Guttural Pouch Surgery Flashcards
what is in the medial compartment of the guttural pouch?
internal carotid artery
vagus/CN X
sympathetic trunk
cranial cervical ganglion
glossopharyngeal/CN IX
hypoglossal/CN XII
pharyngeal branch of CN X
what is in the lateral compartment of the guttural pouch?
external carotid artery
maxillary artery
facial nerve
is tympanic swelling painful or non-painful?
non-painful
what is the medical management treatment for guttural pouch tympany?
anti-inflammatories
antibiotics
decompression
what are the surgical treatment options?
partial resection of guttural pouch septum
stoma (fistula) at level of pharyngeal opening
salpingopharyngeal fistula
what is the prognosis of bilateral guttural pouch tympany?
poor
what is guttural pouch empyema?
accumulation of purulent material
where is the incision made for a modified whitehouse?
ventral and parallel to linguofacial vein
when is the prognosis of guttural pouch empyema poor?
if neurologic deficits
what does guttural pouch mycosis affect?
neurovascular structures
what is the most common sign of guttural pouch mycosis?
hemorrhage
how can guttural pouch mycosis be diagnosed with endoscopy?
diphtheritic membrane
fungal plaque
hemorrhage
what can you give to prevent hemorrhage?
aminocaproic acid
can you perform a salpingopharyngostomy with hemorrhage?
no
what is in the ventral part of the medial compartment?
pharyngeal branch of CN X
what is visible outwardly with guttural pouch tympany?
tympanic swelling: unilateral or bilateral
how can you decompress a guttural pouch tympany?
pharyngeal orifice: catheter or pipette
percutaneous: needle or skin incision
what are the surgical treatment options for guttural pouch tympany?
partial resection of guttural pouch septum
stoma (fistula) at level of pharyngeal opening
salpingopharyngeal fistula
what is a complication with guttural pouch tympany?
iatrogenic nerve damage
what pathogens can lead to guttural pouch empyema through a complication of a respiratory tract infection?
b-hemolytic streptococcus
Streptococcus equi subsp equi
what is S. equi M protein ELISA for?
diagnosis of guttural pouch empyema
vaccines cause false positives
what can you treat acute guttural pouch empyema with?
anti-inflammatories
antibiotics
N-Acetyl cysteine
what are the surgical options for guttural pouch empyema (failed medical management or too many chondroids)?
whitehouse
modified whitehouse (best)
viborg’s triangle
hyovertebrotomy
where is the incision with hyovertebrotomy?
cranial and parallel to wing of atlas
what are the borders of viborg’s triangle?
ventral ramus of mandible
linguofacial vein
sternocephalicus tendon
what are the positives of a modified whitehouse approach?
excellent ventral drainage
access to entire guttural pouch
who gets guttural pouch mycosis most commonly?
adults
warm and humid areas
what species are identified in guttural pouch mycosis?
Aspergillus sp most common
A. fumigatus
A. nidulans
what are the clinical signs of guttural pouch mycosis?
hemorrhage
dysphagia
horner’s syndrome
facial paralysis
abnormal head position
why would you give aminocaproic acid to a horse with guttural pouch mycosis?
stop and prevent hemorrhage
what are some antifungals you can treat guttural pouch mycosis with?
itraconazole
enilconazole
amphotericin B
ketoconazole
miconazole
when can you perform a salpingopharyngostomy with guttural pouch mycosis?
only if no hemorrhage
where can you occlude arteries for guttural pouch mycosis?
internal carotid artery: origin, at sigmoid flexure, or dorsal to roof of pouch
external carotid artery: origin
maxillary artery: caudal to caudal alar foramen
should you give anti-fungals post-operatively for guttural pouch mycosis?
no
