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RUSVM Large Animal Surgery > Equine Respiratory Surgery, Arytenoid Chondritis, Guttural Pouch Issues > Flashcards

Equine Respiratory Surgery, Arytenoid Chondritis, Guttural Pouch Issues Flashcards

Taught by Dr. Bernard Grevemeyer

1
Q

What is your diagnosis?

A

Progressive ethmoid hematoma

  • Clinical signs:
    • Epistaxis (bilateral)
    • Seroanguineous nasal exudate
    • Stridor
  • Cause: nasogastric tubing
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2
Q

What is the suspected cause of ethmoid hematoma in equines?

A

nasal gastric tubing

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3
Q

Which of these radiographs shows a progressive ethmoid hematoma in this horse?

A

The one that says “PEH” on it

The way I understand it, the letters “PEH” will not be present on the hematoma in normal radiographs

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4
Q

What procedure is taking place here?

A

Trephination

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5
Q

What is the main postoperative complication associated with surgical removal of ethmoid hematomas?

A

Hemorrhage

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6
Q

What is the composition of an ethmoid hematoma when viewed on histopathology?

A
  • Outer surface: respiratory epithelium
  • Central: hemosiderin-filled macrophages
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7
Q

T/F: Chemical ablation with formalin is an acceptable treatment for ethmoid hematomas

A

True

  • Transendoscopic Chemical Ablation:
    • 4% formalin via biopsy channel of endoscope
    • Can be done on an outpatient basis
    • Repeat in 2-3 weeks
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8
Q

Definitive diagnosis of progressive ethmoid hematoma in horses is made by:

  • Endoscopic exam
  • History and PE
  • CT
  • Histopathologic exam
A

Histopathologic exam​

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9
Q

What is the prognosis for long term resolution of progressive ethmoid hematoma?

  • Grave no matter what treatment is performed
  • Good if treated with intralesional formalin
  • Guarded to poor no matter what treatment is performed
  • Good if treated with surgical excision and cryotherapy of the base
A

Guarded to poor no matter what treatment is performed​

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10
Q

In what breed have there been no reports of progressive ethmoid hematoma?

  • Warmblood
  • Arabian
  • Tennessee walking horse
  • Standardbred
A

Standardbred​

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11
Q

What causes the color variations of the progressive ethmoid hematoma when viewed through a video endoscope?

A

Type and distribution of hemoglobin pigments​

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12
Q

What is the most common clinical sign observed in horses with progressive ethmoid hematoma?

A

Epistaxis

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13
Q

Which survey radiographic view most consistently demonstrates the lesion associated with progressive ethmoid hematoma?

  • Dorsoventral
  • Oblique
  • Lateral
  • None of the above
A

Lateral

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14
Q

Formalin (10%) treatment for progressive ethmoid hematoma in the horse is administered via what route?

A

intralesional injection

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15
Q

To monitor for recurrence after treatment of a progressive ethmoid hematoma, repeat endoscopic exam should be performed at ________ intervals for ________.

  • 2 weeks; 2 years
  • 1 month; 1 year
  • 3-6 months; 5 years
  • 1 year; 10 years
A

To monitor for recurrence after treatment of a progressive ethmoid hematoma, repeat endoscopic exam should be performed at 3-6 month intervals for 5 years.

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16
Q

What is the cause of primary sinusitis?

A

upper respiratory tract infection (URTI)

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17
Q

What are the causes of secondary sinusitis?

A
  • Dental disease
  • Facial fractures
  • Cysts
  • Neoplasia
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18
Q

What are the clinical signs associated with sinusitis?

A
  • Nasal discharge: serosanguineous
  • Coughing
  • Facial deformity
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19
Q

What is the surgical treatment for sinusitis?

A

Sinusotomy (trephination)

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20
Q

Aftercare for sinusotomy involves:

A
  • Antibiotics + NSAIDs
  • Leave open and flush daily
  • Prognosis is good/excellent
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21
Q

What is this horse doing?

A

Cribbing

  • Grasp object with incisors
  • Contract ventral neck muscles
  • Pull backward
  • Consequences:
    • Maybe colic
    • Abnormal wear of incisors
    • Weight loss
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22
Q

Identify this piece of equipment:

A

Cribbing Strap

When the horse swallows, this puts pressure on the larynx

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23
Q

What is the Modified Forssel’s procedure?

A

Surgical treatment for cribbing

  • Myectomy:
    • Removal of Sternothyrohyoideus and Omohyoideus mm.
  • Neurectomy:
    • Removal of ventral branch of spinal accessory nerve (XI)
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24
Q

The cricoarytenoideus dorsalis muscle is innervated by the __________ nerve

A

recurrent laryngeal nerve

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25
Q

Unilateral or bilateral paralysis of the cricoarytenoid muscle results in a condition known as:

A

Recurrent Laryngeal Hemiplegia (“Roaring”)

Caused by progressive neurogenic atrophy (distal axonopathy) of the recurrent laryngeal nerve (branch of vagus nerve)

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26
Q

What is the most common cause of upper respiratory noise in the horse?

A

Recurrent Laryngeal Hemiplegia (“Roaring”)

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27
Q

Horses with laryngeal hemiplegia (LH) typically present for:

A

Noise & Exercise Intolerance

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28
Q

What is the Slap Test?

A

Evaluates recurrent laryngeal nerve and portions of spinal cord

  • S**lap withers during endoscopy
  • Observe adduction of _contra_lateral arytenoid cartilage
  • Pathway: spinal cervical cord → medulla decussation → recurrent laryngeal nerve
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29
Q

What is the most common surgical treatment for recurrent laryngeal hemiplegia?

A

Laryngoplasty (Tie-back)

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30
Q

“Asynchronous abduction, but full abduction could be achieved” describes a Grade ___ laryngeal hemiplegia

A

Grade II

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31
Q

“Asymmetry at rest, some movement, but full abduction cannot be achieved” describes a Grade ___ laryngeal hemiplegia

A

Grade III

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32
Q

“Asymmetry at rest and no movement of the arytenoid cartilage” describes a Grade ___ laryngeal hemiplegia

33
Q

What are some complications associated with laryngoplasty?

A
  • Prosthesis failure
  • Loss of abduction
  • Seroma
  • Cough
  • Dysphagia
34
Q

What should be done if an animal is coughing following a tieback procedure?

A

Remove the sutures and start over again

35
Q

Identify this instrument:

A

Roaring Bur

36
Q

What is arytenoid chondritis?

A

Inflammation and thickening of the arytenoid cartilage​

37
Q

What is a partial arytenoidectomy?

A

Removal of the arytenoid body and corniculate process

  • 50% of racehorses return to racing
  • Significantly improved upper airway flow dynamics
  • Coughing may be noted after surgery
  • Preferred treatment for arytenoid chondritis
38
Q

___% of racehorses return to racing after a partial arytenoidectomy

39
Q

When the soft palate is dorsally displaced over the epiglottis, it is appropriately termed:

A

Dorsal Displacement of the Soft Palate (DDSP)

40
Q

This image shows a treatment option for what condition?

A

Dorsal Displacement of the Soft Palate (DDSP)

The image shows a tongue tie

41
Q

What is a staphylectomy?

A

resection of the posterior part of the soft palate

May be used for surgical treatment of DDSP

42
Q

Identify this instrument:

A

Bistoury

a surgical knife with a long, narrow, straight or curved blade

43
Q

What intrinsic laryngeal muscle provides arytenoid abduction by drawing the dorsomedial margins of the arytenoid cartilages together?

A

the arytenoideus transversus muscle

44
Q

Which intrinsic laryngeal muscle is not innervated by the recurrent laryngeal branch of the vagus nerve?

  • the cricoarytenoideus dorsalis
  • the arytenoideus transversus
  • the cricothyroideus
  • the thyroarytenoideus
A

the cricothyroideus​

45
Q

A remnant of the thyroglossal duct is thought to cause:

  • Dorsal epiglottic abscessation
  • Subepiglottic granulomas
  • Epiglottitis
  • Subepiglottic cysts
A

Subepiglottic cysts​

46
Q

Alone, which recommended treatment for RLN does not improve upper airway noise or return the upper respiratory airflow mechanics to baseline values?

  • Laryngoplasty
  • Bilateral ventriculocordectomy
  • Unilateral laser vocal cordectomy
  • None of the above
A

Unilateral laser vocal cordectomy​

47
Q

Laryngoplasty failure can be corrected by:

  • Partial arytenoidectomy
  • Ventriculectomy
  • Bilateral ventriculocordectomy
  • Unilateral laser vocal cordectomy
A

Partial arytenoidectomy​

48
Q

Which upper airway disturbance is thought to be caused by a developmental abnormality of the fourth branchial arch?

  • A subepiglottic cyst
  • Axial deviation of the aryepiglottic folds
  • Epiglottic retroversion
  • Rostral displacement of the palatopharyngeal arch
A

Rostral displacement of the palatopharyngeal arch​

49
Q

Which nerve/muscle combination is used when performing a neuromuscular–pedicle graft to treat recurrent laryngeal neuropathy (RLN)?

  • Hypoglossal nerve/hyoepiglotticus muscle
  • First cervical nerve/omohyoideus muscle
  • External branch of the cranial laryngeal nerve/cricothyroideus muscle
  • External branch of the cranial laryngeal nerve/thyrohyoideus muscle
A

First cervical nerve/omohyoideus muscle​

The neuromuscular–pedicle graft technique entails creating a pedicle graft involving the first cervical nerve and the omohyoideus muscle and implanting the entire graft into the affected cricoarytenoideus dorsalis muscle.

50
Q

Which of the following is not a complication of surgical correction of epiglottic entrapment?

  • Reentrapment
  • Dorsal displacement of the soft palate
  • Laceration of the epiglottis
  • Epiglottic retroversion
A

Epiglottic retroversion​

51
Q

Which of the following disorders results in distortion of the corniculate process of the arytenoid cartilage, causing decreased arytenoid cartilage abduction, axial displacement of the arytenoid cartilage, and rostral displacement of the palatopharyngeal arch?

  • Axial deviation of the aryepiglottic folds
  • Rostral displacement of the palatopharyngeal arch
  • Arytenoid chondritis
  • Dorsal epiglottic abscessation
A

Arytenoid chondritis​

52
Q

In a resting horse, what fraction of the total resistance to airflow is in the upper airway?

53
Q

Videoendoscopy with the patient at rest allows diagnosis of all the following upper respiratory disturbances except:

  • Arytenoid chondritis
  • Axial deviation of the aryepiglottic folds
  • Persistent dorsal displacement of the soft palate (DDSP)
  • Persistent epiglottic entrapment
A

Axial deviation of the aryepiglottic folds​

54
Q

The intrinsic musculature of the pharynx includes all of the following except the:

  • Tensor veli palatini
  • Levator veli palatini
  • Palatopharyngeus
  • Hyoepiglotticus
A

Hyoepiglotticus​

55
Q

Which of the following extrinsic muscles of the pharynx is innervated by the pharyngeal branch of the vagus nerve?

  • Genioglossus
  • Thyrohyoideus
  • Sternohyoideus
  • Sternothyroideus
A

Thyrohyoideus​

56
Q

Rostral pharyngeal collapse has been experimentally reproduced by transecting the tendon of the _________ muscle.

A

tensor veli palatini

57
Q

Staphylectomy, epiglottic augmentation, rostral palatoplasty, and sternohyoideus/sternothyroideus myectomy are all treatments for:

  • Rostral pharyngeal collapse
  • Nasopharyngeal cicatrix
  • Dorsal pharyngeal collapse
  • DDSP
58
Q

Dysfunction of the ________ muscle causes collapse of the pharyngeal roof during dorsal pharyngeal collapse

A

stylopharyngeus caudalis

59
Q

Which of the following is not an acceptable treatment for nasopharyngeal cicatrix?

  • Antiinflammatory medications
  • Transendoscopic laser transaction
  • Permanent tracheostomy
  • Partial arytenoidectomy
A

partial arytenoidectomy

60
Q

Which upper respiratory disturbance may predispose a horse to DDSP as a result of inflammation of the pharyngeal branch of the vagus nerve?

  • Pharyngeal lymphoid hyperplasia
  • Elongated soft palate
  • Subepiglottic cyst
  • Epiglottic hypoplasia
A

Pharyngeal lymphoid hyperplasia​

61
Q

What is the maximal length that should be removed from the soft palate during staphylectomy for correction of DDSP?

62
Q

What is the most likely diagnosis in this horse?

A

Guttural pouch tympany

63
Q

Which approach to the guttural pouch is illustrated below?

A

Hyovertebrotomy

The problem with this approach is that there is no ventral drainage

64
Q

Which approach to the guttural pouch is illustrated below?

A

Viborg’s Triangle

  • Borders:
    • Sternomandibular muscle
    • Linguofacial vein
    • Caudal border of vertical ramus of the mandible
65
Q

Which approach to the guttural pouch is illustrated below?

A

Modified Whitehouse

66
Q

What are the causes of guttural pouch empyema?

A
  • Upper respiratory infection
  • Abscessation of the retropharyngeal LN
  • Fracture of stylohyoid bone
67
Q

Is guttural pouch empyema usually unilateral or bilateral?

A

Unilateral

68
Q

What are the main clinical signs associated with guttural pouch mycosis?

A

Epistaxis and Dysphagia

69
Q

What structure in the guttural pouch is most commonly affected by mycosis?

A

internal carotid artery

70
Q

Which surgical approach to the guttural pouches does not provide ventral drainage?

  • Hyovertebrotomy
  • Whitehouse
  • Viborg’s triangle
  • Modified Whitehouse
A

Hyovertebrotomy​

71
Q

Which surgical approach is best suited for treat­ing guttural pouch mycosis?

  • A low hyovertebrotomy
  • Viborg’s triangle
  • Whitehouse
  • Modified Whitehouse
A

Viborg’s triangle​

72
Q

What is the most common complication of gut­tural pouch surgery?

  • Blindness
  • Dysphagia
  • Facial nerve paralysis
  • Abnormal respiratory noise
A

Blindness​

73
Q

Mycotic lesions of the guttural pouch have a propensity for developing in the __________ artery

A

internal carotid

74
Q

Which organisms are most commonly grown from diphtheritic plaque in cases of guttural pouch mycosis?

  • A fumigatus and Streptococcus equi
  • E. nidulans and Histoplasma capsulatum
  • E. nidulans and A. fumigatus
  • Candida albicans and Blastomyces dermatitis
A

E. nidulans and A. fumigatus

75
Q

What is the most common presenting sign of guttural pouch mycosis?

  • Dysphagia
  • Bilateral epistaxis, especially after work
  • Facial nerve paralysis
  • Unilateral epistaxis at rest
A

Unilateral epistaxis at rest

76
Q

Which ancillary procedure is most effective in diagnosing guttural pouch mycosis?

  • Endoscopy
  • Radiography
  • Ultrasonography
  • Fluoroscopy
A

Endoscopy​

77
Q

What is the recommended therapy for guttural pouch mycosis?

  • Scraping the fungal plaque off the guttural pouch membrane
  • Irrigation with antifungal medication
  • Surgery
  • Systemic antifungal medication
A

Surgery​

78
Q

Which artery is most likely to cause retrograde blood flow to mycotic lesions in the external carotid and maxillary arteries?

  • Linguofacial
  • Major palatine
  • Infraorbital
  • External ophthalmic
A

Major palatine​

79
Q

Current surgical techniques for arterial occlusion in treating guttural pouch mycosis include:

  • Ligation
  • Balloon catheterization
  • Transarterial coil embolization
  • All of the above
A

All of the above​

RUSVM Large Animal Surgery (32 decks)

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