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Large Animal Surgery > Equine Guttural Pouch > Flashcards

Equine Guttural Pouch Flashcards

1
Q

What is the guttural pouch?

A

air-filled diverticulum of the auditory (Eustachian) tube that communicates with the nasopharynx and opens routinely during swallowing

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2
Q

Guttural pouch, radiograph:

A
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3
Q

Where is the guttural pouch found? Where does the floor lie? What bone is found within?

A

extends from the roof of the pharynx to the base of the skull and from the atlantooccipital joint to the dorsal pharyngeal recess

on the pharynx

stylohyoid - divides it into medial and lateral compartments (medial is larger)

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4
Q

Guttural pouch, ventral view

A
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5
Q

Guttural pouch:

A

ostia = cartilaginous opening into pharynx

plica salpingopharyngeum = mucosal flap

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6
Q

What are the components of the medial compartment of the guttural pouch?

A
  • internal carotid a.
  • vagus n. (X)
  • glossopharyngeal n. (IX)
  • hypoglossal n. (XII)
  • spinal accessory n. (XI)
  • cranial laryngeal
  • cranial cervical ganglion
  • cervical sympathetic trunk
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7
Q

What are the components of the lateral compartment of the guttural pouch?

A
  • external carotid a.
  • facial n. (VII)
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8
Q

Guttural pouch compartments:

A
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9
Q

What is guttural pouch tympany? What causes it?

A

air distension in the guttural pouch

congenital abnormality that causes the pharyngeal opening (ostia, plica salpingopharyngeum) to malfunction and act as a one-way valve

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10
Q

When is guttural pouch tympany most commonly seen? What horses are overrepresented?

A

shortly after birth to 1 year —> usually unilateral, but may be bilateral

Arabian* and Paint foals

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11
Q

What is the most common clinical sign associated with guttural pouch tympany?

A

swelling in the parotid region, usually non-painful, elastic, and bilateral despite unilateral lesion —> swelling spreads and compresses the contralateral side

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12
Q

What are 2 possibly complications associated with guttural pouch tympany?

A
  1. respiratory distress - swelling compresses pharynx and trachea dorsally
  2. interference with deglutition (swallowing) - aspiration pneumonia (milk, mucopurulent)
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13
Q

How is guttural pouch tympany diagnosed?

A
  • clinical signs
  • endoscopy (can’t see larynx due to swelling)
  • radiographs (enlarged pouch, radiolucency)
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14
Q

What is seen on radiographs in cases of guttural pouch tympany?

A

gas distension causes radiolucent margins of the guttural pouch to extend down the neck

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15
Q

What are 3 options for treating guttural pouch tympany?

A
  1. needle compression - short term
  2. indwelling foley catheter for 4-6 weeks - creates a better opening
  3. make a permanent hole to deflate
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16
Q

What are the 2 options for permanent fenestration when treating guttural pouch tympany? What is prognosis like?

A
  1. median septum - air trapped in the right side can move to the left and be dispelled
  2. salpingopharyngeal fistula - hole through pharynx into GP for better airflow

good with surgery

17
Q

What is guttural pouch empyema? What are the 2 most common etiologies?

A

purulent exudate in the guttural pouch

  1. secondary to Streptococcus equi (Strangles)* or zooepidemicus URT infection
  2. secondary to rupture of the retropharyngeal LN abscess into GP
18
Q

What clinical signs are most commonly associated with guttural pouch empyema?

A
  • chronic unilateral mucopurulent nasal discharge lacking discharge noticed when head is lowered
  • NO external swelling of GP
  • swelling of adjacent LNs
  • extended head carriage
  • excessive respiratory noise
  • difficulty swallowing/breathing due to inflamed CN in the GP
19
Q

How is guttural pouch empyema diagnosed?

A
  • clinical signs
  • endoscopy - purulent exudate observed
  • radiographs - dependent fluid lines, generalized ST swelling
  • culture and sensitivity - confirmation of causative agent
20
Q

Guttural pouch empyema, endoscopy:

A
  • exudate can compress airway
  • purulent material dries out and accumulated into chondroids
21
Q

How is guttural pouch empyema treated?

A

flush GP with physiologic saline

+/- place indwelling catheter
+/- local antibiotics (KPen) for refractory cases

22
Q

What flush is thought to be able to dissolve guttural pouch chondroids? What is the preferred treatment option?

A

acetylcysteine (debatable)

physical removal - endoscopically with a snare or surgically

23
Q

What is prognosis of guttural pouch empyema/chondroids?

A
  • good once resolved
  • neurological signs generally resolve
24
Q

What are the 4 general approaches for accessing the guttural pouch?

A
  1. hyovertebrotomy - caudal vertical excision
  2. Viborg’s triangle
  3. modified Whitehouse
  4. Whitehouse - ventral, must pass larynx
25
What are the 3 outlines of Viborg's triangle?
1. tendon of the sternocephalicus 2. linguofacial vein 3. vertical ramus of the mandible
26
What is the most common etiology of guttural pouch mycosis? How does it affect the guttural pouch?
Aspergillus fumigatus - formation of a diphtheritic membrane (black/yellow) - necrosis of underlying structures, like carotid and stylohyoid
27
What is the most common sign of guttural pouch mycosis? What 3 signs occur with cranial nerve damage?
epistaxis - mild to intermittent initially, but can quickly lead to rapid hemorrhage, causing the horse to bleed to death 1. dysphagia 2. respiratory noise 3. Horner's syndrome
28
How is guttural pouch mycosis diagnosed?
- clinical signs - endoscopy
29
When is medical treatment for guttural pouch mycosis recommended? What topical and systemic antifungals are used? What other type of treatment is done?
no arterial involvement - TOPICAL via indwelling catheter - Enilconazole, Fluconazole - SYSTEMIC - Itraconazole - treat for months! remove diphtheritic membrane endoscopy
30
What surgical treatment is recommended for guttural pouch mycosis?
arterial occlusion with balloon catheter or transarterial coil embolization* proximal and distal to lesion (enter through common carotid) under fluoroscopic guidance - Circle of Willis provides collateral circulation to the brain, allowing for bleeds from both sides of the lesion
31
What is prognosis of guttural pouch mycosis like?
- 80% survival if surgery is timely - 50% of horses with hemorrhage bleed to death - neurologic deficits may not resolve or take months
32
What is temporohyoid osteopathy?
progressive disease of the middle ear causes the TH joint to fuse and eventually fracture the petrous part of the temporal bone, resulting in CN VII and CN VIII damage (+/- CN IX or CN X)
33
What is the most common etiology of temporohyoid osteopathy? What are the 3 parts of the temporohyoid joint?
inner or middle ear infection with hematogenous spread 1. stylohyoid 2. tympanohyoid cartilage 3. squamous part of temporal bone
34
What are the most common early and advances signs of temporohyoid osteopathy?
EARLY - behavioral issues (due to pain), including head tossing, shaking, ear rubbing, and resistance under asddle ADVANCED (TH joint fusion) - fractured petrous temporal bone alters the movement of the tongue and larynx, commonly with swallowing, vocalizing, and head/neck movement or oral exams/floating
35
What 3 sets of neurological signs are associated with temporohyoid osteoarthropathy?
1. vestibulocochlear (VIII) - asymmetric ataxia, head tilt with pull toward affected side, spontaneous nystagmus slowly toward affected side 2. facial (V) - facial paralysis, decreased tear production, inability to close eye 3. glossopharyngeal (IX), vagus (X) - dysphagia (rare)
36
How is THO diagnosed?
- clinical signs - neuro/behavioral signs - endoscopy - thickened stylohyoid bone within GP - radiographs - CT
37
What treatments are recommended for THO? What is prognosis like?
- mild = systemic antibiotics, NSAIDs - advanced = surgical fair - neuro signs can persist > 1 year
38
What is the purpose for surgical treatment of THO? What are the 2 options?
relieve pressure on temporal bone 1. partial stylohyoidectomy - bone can regrow 2. ceratohyoidectomy - remove ceratohyoid bone, more successful

Large Animal Surgery (32 decks)

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