cat/6/neutered male/domestic mediumhair/8lbs
Hello! I'm hoping to get some advice about an ongoing issue my kitty Shortbread has. He has been to so many different vets at this point and no one really knows how to treat his problem, so at this point it's just maintenance.
Theres a LOT of history here so I apologize in advance for the wall of text, I tried to summarize but theres just so much info its really difficult.
For background info I'm a shelter worker and I adopted my cat back in October 2023 when he was already a young adult, estimated to be between 1-3 years via teeth. I know that he came from a hoarding situation so there was definitely a ton of inbreeding going on. I also know that he was not given a proper diet while he was living there (I've been told he lived off of hotdogs but I'm not sure if that was exclusively what he ate), and when I brought him home he was super tiny at 4.5 pounds.
Not only did he weigh very little, he was just a really small guy in general, about the size of a 4 month old kitten. I was under the impression that he was this way because of malnutrition as a kitten, and that since he was already an adult, he would most likely stay the size he's at or only get slightly bigger. Over the last couple of years however he has grown to the size of a normal, albeit somewhat petite, male cat. He weighed 9 pounds at his last appointment in August. So it is very possible he was just aged wrong and was, in fact, a 4 month old kitten with horrendous teeth.
A couple of days after bringing him home I noticed a swelling on the bridge of his nose, right on the center. I brought it up to the vet at his first exam, and was told to just keep an eye on it and to bring him back in if it gets any worse. Over the next week or two it did increase in size, so I brought him to urgent care to see what more we could do.
The first thing that they suggested was a possible fungal or bacterial infection, and suggested a cytology of the site. Got that done, started a course of amoxi-clav and was awaiting test results for a few days when I noticed the swelling had gotten significantly worse and was turning purple and shiny. He was starting to lose hair in the area as well. Back to the vet we went! On the drive to the vet he actually burst it open rubbing his face on the kennel door, draining purulent discharge and blood.
Got the spot drained and cleaned, sent out another sample for bacterial culture, and was prescribed an additional med, onsior, while we awaited results. He was sent home with a cone as well. Things looked to be improving, the swelling decreased and he was given the all clear at his recheck appointment.
Over the next couple of months I noticed it would intermittently swell slightly but now that there was an exit hole, it would drain and the swelling would go back down. This happened a few times before I brought him back to the vet. This time they recommended a mass removal surgery with the caveat that they would likely not be able to get complete margins and the mass may regrow.
Went ahead with the surgery and was informed that there was a hole extending into the deeper tissues of the head, and they were able to flush out a large amount of thick tissue that was most consistent with a cyst. Sent out a biopsy to rule out cancer (negative thank goodness!!). They weren't able to remove everything as they didn't want to risk damaging sinuses or facial nerves. Sent home with a cone and more antibiotics + pain meds.
Results came back, e. coli and enterobacter. Switched up antibiotics. Got sutures removed, things were looking good again for a while.
3 months later swelling came back and the site burst again. Back to vet. Consulted with advanced surgery team, who informed me a CT would be necessary before anything could really be tried surgically again as the area is so intricate. Agreed to get it done but had to wait a few months to scrounge up enough money.
CT day finally arrives, learned that there was no invasion of the surrounding bone which was good. I will copy and paste the radiologist interpretation here:
"A small, approximately midline soft tissue attenuating structure is identified extending to the subcutis at the level
of the nasal bone. The structure extends caudoventrally through the maxillary bone towards the nasal septum. A well-defined osseous defect, with smoothly defined margins is identified. The contents of this "bone tunnel" are hypoattenuating. It extends caudally to a blind ending defect in the nasal septum. The tubular soft tissue
attenuating structure measures approximately 5 mm in diameter. It is approximately 15 mm in length. It extends
to the nasal septum at the level of the rostral extent of the zygomatic arch. There is no evidence of a palatal cleft. The nasal cavity is unremarkable. There is no evidence of turbinate destruction or soft tissue attenuating material within. The frontal sinuses are small but otherwise unremarkable. The remainder of the study is unremarkable.
Assessment:
Findings are consistent with a cleavage of the nasal septum and rostral midline of the maxilla. This has created a 5 mm diameter sinus which extends to a blind ending cavity on the midline of the nasal septum. The continual discharge suggests that there is an epithelial lining to the lesion. Almost certainly, this finding is a
congenital/developmental defect.
There is no evidence of further congenital skull defects. The nasopharynx is unremarkable and the hard palate
appears intact."
The problem now is that no one that I have consulted has ever heard of this issue or knows what to do for it. Another surgery was suggested, to be aggressive and go in and remove the epithelial lining, but this would be incredibly invasive, has a high risk for complications, and wouldn't even be guaranteed to work because the surgeon has never done it before (this was a board certified who had been practicing for years and years at this point). Got a second opinion from a different vet at the same facility and she was of the same opinion, that the risks wouldn't be worth it unless his quality of life is significantly impacted from the growth. That vet also prescribed an antibiotic ointment to use as needed if his nose was acting up, and we can revisit if anything changes.
It's been a little over a year now since that visit, and things have stayed mostly the same. His nose doesn't really swell up anymore, but he does have a chronic scab that falls off every couple of days. It oozes discharge when this happens, although pretty minimally. Typically it's just a small amount of blood, and I just clean it up with KET wipes and it scabs over again.
Since day one this issue has not seemed to bother Shortbread at all. He is very happy, playful, and affectionate, exactly the same as when I first adopted him. It doesn't seem to impact his quality of life at all, and he is fine with me cleaning it/interacting with the area so I can only hope it's not super painful. He leaves it alone for the most part, save for sometimes accidentally scratching it open while cleaning.
So I suppose my question is this: has anyone ever heard of this or anything like this? Are there any additional treatments I should consider? I just want to know that I'm doing everything I possibly can for my little buddy, he really is my whole world.
I have copies of all of his records if anyone wants to see the CTs or his test results or anything like that.
Thank you to anyone who's taken the time to read through this whole post, even if you don't have any suggestions, I appreciate it a lot 🩷