Guttural Pouch Surgery

Question 1

what is in the medial compartment of the guttural pouch?

Answer 1

internal carotid artery
vagus/CN X
sympathetic trunk
cranial cervical ganglion
glossopharyngeal/CN IX
hypoglossal/CN XII
pharyngeal branch of CN X

Question 2

what is in the lateral compartment of the guttural pouch?

Answer 2

external carotid artery
maxillary artery
facial nerve

Question 3

is tympanic swelling painful or non-painful?

Answer 3

non-painful

Question 4

what is the medical management treatment for guttural pouch tympany?

Answer 4

anti-inflammatories
antibiotics
decompression

Question 5

what are the surgical treatment options?

Answer 5

partial resection of guttural pouch septum
stoma (fistula) at level of pharyngeal opening
salpingopharyngeal fistula

Question 6

what is the prognosis of bilateral guttural pouch tympany?

Answer 6

poor

Question 7

what is guttural pouch empyema?

Answer 7

accumulation of purulent material

Question 8

where is the incision made for a modified whitehouse?

Answer 8

ventral and parallel to linguofacial vein

Question 9

when is the prognosis of guttural pouch empyema poor?

Answer 9

if neurologic deficits

Question 10

what does guttural pouch mycosis affect?

Answer 10

neurovascular structures

Question 11

what is the most common sign of guttural pouch mycosis?

Answer 11

hemorrhage

Question 12

how can guttural pouch mycosis be diagnosed with endoscopy?

Answer 12

diphtheritic membrane
fungal plaque
hemorrhage

Question 13

what can you give to prevent hemorrhage?

Answer 13

aminocaproic acid

Question 14

can you perform a salpingopharyngostomy with hemorrhage?

Answer 14

no

Question 15

what is in the ventral part of the medial compartment?

Answer 15

pharyngeal branch of CN X

Question 16

what is visible outwardly with guttural pouch tympany?

Answer 16

tympanic swelling: unilateral or bilateral

Question 17

how can you decompress a guttural pouch tympany?

Answer 17

pharyngeal orifice: catheter or pipette
percutaneous: needle or skin incision

Question 18

what are the surgical treatment options for guttural pouch tympany?

Answer 18

partial resection of guttural pouch septum
stoma (fistula) at level of pharyngeal opening
salpingopharyngeal fistula

Question 19

what is a complication with guttural pouch tympany?

Answer 19

iatrogenic nerve damage

Question 20

what pathogens can lead to guttural pouch empyema through a complication of a respiratory tract infection?

Answer 20

b-hemolytic streptococcus
Streptococcus equi subsp equi

Question 21

what is S. equi M protein ELISA for?

Answer 21

diagnosis of guttural pouch empyema
vaccines cause false positives

Question 22

what can you treat acute guttural pouch empyema with?

Answer 22

anti-inflammatories
antibiotics
N-Acetyl cysteine

Question 23

what are the surgical options for guttural pouch empyema (failed medical management or too many chondroids)?

Answer 23

whitehouse
modified whitehouse (best)
viborg’s triangle
hyovertebrotomy

Question 24

where is the incision with hyovertebrotomy?

Answer 24

cranial and parallel to wing of atlas

Question 25

what are the borders of viborg's triangle?

Answer 25

ventral ramus of mandible linguofacial vein sternocephalicus tendon

Question 26

what are the positives of a modified whitehouse approach?

Answer 26

excellent ventral drainage access to entire guttural pouch

Question 27

who gets guttural pouch mycosis most commonly?

Answer 27

adults warm and humid areas

Question 28

what species are identified in guttural pouch mycosis?

Answer 28

Aspergillus sp most common A. fumigatus A. nidulans

Question 29

what are the clinical signs of guttural pouch mycosis?

Answer 29

hemorrhage dysphagia horner's syndrome facial paralysis abnormal head position

Question 30

why would you give aminocaproic acid to a horse with guttural pouch mycosis?

Answer 30

stop and prevent hemorrhage

Question 31

what are some antifungals you can treat guttural pouch mycosis with?

Answer 31

itraconazole enilconazole amphotericin B ketoconazole miconazole

Question 32

when can you perform a salpingopharyngostomy with guttural pouch mycosis?

Answer 32

only if no hemorrhage

Question 33

where can you occlude arteries for guttural pouch mycosis?

Answer 33

internal carotid artery: origin, at sigmoid flexure, or dorsal to roof of pouch external carotid artery: origin maxillary artery: caudal to caudal alar foramen

Question 34

should you give anti-fungals post-operatively for guttural pouch mycosis?

Answer 34

no