E2: Respiratory surgery, Guttural pouch Flashcards
Diagnosis?
Epidermal inclusion cyst
What type of noise do you expect from a horse with redundant alar folds? How is the fold stabilized?
Expiratory
Large temporary mattress suture (for diagnosis)
A foal presents with stridor, nasal discharge, and facial distortion. What is the likely diagnosis?
Wry nose
What should you do preoperatively before nasal septum surgery?
Collect 4-8L of blood
Tracheotomy
What is the incsion called that you make to access the nasal septum?
Trephine hole
Where is the lesion if there is unilateral epistaxis?
Cranial to the caudal edge of the nasal septum
What noise do you expect from a horse with a progressive ethmoid hematoma?
Stridor
T/F: The nasal sinuses can be evaluated using an endoscope.
False
What is used for transendoscopic chemical ablation? When must it be repeated?
4% formalin
In 2-3 weeks
Which surgical approach to the guttural pouches does not provide ventral drainage?
a. Hypovertebrotomy
b. Viborg’s triangle
c. Whitehouse
d. Modified Whitehouse
a. Hypovertebrotomy
Which surgical approach is best suited for treating guttural pouch mycosis?
a. Low hyovertebrotomy
b. Viborg’s triangle
c. Whitehouse
d. Modified Whitehouse
a. Low hyovertebrotomy
What is the most common complication of guttural pouch surgery?
a. blindness
b. dysphagia
c. facial nerve paralysis
d. abmormal respiratory noises
b. dysphagia
Mycotic lesions of the guttural pouch have a propensity for developing in the _____ artery.
a. maxillary
b. external carotid
c. internal carotid
d. palatine
c. internal carotid
Which organisms are most commonly grown from diphtheritic plaques in cases of guttural pouch mycosis?
a. A. fumigatus and S. equi
b. E. nidulans and H. capsulatum
c. E. nidulans and A. fumigatus
d. C. albicans and B. dermatitis
c. E. nidulans and A. fumigatus
What is the most common presenting sign of guttural pouch mycosis?
a. dysphagia
b. bilateral epistaxis, especially after work
c. Facial nerve paralysis
d. Unilateral epistaxis at rest
d. Unilateral epistaxis at rest
Which ancillary procedure is most effective in diagnosing guttural pouch mycosis?
a. endoscopy
b. radiography
c. US
d. Fluroscopy
a. endoscopy
What is the recommended therapy for guttural pouch mycosis?
a. scraping the fungal plaque off the guttural pouch membrane
b. irrigiation with antifungal medication
c. surgery
d. systemic antifungal medication
c. surgery
Which artery is most likely to cause retrograde blood flow to myocotic lesions in the external carotid and maxillary arteries?
a. linguofacial
b. major palatine
c. infraorbital
d. external ophthalmic
b. major palatine
Current surgical techniques for arterial occlusion in treating guttural pouch mycosis include
a. ligation
b. baloon catheterization
c. transarterial coil embolization
d. all of the above
d. all of the above
Definitive diagnosis of ethmoid hematoma in horses is made by
a. endoscopic examination
b. history and clinical examination
c. CT
d. histopathologic examination
d. histopathologic examination
What is the prognosis for long-term resoluition of progressive ethmoid hematoma?
a. grave no matter what treatment is performed
b. good if treated with intralesional formalin
c. guarded to poor no matter what treatment is performed
d. good if treated with surgical excision and cryotherapy
c. guarded to poor no matter what treatment is performed
In what breed have there been no reports of progressive ethmoid hematoma?
Standardbred
What causes the color variations of progressive ethmoid hematoma when viewed through a video endoscope?
a. age of the leison
b. fibrosis of the mass
c. type and distribution of hemoglobin pigments
d. none of the above
c. type and distribution of hemoglobin pigments
What is the most common clinical sign observed in horses with progressive ethmoid hematoma?
a. coughing
b. epistaxis
c. head pressing
d. respiratory distress
b. epistaxis
Mild, intermittent, unilateral
Which survey radiographic view most consistently demonstrates the lesion associated with progressive ethmoid hematoma?
Lateral
Diagnostic differentials after visualization of the mass lesion (which looks to be progressive ethmoid hematoma) with the video endoscop should include all of the following except:
a. pulmonary neoplasia
b. nasal trauma
c. nasal neoplasia
d. mycotic rhinitis
a. pulmonary neoplasia
What is the most substantial complication after surgical excision of a progressive ethmoid hematoma?
a. facial deformity
b. respiratory distress
c. wound dehiscence
d. hemorrhage
b. respiratory distress
Most common intra-op complication = hemorrhage
What is the most common cause of noise in a horse?
ILH
Formalin (10%) treatment for progressive ethmoid hematoma in the horse is administered via which route?
a. intralesional injection
b. intravenous injection
c. intramuscular injection
d. Via NG tube
a. intralesional injection
To monitor for recurrence after treatment of a progressive ethmoid hematoma, repeat endoscopic examinations should be performed at ____ intervals for ____.
a. 2- week; 2 years
b. 1-month; 1 year
c. 3- to 6-months; 5 years
d. 1-year; 10 years
c. 3- to 6-months; 5 years
What are the landmarks for the maxillary sinus? Where do you make your incision?
Medial canthus of the eye = rostral compartment
Cranial edge of the facial crest = caudal compatment
1 cm above the line between the 2 landmarks
Alternative 2nd landmark = intraorbital foramen ; then incsion half way between the landmarks
T/F: Trephination sites are usually left open and should be flushed daily (for 1 day past finding flakes in the flush).
True
Also antibiotics and NSAIDs
T/F: Getting your horse a goat buddy may prevent the horse from cribbing.
True
The removal of which muscles can be used to treat/prevent cribbing? Which nerve can be removed?
Sternomandibularis
Sternothryohyodeus
Omohyoideus
Ventral neck muscles
Ventral branch of CN XI (spinal accessory nerve)
The modified Forssel’s procedure is done to prevent the distortion caused by the surgical treatment of cribbing. In addition to a neurectomy of the ventral branch of CN XI, which muslces are myoectomized for this procedure?
Sternothyrohyoideus
Omohyoideus
How many tracheal rings worth of muscle is removed in the modified Forssel’s procedure?
10
Nicking which 2 structures during a modified Forssel’s can cause profuse bleeding?
Jugular vein
Thyroid gland
Which nerve innervates the cricoarytenoideus dorsalis muscle? What is it’s parent?
Recurrent laryngeal
Vagus
Which side is usually aftected in a roarer?
Left
What type of noise is roaring?
Inspiratory
During a slap test, the withers are slapped during endoscopy and the _____of the _________ arytenoid cartilage is observed.
a. abduction, contralateral
b. abduction, ipsilateral
c. adduction, contralateral
d. adduction, ipsilateral
c. adduction, contralateral
How many grades of ILH are there?
4
(I - IV)
What is the common name for a laryngoplasty?
Tieback surgery according to Marks
The skin incision for a tieback surgery is ventral to which vein?
Linguofacial
Which muscle will be atrophied in a horse with chronic ILH?
Crycoarytenoideus dorsalis
Which of these is NOT a complication associated with tieback?
a. seroma
b. cough
c. epistaxis
d. dysphagia
c. epistaxis
In which position is a venticulectomy performed?
Dorsal recumbency
What’s this?
Roaring burr
How do you know whether you have excised enough of the ventricle during a ventriculectomy? Which ventricle should be removed if the left side is affected?
Place on finger, should cover distal 1/3
Both
What can be done to reinnervate the cricoarytenoid muscle?
Neuromusclar pedicle graft
What is removed in a total arytenoidectomy? Partial?
Total: Arytenoid body, corniculate, muscular process
Partial: Arytenoid body, corniculate Preferred treatment
What is the vet term for “choking up”
DDSP
What is the preferred surgery for DDSP?
Laryngeal tie-forward
Used to be myoectomy of sternothyrohyoideus muscle
What’s this and what is it used for? What is the alternative?
Bistoury
To transaxially divide the membrane entrapping the epiglottis in case of EE
Laser
