Laryngeal paralysis Flashcards
absence of abduction of the arytenoid cartilages during inspiration
laryngeal paralysis
with laryngeal paralysis there is absence of abduction of arytenoid cartilages during (inspiration or expiration)
inspiration
laryngeal collapse is (structural / functional) issue while paralysis is a
collapse: structural
paralysis: functional
Is unilateral or bilateral laryngeal paralysis more common to see symptoms
Bilateral
(hard to see unilateral unless working dog or owners very engaging with pet)
T/F: laryngeal paralysis is only acquired
False -
it can be congenital or acquired
What causes congenital laryngeal paralysis
Central neurologic lesion
dogs <1 year of age
breeds: Husky, bouvier de flandres, rottweiler, dalmation
What kinds of dogs do you typically see congenital laryngeal paralysis in
Dogs <1 year of age
Husky, Bouvier de Flandres, Rottweiler, Dalmation
At what age is congenital laryngeal paralysis typically seen
<1 year
-often onset of signs by 6 months
-huskies typically have blue eyes, really white facial markings, and oral mucosal tags or tissue bands
What typically causes acquired laryngeal paralysis
A peripheral lesion
1) Trauma
2) Compressive masses
3) Iatrogenic - damage to recurrent laryngeal nerve
4) Polyneuropathy (endocrine, infectious, immune-mediated, hypothyroidism)
5) Idiopathic polyneuropathy **(most common)
What might cause a polyneuropathy leading to laryngeal paralysis
-Endocrine
-Infectious
-Immune mediated
-Hypothyroid??
-Idiopathic **
What breeds typically get idiopathic polyneuropathy - laryngneal paralysis
Labs
Golden Retrievers
St. Bernard
Irish Setter
mostly older dogs
(multiple nerves affected)
What age of dogs typically get idiopathic polyneuropathy - laryngneal paralysis
Older dogs
With idiopathic polyneuropathy - laryngneal paralysis, what nerves are often affected
Recurrent Laryngeal N. often affected first (multiple nerves can be effected)
-sciatic?
-nerve to esophagus?
What muscle does the recurrent laryngeal nerve innervate
cricoarytneoideus dorsalis m (CAD)
What does GOLPP stand for
Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP)
How do dogs with Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP) present
Acute on Chronic:
-Inspiratory stridor
-Collapse
-Upper airway obstruction
-Pulmonary edema
-Aspiration pneumonia
-Heatstroke
Chronic:
-Inspiratory stridor
-Exercise intolerance
-Change in bark
-Cough and gagg
-Aspiration pneumonia
What sound is heard with Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP)
inspiratory stridor
-Inspiratory obstructive dyspnea (slow and deep)
What is a result of the inspiratory stridor seen in dogs with laryngeal paralysis
1) Inspiratory stridor
2) Upper airway obstruction
3) Laryngeal edema and inflammation
4) Acute respiratory distress, cyanosis, syncope
Laryngeal paralysis you might hear upper airway sounds with
inspiratory stridor with pneumonia (cough), hyperthermia
What should you include in your workup for Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP)
Neurologic Exam!
-Assess gag reflex
-Muscle wasting
-Weakness
-CP deficits in pelvic limbs
-Cranial tibial muscle atrophy
Ask about GI history!!
With Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP), what might also occur
GI signs - nerves also innervate the esophagus and other GI organs
(can have esophageal dysmotility or megaesophagus)
How does laryngeal paralysis sound
Inspiratory Stridor
-Inspiratory Obstructive Dyspnea
-Slow and Deep
What are you differentials for an inspiratory stridor
-Laryngeal paralysis
-Laryngeal collapse
-Laryngeal mass (extraluminal or intraluminal)
-Pharyngeal mass
What is significant about feline laryngeal paralysis
Dont necessarily hear stridor
Can be clinical for unilateral -
weight loss might be a sign
Cause- idiopathic for most (not that common)
T/F: cats can be clinical for unilateral laryngeal paralysis
True
you might not necessarily hear stridor
What are common clinical signs of laryngeal paralysis in cats
Tachypnea
Dyspnea
Dysphagia
Weight loss
Voice change
coughing
lethargy
What is the typical age of onset for laryngeal paralysis in cats
4month-17 years (medial 11years)
What diagnostics should you do for Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP)
1) Routine blood work (WBC-pneumonia)
2) Endocrine function (hypothyroidism)
3) Thoracic radiographs +/- esophagram
4) Sedated laryngeal exam
What might you see on thoracic rads for dogs with Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP)
1) Megaesophagus
2) Aspiration pneumonia
3) Pulmonary edema
4) Mediastinal Masses
pre-op pneumonia increases the risk of post-op complications by 2.75 times
How does megaesophagus affect prognosis of Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP) cases
if they have megaesphagus they have an increased risk of aspiration pneumonia
For a laryngeal exam, what can you do for pre-medication
Acepromazine
Methadone
Hydromorphone
Fentanyl
Dexmedetomidine
all can affect laryngeal function
When doing laryngeal exams, what can you do to lightly anesthetize the dog
-Propofol 4-6mg/kg IV to effect
-Dopram 1mg/kg IV to effect
-Metoclopramide (for risk of aspiration pneumonia)
central respiratory stimulant that is helpful for laryngeal exams
Dopram 1mg/kg IV to effect
When doing a sedated laryngeal exam, what drug is given to reduce the risk of aspiration pneumonia
Metoclopramide
In dogs with laryngeal paralysis, what can you do
-Rest
-Cooling
-Supplemental Oxygen
-Acepromazine: 0.01-0.03 mg/kg IV, max dose of 2mg
-Butorphanol 0.2-0.3 mg/kg IV
-Dexamethasone 0.1-0.25 mg/kg IV
1) Endotracheal intubation - not all dogs can be extubated
2) Temporary tracheostomy: 10x more likely to develop a post-op complication; 9x more likely to die
What is paradoxical motion
a dog with laryngeal paralysis but when the patient inspires, the larynx closes
-Common to see on Dopram
common to see vocal chords flapping
Paradoxical motion of the larynx is common to see when the patient is on
Dopram
Dogs that have a temporary tracheostomy have
10x more likely to develop a post-op complication; 9x more likely to die
What are the different surgical treatments for laryngeal paralysis
1) Arytenoid lateralization
2) Ventriculocordectomy and partial aryenoidectomy (oral approach or ventral larngotomy)
3) Bilateral Ventriculocordectomy
(oral approach and ventral laryngotomy)
4) Permanent tracheostomy
What is the most common surgical treatment for laryngeal paralysis
Arytenoid lateralization
Why is bilateral arytenoid lateralization not recommended
because of aspiration pneumonia risk
Arytenoid lateralization functions to
increase diameter of rima glottis
Is Arytenoid lateralization done unilaterally or bilaterally
unilaterally
Permanent tracheostomy is used in laryngeal cases that have
Cases that are high risk
1) High risk of aspiration pneumona
2) Megaesophagus
3) Hiatal hernia
In arytenoid lateralization, where does your suture go through
the muscular process of the arytenoid
In larynx surgery, what are some landmarks
-Cricoid/Trachea Junction
-Dorsal wing of the thyroid cartilage
-Hyoid bone- go caufal
-Muscular porcess of the arytenoid
Where does the suture go in laryngeal paralysis sx
suture goes in the back of the cricoid, comes out through cricoid and to muscular process of the arytenoid and then tied
suture mimics the muscle of cricoarytenoideus dorsalis (CAD) muscle
What is the downside of arytenoid lateralization
lifetime risk of aspiration pneumonia
10-20% short term
30% long term
other risks: suture failure, seroma
What is the prognosis of arytenoid lateralization
good to excellent results (90-100%)
long term prognosis is 75% survival at 4 years
What should you do for post-op recovery of arytenoid lateralization
-no opioids
-minimize the use of IV sedatives
-discharge the same day to reduce stress
-no food or water until staanding and walking
-meatball under supervision
-Start oral pain medication and discharge
What should you do for aftercare after arytenoid lateralization
-Carprofen 2.2mg/kg PO BID (if no steroids)
-Gabapentin
-Cisapride 30 min prior to eating x2week
-Canned food meatballs for 2 weeks, then transition to soaked dry kibble
-Harness
-NO SWIMMING
