Lecture 21: Equine Upper Airway conditions Flashcards
What is this
atheroma
What is an atheroma
Epidermal inclusion cyst, contain squamous and keratin debris
Remove atheroma if __ or __-
Obstructive or cosmetic
How do you remove atheroma- 2 ways
- Laser- enucleate, scrap out, pack with formalin
- Burr technique- grab cyst, pack with formalin
What is this
nasal polyp
Nasal polyps attach in ___
Caudal nasopharynx
How do you remove nasal polyp
Amputate with cutting loop or OB wire tube
Nasal mucosal hemorrhage, what is causing it here
leaky vein
What are the 3 causes of nasal mucosal hemorrhage in non-race horses
- Leaky vein
- Ethmoid hematoma
- Guttural pouch mycosis
How do you tx nasal mucosal hemorrhage caused by leaky vein
- Cauterize
- Silver nitrate stick
What is choanal atresia
Failure of buconasal membrane rupture in early gestation
Bilateral choanal atresia is __at birth without ___
Fatal without tracheostomy
What is the main clinical sign of cleft palate
Nasal discharge of milk
What wrong
cleft palate
Horse presented with epistaxis, put scope in and found this- what is it
ethmoid hematoma
An ethmoid hematoma is an enlarging mass in the ___and/or ___
Ethmoturbinate, sinus
Ethmoid hematomas have persistent dark hemorrhage but not ___hemorrhage
Fatal
For ethmoid hematomas you ___every case for sinus involvement
Radiograph
How do you tx ethmoid hematoma
- Debulk as much as possible before laser
- Grab with electrosurgical loop or OB wire loop
- Formalin injection
What diagnostics should be done for all sinus diseases
- Endoscopy
- Oral exam
- Rads
What is circled in red
guttural pouch openings
Young foal presents with this- what is likely dx
Guttural pouch tympany
What causes guttural pouch tympany
Salpingopharyngeal osteum becomes one-way valve trapping air in one or more guttural pouchesw
What is the surgical approach for unilateral guttural pouch tympany
Fenestrate medium septum to allow unaffected side to empty air
What is the best way to tx bilaterally affected guttural pouch tympany
Dorsal pharyngeal recess fenestration (what divides both guttural pouches)wh
Image of guttural pouch- what is wrong
Guttural pouch empyema
What is a common cause of guttural pouch empyema
Retropharyngeal lymph node abscess
How do you tx guttural pouch empyema
- Guttural pouch lavage with coiled or Foley catheter
- Drainage
If you are going to drain a guttural pouch with pus what do you need to be cautious of and know
Know where abscess is pointing because you can damage nerves required for swallowing
From guttural pouch- what are these
chondroids
What wrong
guttural pouch mycosis
Guttural pouch mycosis typically has mycotic plaques on ___ or ___
Internal carotid or maxillary artery
Guttural pouch mycosis is typically due to ___dz
Arterial wall disease
Guttural pouch mycosis requires __ for tx
Embolization of regional arteries
What are some clinical signs of guttural pouch mycosis
Excessive arterial hemorrhage
What is the first thing you do if you suspect guttural pouch mycosis
Sedate horse and do endoscopy
What is the treatment for guttural pouch mycosis and how does it work
Trans arterial coil embolization- selective occlusion of affected vessels- ECA, ICA, MA, and aberrant branches
What is temporohyoid osteopathy
Fusion of temporohyoid joint- reduced mobility in hyoid apparatus
What are some early non-specific signs of temporohyoid osteopathy
Head shaking, ear rubbing, abnormal head position while ridden
What are some advanced signs of temporohyoid osteopathy and what caused these signs
Neurological involvement following fracture of Petrous temporal bone or stylohyoid bone
Ataxia, head tilt, nystagmus, facial nerve signs
How do you dx temporohyoid osteopathy
Rads, endoscopy, CT
what is wrong
Temporohyoid osteopathy
What is medical tx for temporohyoid osteopathy
Antibiotics, anti-inflammatories
What is preferred surgical tx for temporohyoid osteopathy
Ceratohyoidectomy
You can do a osteoectomy of stylohyoid bone to tx temporohyoid osteopathy but what are some possible negative outcomes
Hypoglossal nerve injury, transient dysphagia, regrowth of bone
What wrong
entrapped epiglottis
How do you tx epiglottal entrapment
Transecting membrane
What these and how do you remove
subepiglottal cysts- remove via snare or laser
What wrong
dorsal displacement of soft palate
What is the most common cause of dorsal displacement of soft palate
Upper airway irritation compromising muscle tone
All treatments for dorsal displacement of soft palate are aimed at ___
Maintaining epiglottis dorsal to soft palate
What are some ways to tx dorsal displacement of soft palate
- Relieve inflammation before sx
- Tongue tie
- Sternothyroideus tenectomy
- Laser soft palate
- Tie forward
- Trim soft palate
If you have a permanently dorsal displaced soft palate what is appropriate tx
Trim soft palate
If you only need to tx dorsal displacement of soft palate during a race what can you do
Tongue tie
During a tie forward for dorsal displaced soft palate you tie ___ to ___
Cricoid cartilage to basihyoid bone
What is affected in laryngeal hemiplegia/roaring
Paresis of left recurrent laryngeal nerve affected cricoartyenoideus dorsalis muscle
What are some clinical signs of laryngeal hemiplegia
Airway noise at exercise (not rest), exercise intolerance
What causes the airway noise in laryngeal hemiplegia
Vocal folds and cords
What causes the exercise intolerance in laryngeal hemiplegia
Cartilage collapse
Horse presents to you “roaring”, endoscopy reveals this, what is wrong
laryngeal hemiplegia
What is grade 1 laryngeal hemiplegia
Normal
What is grade 2 laryngeal hemiplegia
Asynchronous movements, full abduction possible with stimulation, 20% signs at exercise
What is grade 3 laryngeal hemiplegia
Asynchronous movement, full abduction can’t be induced, 80% signs at exercise
What is a grade 4 laryngeal hemiplegia
No movement during any phase of respiration
What are the 3 possible treatments of laryngeal hemiplegia
- Prosthetic laryngoplasty with ventriculocordectomy
- Ventriculocordectomy alone
- Partial artytenoidectomy
Ventriculocordectomy alone is only appropriate for ___
Non-athletes
What is a prosthetic laryngoplasty with ventriculocordectomy
Tie back surgery and removal of vocal folds, cords,and saccule
A ventriculocordectomy removes source of __ and stabilizes tie back sx by ___
Airway noise, artyenoid thyroid cartilage adhesion
What are some complications of prosthetic laryngoplasty
- Suture infection
- Dysphagia, coughing from over abduction
Removed vocal cord for laryngeal hemiplegia and then had leaky larynx, could not fully close. What can you inject to make bigger
hyaluronic acid
When you have a failure of surgery for laryngeal hemiplegia you should always do a ___exam
Dynamic
If you are hearing “roaring” noise from patient who had a left laryngeal hemiplegia prosthetic laryngoplasty and ventriculodectomy what is likely the problem
Right side experiencing problems now because if you removed vocal cords and folds on left then you can;t have noise coming from left
What wrong
arytenoid chondritis
What typically causes artyenoid chondritis
Abscess in arytenoid cartilage
What are some clinical signs of arytenoid chondritis
upper airway noise during exercise, exercise intolerance, airway emergency
What are some differential diagnosis for upper airway noise
Left laryngeal hemiplegia, arytenoid chondritis, granuloma/ulcer on larynx
Horses with arytenoid chondritis may also have left laryngeal hemiplegia due to ___
Left laryngeal hemiplegia will cause left slide to smack into right side causing ulcer and then arytenoid chondritis
Which one is left laryngeal hemiplegia va arytenoid chondritis
Left: Laryngeal hemiplegia
Right: arytenoid chondritis
How can you tx arytenoid chondritis
- Laser debridement through trochanter in cricothyroid membrane
- Conventional debdriment through standing laryngotomy
What is a partial arytenoidectomy
Remove entire artyenoid cartilage except muscular process
T or F: partial arytenoidecotmy can be done in athletes
True
Where do you put in a trach and what muscles and ligament you cutting through
Ventral, mid cervical region
Cut through annular ligament and sternothyroideus muscle
What this
tracheotomy tube set
what this
Foal trach set
Do not cut ___ in foals when doing a trach, will make a knot
Tracheal rings
T or F: inflate cuff when during a trach on a foal to secure airway
FALSE- never inflate cuff because it can clog at end of tube and then they can’t breath around inflated cuff
