This cat's condition was diagnosed with a combination of the CT scan using 1-mm slices (rather than the previous 3-mm slices
in which a narrow lesion was missed) and retroflexed rhinoscopy. These lesions are often missed on antegrade rhinoscopy alone.
During the rhinoscopy, interventional endoscopic techniques were used to place a nasopharyngeal stent inside the cat's nasopharynx
through the nostril and permanently open the stenosis noninvasively. The owner was offered serial balloon dilation procedures
to try and treat this stenosis but elected immediate stent placement to try and maintain permanent patency. This technique
requires a combination of fluoroscopy and endoscopy to appropriately place the nasopharyngeal stent across the stenosis (Figures
3 and 4).
Figure 3: A retroflexed endoscopic series of images during the placement of a balloon-expandable metallic stent (BEMS) for
nasopharyngeal stenosis. A) The nasopharyngeal stenosis. B) A guidewire running from the nares and through the small nasopharyngeal
opening. C) A balloon is passed over the guidewire; the opening is pre-balloon dilated. D) A balloon preloaded with a stent
is advanced over the guidewire and then the stent is deployed by dilating the balloon. The nasopharyngeal stenosis is now
effaced and the airway is open.
This patient was discharged the same afternoon as the simultaneous diagnosis and treatment. The recommendation was to continue
two weeks of clindamycin (11 mg/kg orally b.i.d.) and a tapering course of prednisolone (1.5 mg/kg/day tapered over three
months). The cat was immediately able to breath through its nose upon recovery from anesthesia. It continued to have minor
nasal discharge for the next 24 hours, at which point it ceased. It had no difficulty eating, drinking or breathing and was
able to sleep in bed with the owner permanently. The cat gained 2 lb in the first month after stent placement, and the owner
reported an excellent appetite. The owner reported complete return to kittenlike behavior, which the cat has maintained over
the following three years.