Laryngeal Paralysis Flashcards

1
Q

Briefly explain the laryngeal anatomy

A

From cranial to caudal the cartilages are the epiglottic, arytenoid, thyroid, and cricoid carriages. The arytenoid cartilages are paired, the thyroid you can’t see when looking intraorally and then the cricoid is caudal to the thyroid and innervated by the recurrent laryngeal nerve

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2
Q

Why is the larynx important?

A

The larynx prevents aspiration, controls airway resistance (glottic opening) , voice production

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3
Q

Laryngeal paralysis results from the __ nerve which is a branch of the vagus nerve and innervates the ___ muscle. Laryngeal paralysis is more common in __ and ___

A

Laryngeal paralysis results from the recurrent laryngeal nerve which is a branch of the vagus nerve and innervates the cricoarytendoideus muscle. Laryngeal paralysis is more common in dogs and males

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4
Q

Name some breeds associated with congenital laryngeal paralysis and when clinical signs start and what they look like

A

Bouvier does flandres, Dalmatians, huskies, and Rottweilers

The onset of clinical signs in <1 yr old and is progressive neurologic degeneration

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5
Q

Acquired laryngeal paralysis is most common in labs/golden, Saint Bernards and Irish setters with the mean age affected being __ . It is commonly __ with a generalized __ but may be caused by neoplasia such as __ or __ OR an __ or __polyneuropathy

A

Acquired laryngeal paralysis is most common in labs/golden, Saint Bernards and Irish setters with the mean age affected being 9 yrs. It is commonly idiopathic with a generalized polyneuropathy but may be caused by neoplasia such as thyroid tumores or mediastinal masses OR an endocrine or immune mediated polyneuropathy

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6
Q

Briefly scribe the clinical presentation of a patient with acquired laryngeal paralysis

A

The disease progressions is typically slow with exercise intolerance, inspiratory stridor and early signs of voice changes, gagging, and coughing with food and water intake. These patients may be at an increased risk of heatstroke

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7
Q

What diagnostics might be performed for acquired laryngeal paralysis?

A
  • CBC, Biochem, UA
  • T4, TSH
  • Thoracic + cervical rads
  • esophagram/swallow studies
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8
Q

Aspiration pneumonia occurs in __ dogs with laryngeal paralysis and up animals have up to __ risk of aspiration pneumonia post surgery. What can you pre-treat with?

A

Aspiration pneumonia occurs in 7.9% dogs with laryngeal paralysis and up animals have up to 21% risk of aspiration pneumonia post surgery. Pre-treat with metoclopramide

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9
Q

On laryngeal examination the arytenoids/vocal folds should __ during inspiration

A

On laryngeal examination the arytenoids/vocal folds should abduct during inspiration

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10
Q

What does doxopram do for a laryngeal exam?

A

its a CNS stimulant that causes the cartilages to move more significantly after administration

Dogs without laryngeal paralysis will open the arytenoids on inspiration, this drug helps make the motion more obvious

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11
Q

Explain paradoxical motion on a laryngeal exam

A

Paradoxical motion happens on a laryngeal exam when a dog has laryngeal paralysis or collapse. When the animal takes a breath in the cartilages will be closed but when the animal exhales the cartilages will open from the physical forces of exhalation not because of nerve innervation.

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12
Q

In an emergency situation, how can you medically manage laryngeal paralysis?

A
  • Provide a cool environment or cold ice baths if the temp is >105F
  • supplement O2
  • IV sedation with ace or torb
  • IV corticosteroids
  • cautious with fluid therapy
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13
Q

In an emergency situation, how can you medically manage laryngeal paralysis?

A
  • Provide a cool environment or cold ice baths if the temp is >105F
  • supplement O2
  • IV sedation with ace or torb
  • IV corticosteroids
  • cautious with fluid therapy
  • intubation, surgery, or a temporary tracheostomy may also be warranted
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14
Q

How could you treat a patient with laryngeal paralysis without surgery?

A

Start by treating the concurrent problems then work on weight loss, stress reduction, exercise restriction, and avoidance of high temperatures. This is only ok to do if the case is mild.

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15
Q

__ is the treatment of choice for animals with moderate to severe clinical signs of laryngeal paralysis and the goal is to __ airway resistance

A

Surgery is the treatment of choice for animals with moderate to severe clinical signs of laryngeal paralysis and the goal is to decrease airway resistance

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16
Q

__ and __ are standard surgical procedures for laryngeal paralysis

A

Arytenoid lateralization and cricoarytenoid lateralization are standard surgical procedures for laryngeal paralysis

17
Q

Briefly describe the arytenoid lateralization surgery

A
  1. Left lateral cervical approach with incision parallel and ventral to the jugular
  2. Dissect through the SQ, adipose tissue, platysma muscle and then ventral to the jugular vein
  3. ID the dorsal edge of the thyroid cartilage
  4. Take 2-0 prolene with a taper needle, ID the cricoud cartilage and muscular process then pass suture around the caudal border of the cricoid through the dorsal crest
  5. Pass suture through the muscular process
  6. Check tension of the lateralization suture -> the final glottic opening should be no larger than having an ET tube, make sure they’re not overabducted
18
Q

Improvement is expected in __ of patients undergoing unilateral arytenoid lateralization surgery. What are some potential complications?

A

Improvement is expected in 90% of patients undergoing unilateral arytenoid lateralization surgery. Complications expected are aspiration pneumonia, persistence of signs, suture failure, or cartilage fracture. They may end up needed the contra lateral side done but unilateral is typically preferred.

19
Q

Feline laryngeal paralysis is __ with signs of __ and __ most common

A

Uncommon, tachypnea and Dyspnea