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LA DX & TX I > Exam 2 - Equine Surgical Diseases of the Upper Airway > Flashcards

Exam 2 - Equine Surgical Diseases of the Upper Airway Flashcards

1
Q

what is another name for epidermal inclusion cysts?

A

atheromas

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2
Q

what is the treatment for atheromas?

A

medical - injection of alcohol or formalin

surgical - extirpation

good prognosis - cosmesis may be an issue

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3
Q

what is the pathogenesis of redundant alar folds?

A

tissue that creates the false nostril creates an inhalatory obstruction & stertor

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4
Q

how is redundant alar folds diagnosed?

A

lifting with a finger to see if that solves the problem or suturing percutaneously while exercising

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5
Q

what is the treatment for redundant alar folds?

A

surgical resection required

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6
Q

what are some causes of unilateral epistaxis?

A

trauma, sinus disease, & progressive ethmoid hematoma

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7
Q

what are some causes of bilateral epistaxis?

A

GP mycosis

exercise induced pulmonary hemorrhage

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8
Q

where do you expect the lesion to be in the nasal passages for unilateral nasal discharge? what about bilateral nasal discharge?

A

unilateral - rostral to the nasal septum

bilateral - caudal to nasal septum

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9
Q

what is the most common cause of bilateral epistaxis?

A

exercise induced pulmonary hemorrhage

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10
Q

what is the treatment for ethmoid hematomas?

A

transendoscopic injection of 4-10% formalin - multiple treatments

surgical extirpation - big deal, severe hemorrhage, can originate in the sinus

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11
Q

what are some common causes of unilateral purulent discharge?

A

sinusitis

guttural pouch empyema

fungal rhinitis

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12
Q

what are some common causes of bilateral purulent discharge?

A

guttural pouch empyema

nasopharyngeal or tracheal disease

thoracic disease

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13
Q

what is probably the most common upper airway problem seen in equine practice?

A

paranasal sinusitis

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14
Q

what is the big difference between primary & secondary sinusitis?

A

primary - diagnosis of exclusion

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15
Q

what would you expect to see on culture in primary sinusitis?

A

1 bug!!!

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16
Q

what is the treatment of primary sinusitis?

A

empirical - 30 days of antibiotics, commonly use trimethoprim-sulfa

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17
Q

what should you rule out in secondary sinusitis?

A

trauma, neoplasia, nasal passage/oral disease, apical dental disease

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18
Q

what is the most common neoplasia seen in equine upper airways?

A

squamous cell carcinoma

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19
Q

why does the presence of anaerobic bacteria on an oral exam in a horse with suspected secondary sinusitis help your physical exam?

A
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20
Q

what sinus does the blue dot indicate? what is the landmark?

A

frontal sinus - most versatile

60% of the distance from mid-line to the medial canthus

0.5cm caudal to the line joining the medial canthus

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21
Q

what sinus does the black dot indicate? what is the landmark?

A

caudal maxillary sinus

2cm rostral & 2cm lateral to the medial canthus

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22
Q

what sinus does the red dot indicate? what is the landmark?

A

rostral maxillary sinus

40% of the distance from the rostral end of the facial crest to the level of the medial canthus

1cm ventral to a line joining the infraorbital foramen to the medial canthus

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23
Q

what are the most common signs of paranasal cysts?

A

facial deformation, nasal discharge, respiratory noise, & unilateral decreased airflow

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24
Q

what is the treatment for paranasal cysts?

A

surgical extirpation - usually done sinuscopically

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25
Q

what is a major differential for a paranasal cyst? prognosis?

A

squamous cell carcinoma - very bad prognosis

both lesions are expansile & space occupying

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26
Q

what animals are typically affected by paranasal cysts?

A

horses of any age but most commonly young adults

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27
Q

what surgical approach is shown here? what are the landmarks?

A

maxillary flap

dorsal to the facial crest

rostral to the medial canthus

ventral to the nasolacrimal duct

caudal to the rostral aspect of the facial crest

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28
Q

what surgical approach is shown here? what are the landmarks?

A

frontonasal flap

midline

just caudal to the medial canthus

dorsal to the nasolacrimal duct

caudal to the rostral aspect of the facial crest

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29
Q

what are the advantages & disadvantages of using a bone flap as a surgical approach?

A

pros: greater surgical exposure, can be done standing or under general, & doesn’t require special equipment or techniques

cons: higher complications rate, making the flap can be hard, & requires a separate trephination site to allow for repeat lavage

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30
Q

what sinuses are indicated by the blue, red, & black dots?

A

blue - frontal sinus

red - rostral maxillary sinus

black - caudal maxillary sinus

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31
Q

what are the advantages of using sinuscopy?

A

minimally invasive, excellent access, can be done standing so less hemorrhage, & allows repeated, high volume lavage

32
Q

how is a sinus lavage performed?

A

trephine a hole using a 14 G needle & drill

use tap water with dilute betadine and salt or sterile saline

use a sterile stomach pump & tube with an electronic fluid pump or gravity/drip set

33
Q

what is the I-IV grading system used for pharyngeal collapse?

A

I - 1 wall collapses

II - 2 walls collapse

III - 3 walls collapse

IV - 4 walls collapse

34
Q

what is the mild-severe grading system used for pharyngeal collapse?

A

mild - obstruction is equivalent to the closure of the pharynx to the rima glottis

low moderate - obstructs 30% of the glottis

high moderate - obstructs 50% of the glottis

severe - complete closure of the pharynx with opposing pharyngeal walls touching each other

35
Q

what is the treatment for pharyngeal collapse?

A

not a lot - rule out lower airway disease & manage if present & rule out neurologic disease & treat if present

fenestrate guttural pouch

treat inflammation

36
Q

what are some major diseases that affect the guttural pouch?

A

empyema, chondroids, guttural pouch mycosis, guttural pouch tympany, & temporohyoid osteoarthropathy (THO)

37
Q

if guttural pouch mycosis is found incidentally or the horse isn’t actively hemorrhaging, what can be done?

A

fenestration has been shown to resolve the mycotic plaque without systemic or topical treatment

38
Q

if guttural pouch mycosis is found and the horse is actively hemorrhaging, what can be done?

A

occlude the vessels involved!!!

39
Q

what are the pros & cons for using a transarterial coil/plug embolization in a horse with guttural pouch mycosis?

A

pros - excellent prognosis if caught in time

cons - requires specialized equipment & expertise

40
Q

how is catheter embolization used for guttural pouch mycosis in a horse that is actively hemorrhaging?

A

catheterize internal carotid, external carotid, & major palatine artery to occlude the maxillary artery

remove catheters later

41
Q

what is protective for nasopharyngeal cicatrix?

A

stalling & moving them out of texas

42
Q

what are some presentations seen in nasopharyngeal cicatrix?

A

severity of obstruction

environmental concerns - most likely will see more in summer

active inflammation vs. chronic scarring

43
Q

what disease process is shown?

A

nasopharyngeal cicatrix

44
Q

what is the treatment for mild nasopharyngeal cicatrix?

A

no obstruction - coughing & nasal discharge

medical management with throat spray, potentially antibiotics, & change environment

45
Q

what are some signs of severe nasopharyngeal cicatrix?

A

maybe minimal

nostril flaring, extended head/neck, distressed, & very loud breathing

46
Q

what are the 5 major disease processes that affect the larynx in horses?

A
  1. dorsal displacement of the soft palate
  2. recurrent laryngeal neuropathy
  3. subepiglottic cyst
  4. epiglottic entrapment
  5. axial deviation of the aryepiglottic folds (racehorses - must use dynamic exam)
47
Q

what disease process is shown here on this dynamic exam?

A

axial deviation of the aryepiglottic folds

48
Q

what clinical signs are seen with persistent dorsal displacement of the soft palate?

A

coughing, aspiration pneumonia, & weight loss

49
Q

what clinical signs are seen with dorsal displacement of the soft palate?

A

intermittent or permanent

exercise intolerance - may be severe enough to cause dyspnea, cyanosis, or collapse

noise during exercise - primarily expiratory

50
Q

what is the pathophysiology of dorsal displacement of the soft palate?

A

caudal free margin becomes malpositioned dorsal to the epiglottis

cross-sectional area of the pharynx is reduced

airflow resistance increased which causes abnormal respiratory noise & exercise intolerance (exhalatory obstruction)

51
Q

what are some suggested etiologies of dorsal displacement of the soft palate?

A

secondary to generalized pharyngeal inflammation

hypoplastic/malformed epiglottis

neuromuscular dysfunction - palate

secondary to RLN - increased respiratory pressure

excessive laryngeal retraction - laryngohyoid malposition

52
Q

how is dorsal displacement of the soft palate diagnoses?

A

upper airway endoscopy - resting has a strong PPV but dynamic is better

rest - 60% of horses had laryngeal asymmetry & 10% had DDSP

exercising - 15% had laryngeal asymmetry & 50% had DDSP

53
Q

what is a laryngeal tie-forward?

A

reposition the laryngohyoid apparatus - advances the larynx rostrally using the basihyoid bone as an anchor & decreases the distance between the larynx & hyoid

combine with tenectomy of sternothyroideus

54
Q

what is a laryngeal tie-forward used to treat surgically?

A

dorsal displacement of the soft palate

55
Q

what is the pathogenesis of recurrent laryngeal neuropathy?

A

loss of myelinated nerve fibers in the recurrent laryngeal nerve (left more common) & progressive atrophy of the cricoarytenoideus dorsalis muscle

56
Q

what are the proposed mechanisms of RLN?

A

mechanical stress, ischemic nerve damage, pressure/trauma, infectious, vitamin deficiencies, & toxic insults

57
Q

what are the clinical signs of RLN?

A

inspiratory noise, exercise intolerance

58
Q

what is this lesion?

A

paralysis of the left recurrent laryngeal nerve

59
Q

how is RLN diagnosed?

A

endoscopy - resting & dynamic

ultrasound - echogenicity of the cricoarytenoideus dorsalis muscle

60
Q

what are grades I-IV of RLN at rest?

A

I - normal abduction & symmetry of both arytenoids

II - asynchronous movement, full abduction achieved (sub grades I-III)

III - asynchronous movement, full abduction not achieved (sub grades I-III)

IV - complete paralysis

61
Q

what are the dynamic grades A-C of RLN ?

A

A - symmetric full abduction

B - arytenoid/vocal fold incomplete abduction

C - severe dynamic laryngeal collapse with exercise

62
Q

what does treatment of RLN depend on?

A

severity, discipline of the horse, presenting complaint - noise only, & results of diagnostic exams

63
Q

when is a tie-back indicated for RLN?

A

exercise intolerance

unacceptable noise in competition

arytenoid collapse on dynamic scope

progressive disease

64
Q

what treatment options are available for RLN?

A

nothing

tie-back procedure

ventriculocordectomy (noise)

combination

65
Q

why is a tie-back important?

A

cost, complications - coughing, dysphagia, pneumonia, infection/seroma

66
Q

what is the success rate of tie-back surgery?

A

50-90%

67
Q

what is the primary surgical intervention for RLN?

A

prosthetic laryngoplasty - almost always done standing

68
Q

what are the treatment options for a subepiglottic cyst? what is the prognosis?

A

gigli wire snare or laser

excellent

69
Q

what are the treatment options for epiglottic entrapment? what about using a hooked bistoury?

A

laser - greater than 90% success, don’t laser the cartilage

hooked bistoury - big complications

70
Q

what may be seen on tracheal evaluation that is supportive of inflammatory airway disease in horses?

A

increased mucus in the trachea

71
Q

where should a temporary tracheostomy be placed?

A

middle to caudal 1/3 of the neck where the sternocephalicus muscles converge - way easier to do them standing but let the horse collapse if they’re gonna

tracheal rings 2-6

72
Q

should you use sedation when placing a temporary tracheostomy?

A

no - avoid if at all possible

73
Q

what is more common primary or secondary sinusitis?

A

secondary

74
Q

what causes secondary sinusitis in horses?

A

basically a sequelae of other issues - trauma, neoplasia, nasal passage/oral disease, apical dental disease

75
Q

how do you treat secondary sinusitis?

A

treat the primary cause

76
Q

what teeth communicate with the caudomaxillary sinus in the horse?

A

10 & 11 cheek teeth

77
Q

what teeth communicate with the rostromaxillary sinus in the horse?

A

8 & 9

LA DX & TX I (45 decks)

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