Tuesday, September 17, 2013

Woody's Honk and Wink. Eyelid agenesis and cleft palate defect in a cat.

This is Woody. He is about 4 months old. He was brought to me last week from the good people at Animal Rescue, Inc. in New Freedom PA.

They originally thought that he might have a nasopharyngeal polyp because he had this constant funny little nasal sound. It sounded a bit like a cross between a stuffy nose and a goose honk. It was a very good guess on their part. They were almost right on the money with their presumption. They were in the right anatomical area, but Woody was missing something, instead of in possession of something extra.

Woody is about as sweet, gentle, loving, affectionate, and adorable as a kitten can be. His story is like so many other kittens at the rescue. Brought in as a baby, raised by volunteers, and now old enough to be looking for a home of his own.

But his path is not so simple and straightforward.

This is Woody.
He is missing the lateral (outside) 2/3rds of his upper eyelid.

Woody was born without complete eyelids.

Sounds crazy, doesn't it?

It is actually a condition called eyelid agenesis.

Eyelid agenesis is very rare in dogs but seen occassionally in cats. In some cases the loss of the lid is mild and only appears to be a cosmetic defect. But for some cats it causes pain, ocular discharge and can even lead to blindness as the hair sweeps over the sensitive cornea with each blink.

This is a picture of my kitty Magpie.
Her eyelids are normal.
I used pictures of my cat Magpie to illustrate what normal looks like. So you will see a picture of Woody and then followed by it will be a picture of either Magpie, or another normal kitten.

This is Woody's right eye.
It too is missing the lateral 2/3rds of the upper eyelid.


Magpie, falling asleep despite my annoying obsessive picture taking.

Woody's eyelid abnormality are what we call an incidental finding. They are not causing him any problems, and although they are not normal, they do not require any intervention on our part, YET.

But the honking sound, that we have to identify.

With a very quick peak, and  a calm gentle tolerant patient we got our first look at the source of the noise.

Woody's mouth.

The above two photos are of the inside of Woody's mouth. What the vet would call an "oral cavity" exam.
Woody is fully awake and this shot is incredibly hard to without drugs.
The right side (it is actually Woody's left side) of the roof of his mouth has a huge open defect.

 This is a sedated kitten before I put the endotracheal tube in their mouth and hook them up to the general anesthesia gas that we use to provide a well controlled plane of anesthesia.The left and right sides of the tissue above the tongue are uniform and symmetrical. The round opening is the soft palate that guides food and water to the back of the mouth. During eating and swallowing the arytenoids shut off the vocal/air tube that goes to the trachea so food doesn't go down the wrong pipe.

The structures of the base of the back of the mouth are specifically designed to direct food, water, and air into the correct tube.

The little pointed tip like structure visible just above the center of the tongue is the epiglottis.
This is looking down into the larynx from the mouth.

Woody is scheduled for surgery in two weeks. I will try to rebuild the soft palate, pharynx, and larynx into a functioning tunnel that will prohibit him from getting food and water pushed up into his nose and segregate these anatomical areas so he won't be prone to regurgitation, oral and nasal cavity aspiration and disease.

Have I ever done this before? No.

Does he need to have this surgery done? Yes.

Am I a little scared? Yes.

I will keep you all posted. Cross your fingers for me.

If the surgery is successful Woody will be looking for a home. If you are interested in adopting him, OR, if you have any pet questions, OR, if you are a surgeon and you would like to assist, (or perform Woody's surgery,,I am happy to pass him off to an expert ;-)), please find me at Pawbly.com. on Twitter @FreePetAdvice, or @pawbly.

Woody had surgery yesterday (September 30, 2013).

He did great!

I closed most of the soft palate defect. I was unable to close it completely for three reasons. First, it is almost impossible to get far enough back in the throat to place sutures and get access to the tissue with the needle. Second, he didn't have a tear for me to correct. He was missing the tissue that was supposed to be there. I couldn't just sew up the two halves of a laceration. I had to use what he was given, and that was not much. He had a hole, and no extra loose ends to collect and package. Third, The tissue swells with trauma, even the precise surgical trauma of a scalpel. I was very concerned that Woody be able to breathe on his own, and if needed I had to be able to replace his endotracheal tube if needed. The tube has to be placed in the very back of the throat. If there is severe or significant swelling you cannot visualize the opening of the trachea from the esophagus.

This is Woody's left eye from above. He is missing the lateral (outside) half of the upper eyelid. This is beginning to cause a few problems. He has hair rubbing on the cornea. Every time he blinks those hairs brush across the cornea, and over time this will cause irritation and could cause eventual scarring. He also has an incomplete blink. There literally isn't enough eyelid to close over the eye. Over time the area that isn't covered by the eyelids will scar and dry out. This will cause an ulcer and this can significantly impact his vision. 

Woody's left eye is worse than the right.

The closure of the cleft palate.

The correction of the left eye.
A conjunctival flap was taken from the bottom lid to create an eyelid and fill the missing gap of tissue.
To be completely honest I have never done this before. If it fails miserably I will let you know..(I always have a plan B ready. I haven't made it yet, but I will if I have to).

LOOK!! the eye closes!

Waking up. 
Thank you to everyone who sent well wishes!

Woody will be back in two weeks for a re-check.


  1. Have you ever heard of a cat not having an epiglottis? We think it was a birth defect...but unsure. He's about 10 years old and only recently started having issues which is how it was discovered....

    1. Hello,
      I have not seen this, but it could happen. I think that it would be very unlikely that your cat could have survived this long without one though. The epiglottis it the mechanism that keeps the food from going down the wrong pipe. I would have expected aspiration or pneumonia long before 10 years old.
      Thanks for reading, and best of luck with your cat.