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Y3 MOD Dentistry > Disease of the equine head and neck 2 > Flashcards

Disease of the equine head and neck 2 Flashcards

1
Q

What structures are separated by the soft palate?

A

Nasopharynx & Oropharynx

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2
Q

What makes the pharynx able to collapse during exercise?

A

Pharynx lacks rigid support by bone/cartilage

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3
Q

Describe the 2 functions of the pharynx

A
  • Passage of air: Nasal cavity to larynx and lower airways

- Passage of ingesta: Oral cavity to oesophagus during swallowing

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4
Q

How do the structures of the pharynx protect the airway?

A
  • Arytenoid closure
  • Vocal cord closure
  • Epiglottis retroversion
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5
Q

The pharynx is innervated by which 3 cranial nerves?

A

V - Trigeminal
X - Vagus
XI - Accessory

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6
Q

What are the 3 main functions of the larynx?

A
  • Breathing
  • Protect lower airway
  • Vocalisation
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7
Q

Describe the structure of the larynx

A

Cartilage structure (in contrast to pharynx)

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8
Q

Name the cartilaginous structures that make up the larynx

A
  • Cricoid cartilage
  • Thyroid cartilage
  • Epiglottis
  • Paired arytenoid cartilages
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9
Q

Which muscle is involved in abduction of the glottis (opening)

A

Cricoarytenoideus dorsalis muscle

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10
Q

Which muscle is involved in adduction of the glottis (closure)

A

Cricoarytenoideus lateralis muscle

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11
Q

Which nerve innervates the Cricoarytenoideus muscles?

A

Recurrent laryngeal nerve

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12
Q

What are the 3 key presenting signs of larynx and pharynx disease?

A
  • Respiratory noise
  • Exercise intolerance
  • Poor performance
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13
Q

How can these the larynx and pharynx be assessed in a clinical exam?

A 
Palpation of the larynx:
- Muscular process of arytenoid
- Cricothyroid articulation
Observation during exercise:
- Listen!
- Inspiratory / expiratory noise
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14
Q

During exercise a horses breathing is coupled with?

A

Their gait

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15
Q

What is the most important diagnostic tool for the pharynx and larynx?

A

Endoscopy

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16
Q

What are the clinical signs of pharynx abnormalities?

A
  • Poor performance
  • Respiratory noise: rest +/or Exercise
  • Dysphagia
  • Respiratory distress
  • Nasal discharge
  • Coughing
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17
Q

Name some of the key disorders of the pharynx

A
  • Dorsal displacement of the soft palate (DDSP)
  • Naso-pharyngeal collapse
  • Pharyngeal lymphoid hyperplasia
  • Cleft palate
  • Foreign body
  • Pharyngeal mass
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18
Q

What are the two types of Dorsal displacement of the soft palate (DDSP)?

A

Intermittent

Persistent

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19
Q

When does intermittent dorsal displacement of the soft palate occur?

A

During intense exercise only

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20
Q

How is intermittent dorsal displacement of the soft palate diagnosed?

A

Dynamic endoscopy

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21
Q

What are the 3 characteristics of soft palate displacement?

A
  • Expiratory obstruction
  • Gurgling noise
  • Horse slows down / pulls up
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22
Q

If the soft palate has displaced, when does it return to normal?

A

On swallowing

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23
Q

What is the proposed pathogenesis of an intermittent dorsal displacement of the soft palate?

A
  • Neuromuscular dysfunction
  • Maybe caused by inflammation in guttural pouch or pharynx
  • Lower airway disease
  • Structural abnormalities
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24
Q

Describe a persistent dorsal displacement of the soft palate

A
  • Soft palate permanently displaced
  • Unable to replace on swallowing
  • Often secondary to other disease
25
Q

What signs from an animals history and clinical exam link to dorsal displacement of the soft palate?

A
  • Exercise intolerance
  • Gurgling / vibrating noise - Mostly expiratory
  • Rider reports: choking down / up, swallowing its tongue
  • Dysphagia: permanent DDSP only
26
Q

How is persistent dorsal displacement of the soft palate diagnosed?

A

Resting endoscopy

27
Q

How is intermittent dorsal displacement of the soft palate treated?

A

Conservative or surgical treatment

28
Q

Describe the different conservative treatments for intermittent dorsal displacement of the soft palate

A
  • Maturity: Common in youngsters
  • Get horses fit: Train the respiratory muscles supporting pharynx
  • Change tack: Keep mouth closed
  • Tongue tie: Stop caudal movement of tongue
  • Treat inflammatory conditions
29
Q

Describe the different surgical treatments for intermittent dorsal displacement of the soft palate

A

• TIE FORWARD:
- Laryngeal advancement procedure
- Sutures placed between basihyoid bone & thyroid cartilage
- Positions the larynx more rostrally & dorsally
• Palatoplasty
• Staphylectomy: partial soft palate resection

30
Q

What is pharyngeal lymphoid hyperplasia

A

Enlargement of lymphoid follicles on the walls & roof of nasopharnynx

31
Q

When should pharyngeal lymphoid hyperplasia be treated?

A

If associated with iDDSP, treatment with anti-inflammatories

- if not its common in young horses and has little clinical significance

32
Q

What are the main features of dynamic pharyngeal collapse?

A
  • Lateral or dorsal walls
  • Yearlings/2yo
  • May resolve if mild
33
Q

What are the features of a cleft palate?

A

Congenital defect diagnosed as foals

See milk coming from the nostrils

34
Q

How is a cleft palate diagnosed?

A
  • Oral examination / endoscopy

- May affect soft / hard palate, variable size and shape

35
Q

Why is surgical repair of a cleft palate often not attempted?

A
  • Direct access difficult via mouth / nasal passages
  • Split mandible at symphysis
  • Difficult, Expensive & dehiscence of repair may occur
36
Q

What are the key clinical signs of laryngeal disorders?

A
  • Respiratory noise
  • Poor performance
  • Dysphagia
  • Coughing
  • Respiratory distress
37
Q

What is the cause of LEFT unilateral paresis / paralysis of the arytenoid cartilage

A

Recurrent laryngeal neuropathy

38
Q

Describe the pathophysiology of recurrent laryngeal neuropathy

A
  • Progressive loss of large myelinated nerve fibres of recurrent laryngeal nerve
  • Neurogenic atrophy of intrinsic laryngeal muscles
  • Loss of abductor and adductor function (cricoarytenoid muscles)
39
Q

How can the history and clinical exam of an animal help diagnose recurrent laryngeal neuropathy?

A
  • Most commonly large breeds
  • Abnormal noise at exercise (‘roaring’) inspiratory
  • Poor performance
40
Q

Describe how endoscopy is used to diagnose recurrent laryngeal neuropathy

A

Assessment of artenoid cartilages for:

  • Symmetry
  • Synchrony
  • Maintenance of abduction
  • Remember it is the left side that will be abnormal
41
Q

Which grading system is used to assess dynamic laryngeal function, describe it?

A 
- Havermeyer system
I = normal
II = can fully abduct
III = can't fully abduct 
IV = paralysis
42
Q

Which factors will influence the management of a horse with recurrent laryngeal neuropathy?

A
  • Clinical findings
  • Use of horse
  • Age / concurrent problems
  • Degree of arytenoid collapse at exercise
  • Owner expectations
  • Economics
43
Q

Name some of the surgical treatments used for recurrent laryngeal neuropathy

A
  • Prosthetic laryngoplasty
  • Ventriculo-cordectomy
  • Laryngeal re-innervation (Nerve graft)
  • Arytenoidectomy
44
Q

Prosthetic laryngoplasty is also known as?

A

‘Tie back’

45
Q

Describe how a Prosthetic laryngoplasty is performed

A
  • Standing / under GA
  • Suture placed: cricoid cartilage and muscular process of left arytenoid cartilage
  • Mimics the action of CAD
  • Permanent abduction of left arytenoid
46
Q

Which potential complications can occur following a Prosthetic laryngoplasty procedure?

A 
Coughing
Seroma formation
Infection of the implant
Dysphagia
Prothesis failure
Chondritis
47
Q

Describe the features of a vocalcordectomy procedure

A

• Removal of left +/- right vocal cord
- Reduce noise
- Remove tissue collapsing into airway
• Standing sedation – laser removal

48
Q

Describe the features of a Ventriculo-cordectomy procedure

A
  • Laryngeal ventricles (saccules) removed - Reduce vibration and noise
  • Laryngotomy (GA or Standing)
  • Or Laser (standing)
49
Q

Describe a laryngeal re-innervation procedure

A
  • Nerve graft
  • Neuromuscular pedicle graft
  • Re-innervation of the CAD
50
Q

Congenital laryngeal dysplasia most commonly occurs on which side?

A

Abnormal development of laryngeal cartilages

- most commonly RHS

51
Q

What is the main sign of vocal cord collapse?

A

Produces a lot of noise!

INSPIRATORY: WHISTLE

52
Q

What are the main features and signs of axial deviation of the aryepiglottic folds?

A
  • Collapse of the ary-epiglottic folds
  • INSPIRATORY
  • THICK NOISE
  • Treatment: Laser resection of the aryepiglottic folds
53
Q

What is arytenoid chondritis?

A

Infection/inflammation of arytenoid cartilage

  • Mucosal ulceration
  • Progressive & painful
54
Q

What are the clinical signs of arytenoid chondritis and how is it diagnosed?

A

Clinical Signs: respiratory noise / obstruction +/- respiratory distress
Diagnosis: Endoscopy

55
Q

How is arytenoid chondritis treated?

A
  • Antibiotics: topical + systemic
  • Partial arytenoid resection
  • Arytenoidectomy (Salvage procedure)
  • Permanent tracheostomy
56
Q

How does epiglottic entrapment occur?

A

Loose subepiglottic tissue wraps over and entraps the epiglottic cartilage

57
Q

What are the clinical signs of epiglottic entrapment

A
  • Respiratory noise
  • Coughing during eating
  • +/- poor performance
58
Q

What are the clinical signs of a sub-epiglottic cyst?

A
  • Respiratory noise
  • Dysphagia (milk / feed)
  • Exercise intolerance

Y3 MOD Dentistry (11 decks)

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