Equine Respiratory Surgery Flashcards
What are 4 differentials for a horse with epistaxis?
Ethmoid hematoma
Guttural pouch mycosis
Ventral straight muscle rupture
Trauma/fracture
What are 3 differentials for a horse with nasal discharge?
Primary sinusitis
Tooth root abscess (secondary sinusitis)
Guttural pouch empyema
T/F: Horses cannot hemorrhage fatally from guttural pouch mycosis
False; roughly 50% that hemorrhage do so fatally
What are the four spaces of the equine head we are concerned with in respiratory Sx?
Oral cavity
Nasal cavity
Paranasal sinuses
guttural pouches
What are the four meatuses and which one do we want the NG tube to go into?
Dorsal (Can hit ethmoid and cause hemorrhage)
Ventral (NG)
Common
Middle
What are the six paranasal sinuses and which one connects directly to the nasal cavity?
Maxillary (connects to nasal cavity)
Frontal
Shpenopalaine
Dorsal, middle, and ventral conchal sinuses
T/F: Tooth issues can sometimes present as sinus issues
True
What are the three mains signs associated with sinus problems?
Facial swelling
Nasal discharge
Abnormal percussion of the sinus
What are the best diagnostics to aid in determining the best course of action when sinus dz present?
Radiography
Endoscopy
How does fluid in the sinuses appear on radiographs?
Increased opacity
Fluid line
Where does one see drainage in the middle nasal meatus?
Nasomaxillary Aperture
What are the five most common surgical diseases of the sinuses?
Sinusitis Ethmoid hematoma Sinus cyst Fractures Neoplasia
What is the most common disease of the sinus causing discharge, what are the two types, and how are they treated?
Sinusitis
Primary infection - Irrigation and systemic abx
Tooth root abscess - Tooth removal and flushing
T/F: Ethmoid hematomas often metastasize
False; they are benign but locally invasive
How are ethmoid hematomas treated?
Trans-endoscopic intralesional formalin injections
Surgical removal via bone flap
T/F: Sinus cysts are not visible radiographically
False
T/F: Sinus cysts removed surgically often results in a poor outcome
False; outcome is usually good with surgical intervention
T/F: Neoplastic lesions are often extensive at time of diagnosis and have poor prognosis
True
What are the six most important anatomical landmarks of the guttural pouch?
Stylohyoid bone External carotid artery Internal carotid artery Maxillary artery Ventral straight muscles Mucosal fold containing glossopharyngeal and hypoglossal nerves
What are five surgical diseases of the guttural pouch?
Tympany Empyema Mycosis Temporohyoid osteoarthropathy Rupture of the ventral straight muscles
What is guttural pouch tympany and how is it treated?
Developmental failure of GP depression resulting in elastic, non-painful swelling of the parotid region; may be unilateral or bilateral
Unilateral - establish an opening in the septum between the tympanic and normal GP
Bilateral - establish openings through the flap in the pharyngeal wall
How does guttural pouch empyema develop and what are three associated signs?
Young horses develop it secondary to URT infections (Strangles)
Intermittent to continuous nasal discharge
Parotid swelling and pain
+/- Dyspnea
What is a chondroid?
Mass of inspissated pus in the guttural pouch
How are chondroids treated?
NSAIDS
Lavage with physiologic solution
Systemic abx if indicated by culture/sensitivity
Sx to remove inspissated pus and chondroids
What are the four surgical approaches to the guttural pouch?
Hyovertebrotomy
Viborg’s triangle
Whitehouse approach
Modified Whitehouse
What is the most common sign of guttural pouch mycosis?
Epistaxis
What are signs related to CN IX-XII damage in regards to guttural pouch mycosis?
Horner’s syndrome
Dysphagia
Dyspnea
T/F: Cranial nerve damage associated with guttural pouch mycosis tends to resolve
False; it is permanent
What are five treatment options for guttural pouch mycosis?
NSAIDs to reduce inflammation (usually too slow)
Blood transfusions and IV for shock
Nutritional support for dysphagia
Vascular occlusion to mitigate bleed risk
Sx
Vitamin E/Selenium given for nerve damage
Which three arteries may be a source of guttural pouch bleed?
Internal carotid
External carotid
Maxillary
How should guttural pouch vasculature be occluded?
NOT ligation (circles of Willis)
Balloon catheter
Transarterial coil embolization
How does temporohyoid osteoarthropathy arise? What cranial nerves does it affect?
Secondary to inner/middle ear infection, associated with fusion of the temporohyoid joint
CN VII and VIII
How is temporohyoid osteoarthropathy treated?
NSAIDS
Styloid ostectomy
Ceratohyoidectomy
What is seen on endoscopy with ventral straight muscle rupture?
Collapse of pharynx
Blood clot
Arteries intact
No diphtheritic membrane
How do horses generally rupture the ventral straight muscles?
Falling over backwards
How is ventral straight muscle rupture treated?
Stall rest for 30d Elevated feed and water Broad-spectrum abx NSAIDS Follow-up exams
