Nasal Passage and pharynx - McCarrel

Question 1

Noise is a clinical sign associated with

Answer 1

Upper airway disease

Question 2

Upper airway PE: Observe

Answer 2

1. Symmetry
2. DIscharges (nasal/ocular)
3. Airflow

Question 3

Upper airway PE: Palpate

Answer 3

1. Larynx

2. Jugular furrow

Question 4

Laryngeal palpation

Answer 4

1. Muscular process
   - More prominant-recurrent laryngeal neuropathy
   - Less prominant-arytenoid chondritis, scar tissue from tie backs
2. Assymmetry of laryngeal cartilages
   - consider laryngeal dysplasia
3. Scar tissue (skin) surgery
   - Ventral-laryngotomy, pharyngotomy, tie forward
   - Lateral-tie-back, guttural pouch surgery

Question 5

Jugular furrow palpation

Answer 5

1. prior surgery
2. trauma
3. venous thrombosis

Question 6

Upper airway PE: Auscultate

Answer 6

Heart and lungs

Question 7

For a functional airway exam, horse should NOT

Answer 7

be sedated

Question 8

Endoscopic eval look at

Answer 8

1. Pharyngeal wall
2. Soft palate
3. Epiglottis and aryepiglottic folds
4. Arytenoid cartilages and vocal folds/saccules
5. Guttural pouches
6. Nasomaxillary aperture
7. Dorsal and ventral conchae and meatuses, nasal septum
8. Trachea (LAST)

Question 9

Atheroma

Answer 9

Ush, young horses, cosmetic

-disfiguring to remove

Question 10

Redundant alar fold

Answer 10

Standardbreds, noise at exercise

Question 11

Nasal lacerations

Answer 11

Try to reconstruct, don’t cut off nose flaps

-nose vascular, heals well

Question 12

Diseases of nasal septum

Answer 12

Rare, sign airway obstruction

-Nasal septum resection-cross match before

Question 13

Outcome nasal septum resection

Answer 13

Improved airflow, don’t think they can athlete

• foals < 6 mo facial dishing
• excess granulation tissue at stump

Question 14

Wry nose

Answer 14

Big huge sx

Question 15

Nasopharynx is dorsal to

Answer 15

Soft palate

Question 16

Oropharynx is ventral to

Answer 16

Soft palate

Question 17

Pharynx

Answer 17

Muscular tube, not rigid

Question 18

Hyoid apparatus function

Answer 18

controls position of larynx

Question 19

Dorsal Displacement of the soft palate is NOT the same as

Answer 19

epiglottic entrapment

Question 20

DDSP definition

Answer 20

Intermittent (dynamic) or persistent (resting) malposition of soft palate dorsal to epiglottis

Question 21

If DDSP is persistant

Answer 21

Look for neurological cause

Question 22

DDSP may be secondary to

Answer 22

epiglottic or subepiglottic dz

Question 23

DDSP CS

Answer 23

1. Noise-EXPIRATORY OBSTRUCTION (only one)
2. Poor performance
3. Dysphagia (persistent DDSP)

Question 24

DDSP DX

Answer 24

1. Exercising endoscopy gold standard

2. Resting endoscopy to rule out secondary causes

Question 25

DDSP secondary to epiglottic lesions TX

Answer 25

1. Treat underlying cause

2. Epiglottic augmentation

Question 26

DDSP caudal retraction of tongue TX

Answer 26

1. Tongue tie

2. Gag bit

Question 27

DDSP Open mouth TX

Answer 27

Figure 8 noseband

Question 28

DDSP Laryngeal position TX

Answer 28

1. Check rein
2. Cornell collar
3. Myectomy or Llewellyn
4. LARYNGEAL TIE FORWARD

Question 29

Gold standard tx for DDSP

Answer 29

Laryngeal tie forward

Question 30

Pharyngeal collapse

Answer 30

Pharynx closes without adduction of arytenoids and flipping up of epiglottis

Question 31

Choanal Atresia

Answer 31

1. Failure of buconasal membrane to resorb

2. Often bilateral, foals die unless you trach immediately

Question 32

Cleft Palate

Answer 32

1. Choose patients with no aspiration, if possible
2. Involvement of hard palate means sx probs will fail
3. SX is always a salvage proc, won’t be an athlete
4. Wait until foal is older if possible

Question 33

Cleft palate sx approaches

Answer 33

1. Laryngotomy/pharyngotomy
2. Mandibular symphysiotomy
3. Intraoral/transnasal endoscope assisted

Question 34

Good approaches to pharynx

Answer 34

1. Transnasal videoendoscopy

2. Transoral videoendoscopy

Question 35

Last resort pharynx approaches - lots of complications

Answer 35

1. Pharyngotomy

2. Laryngotomy