Nicole J. Buote Department of Clinical Sciences, Cornell University, Ithaca, NY, USA Nosectomy can provide feline patients with relief from painful ulcerative conditions as well as supply owners with important prognostic information if a neoplastic process is considered for their pet. Nosectomy is an easy‐to‐perform procedure even with minimal surgical experience, but certain technique recommendations should be followed (e.g., meticulous suturing of skin to mucosa).1,2 While trauma to the nose and brachycephalic nasal stenosis or stricture from previous interventions can be indications for nosectomy in cats, neoplasia is the most common reason for the performance of this procedure. The most common cause for a nosectomy in feline patients is the appearance of cancer along the nasal philtrum, alar folds, or nasal planum (Figure 6.1). Squamous cell carcinoma (SCC) is the most common cancer affecting this area in cats and dogs.1 In cats, SCC originates from the cornified external surface of the nasal planum, which is different than in dogs where it usually grows from the mucous membrane of the nostril or nasal planum.3 Light pigmentation (i.e., white hair coat) has long been identified as a predisposing cause for SCC in animals, as have short hair coats and chronic exposure to ultraviolet light. In one study, white‐haired cats had a 13.4 times higher risk of developing head and neck SCC compared to darker colored cats.4 Other tumors, such as mast cell tumors, lymphoma, fibrosarcoma, malignant melanoma, hemangioma, and fibroma, can be found on the nose as well.1 Noncancerous diseases, such as eosinophilic granulomas and immune‐mediated diseases, can involve the nasal planum and present with a similar erosive or proliferative appearance (Figure 6.2). While rare, trauma to the nasal planum or complications from nasal surgery (e.g., alar fold resections for stenotic nares) can also require nosectomy in cats.2 Complications from nasal surgery in brachycephalic feline breeds are occasionally seen, and while surgeries including ala vestibuloplasty and pedicle flaps can be performed, nosectomy is a simple technique to remove nasal obstructions. Preoperative considerations and diagnostics depend on the primary differential or cause for surgery. If the patient presents with an ulcerative or proliferative lesion on the nose, neoplasia should be the first consideration. Usually, SCC starts as a benign crusting or erythema, which is easily overlooked by owners, but it will eventually advance to a deeper ulcerative lesion. A sharp veterinarian should pursue any lesion in this area aggressively because time wasted leads to lost opportunities for treatment. In cats with SCC, 30% of patients will have SCC in multiple head and neck locations, so a thorough examination of the pinna, periocular region, and neck is recommended.1 If SCC or another neoplasia is suspected, a biopsy of the lesion is recommended before nosectomy is performed. Cytology (fine needle aspiration) or impression smears are not usually accurate because inflammatory cells and hemorrhage are commonly present in both cancerous and noncancerous lesions. Figure 6.1 Photograph of a squamous cell carcinoma on a feline patient. It is evident that a biopsy has been taken from this patient, as a defect and suture are visible. This patient also had ulcerative lesions on both pinna, so those have also been clipped for surgery.
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Nosectomy in Cats
Introduction
Indications/Pre‐operative Considerations
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