Guttural Pouches

Question 1

The guttural pouches are an important anatomic structure:

1. What is the name the structure that is entered through to endoscopically visualise them?
2. What is the volume of them?
3. What is the structure that divided the medial and lateral pouches and which is bigger?
4. What neural structures go through?
5. What vascular structures?

Answer 1

1. Pharyngeal orifice
2. 300-500ml
3. Divided by the stylohyoid bone - medial pouch is larger than the lateral
4. Nerves - 7,9,10,11,12 and sympathetic trunk
5. Vascular structures are internal and external carotid and the maxillary arteries

Question 2

Name the structures that are shown in the guttural pouch shown below:

Answer 2

• Red arrow = internal carotid artery
• Black arrow = cranial nerves

Question 3

For guttural pouch tymphany:

1. What is the cause?
2. What are the clinical signs that are seen?
3. How it is it typically diagnosed?
4. What are the main treatment options?
5. What is the prognosis for this condition?

Answer 3

1. Typically a congenital cause - thought that maybe excessive mucosal flap @ the pharyngeal orifice → serving as a one way valve → air becomes trapped
2. Soft non-painful swelling
3. Radiograph
4. Unilateral tumours - fenestration of the medial septum, bilaterally is resection/modification of pharyngeal orifice
5. Prognosis: good - unless secondary aspiration pneumoniae or other complication

Question 4

For guttural pouch empyema:

1. State the cause and pathogenesis
2. What are the clinical signs?
3. How is a diagnosis made?
4. How is it treated?
5. What is the prognosis?

Answer 4

Pathogenesis:

• Second to upper respiratory infection of rupture of a lymph node

Clinical signs:

• Nasal discharge, regional lymph node enlargement and dysphagia

Diagnosis:

• Endoscopy (exudate in GP) or radiography (fluid lines in GP)

Treatment:

• Aggressive lavage + administration of local and systemic antimicrobials
• Medical therapy fails → surgical lavage and drainage

Prognosis:

• Good to excellent

Question 5

What is the most common cause of guttural pouch empyema?

Answer 5

Streptococcus equi equi (Strangles)

Question 6

For guttural pathogenesis:

1. Where are the fungal plaques typically seen?
2. What are the main clinical signs observed?
3. How is a diagnosis made?
4. What is the treatment of choice?

Answer 6

1. Fungal plaques seen on the dorsal wall of the guttural pouch
2. Erosion of wall of one of the arteries → epistaxis, dysphagia results from damage to the nerves
3. Endoscopy
4. Surgical occlusion of the affected arteries

Question 7

Name the disorder that is shown in the guttural pouch below:

Answer 7

Guttural pouch mycosis - notice the dark fungal plaques on the dorsal aspect of the guttural pouch