Application of animal sunblock ’ s should be applied daily on non-pigmented areas of these patients life long .
REFERENCES
1 . Ladlow JF . Nose . In : Feline Soft Tissue Surgery . Langley- Hobbs SJ , Demetriou JL , Ladlow JF ( eds ). Saunders Elsevier : Edinburg , 2014 , pp . 655-669 2 . Lana SE , Ogilvie GK , Withrow SJ , Straw RC , Rogers KS . Feline cutaneous squamous cell carcinoma of the nasal planum and the pinnae : 61 cases . J Am Anim Hosp Assoc 1997 , 33 : 329-332 .) vet360
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