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Equine II > Static upper respiratory tract > Flashcards

Static upper respiratory tract Flashcards

1
Q

Which meatus is used to pass stomach tubes and scopes?

A

Ventral meatus
- largest
- unlikely to hit ethomoids
- easier to enter guttural pouch

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2
Q

Endoscopy of nasal cavity

A

If you suspect sino-nasal disease

Inspect all nasal meatuses
○ Ventral
○ Common (middle)
○ Dorsal (if wide enough)

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3
Q

False nostril cyst/atheroma

A

Uncommon

Epidermoid cysts can develop in the false nostril lining -> facial swelling in the area of the naso-maxillary notch.

Soft fluctuant swelling 3-4cm diameter

Do not cause nasal airflow obstructions.

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4
Q

Treatment of false nostril cyst/atheroma

A

usually for cosmetic reasons

total surgical removal of the cyst in sedated horse

Needle drainage often leads to infection and recurrence

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5
Q

Equine nasal paralysis

A

Nostrils, nasopharynx and larynx need active muscle for dilation during fast work

Facial nerve paralysis -> nasal paralysis
○ injury at petrous temporal bone, caudal mandible, or buccal branches of VII
○ Tight headcollar, GA lat recumb, buckles damage nerve

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6
Q

Clinical signs of equine nasal paralysis

A

Muzzle twisted towards normal side if unilaterally affected

Droopy eyelid

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7
Q

Prognosis of Equine nasal paralysis

A

Following severe bruising nerves regrow at circa 1cm per month

Severed nerve unlikely to recover

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8
Q

Nostril wounds

A

Need accuarate apposition or can lead to large flap or healing with stenosis

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9
Q

Scrolled ethmoturbinates in a normal horse

A

Next to olfactory lobe of brain at dorso-caudal aspect

Variation in shapes of normal ethomoturbinates - endoscopic appearance

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10
Q

Incidence of progressive ethmoid haematome (PEH)

A

Common

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11
Q

Progressive Ethmoid Haematoma (PEH)

A

An ethmoid haematoma is a haemorrhagic polyp with the histological appearance of a haematoma.

Usually occur in adult horses

Can grow rostrally from the ethmoturbinates within the nasal cavity but also grow within the paranasal sinuses.

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12
Q

History of progressive ethmoid haematoma (PEH)

A

Their capsules release small amounts of blood over very long periods (even years) so the clinical history is of multiple small volumes of (usually) unilateral epistaxis.

Some cases are affected bilaterally.

They are the commonest cause of chronic unilateral low volume epistaxis in the resting horse i.e. DDx from EIPH which occurs after exercise.

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13
Q

What is the commonest cause of chronic unilateral low volume epistaxis in the resting horse

A

Progressive ethmoid haematoma

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14
Q

Possible sequelae of progressive ethmoid haematoma

A

Slow enlargement in the nasal cavity and sinuses causes secondary infection with mucopurulent as well as haemorrhagic nasal discharge, and possibly airflow obstruction, facial swelling and neurological signs as the lesion gets bigger.

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15
Q

Diagnosis of progressive ethmoid haematoma

A

Endoscopically, the PEH is a classic dark red or brown coloured mass seen at the ethmoturbinates or within the nasal cavity or sinuses.

Can be very large or small

See stream of blood from sinus drainage angle if PEH has grown within a sinus

Radiography may show lesions that are contained within the sinuses.

Sinuscopy shows PEH in sinuses

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16
Q

Treatment of progressive ethmoid haematoma

A

repeated, transendoscopic (non-invasive) intra-lesional formalin injections for small to mid-sized lesions in the nasal cavity.

In a standing sedated horse

Have to be repeated q2-3 weeks until lesion fully regressed

For large lesions or those within the sinuses, surgical excision via sinus flap surgery is indicated.
§ Standing sedated
§ Referral
§ Complications include haemorrhage ++

Recurrence is common after treatment (around 50%), but if lesions are found early, they can be injected with formalin and repeat surgery is not frequently required.

Care injecting lesions in sinuses - formalin that remains in sinus will cause damage!

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17
Q

Traumatic epistaxis

A

The nasal mucosa has a well-developed blood supply.

Spontaneous epistaxis does not occur in horses (cf humans)

Major cause of equine epistaxis is EIPH (during/post exercise)

Blunt or sharp trauma, or iatrogenic trauma from naso-gastric intubation or endoscopy (not passed in ventral meatus)can result in significant epistaxis.

If external trauma has occurred, radiography of the head is useful to check there are no significant skull fractures.

Horses can bleed into the sinuses and then experience low grade epistaxis for a few weeks afterwards.

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18
Q

DDx for epistaxis at rest

A

Guttural pouch mycosis

Progressive ethmoid haematoma

Head trauma

Sino/nasal tumours and infections

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19
Q

Treatment of traumatic epistaxis

A

Most traumatic nasal epistaxis in horses will cease spontaneously within a few minutes.

Packing the nasal cavity is possible but difficult!

Almost all are self limiting
○ May lose 5-10L
○ Keep head elevated (headstand)

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20
Q

Tear of rectus capitus muscle in the guttural pouch

A

Very rare

Caused by head trauma

Acute onset of bledding from guttural pouch

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21
Q

Nasal neoplasia

A

Rare

Equine nasal tumours are uncommon but often malignant, e.g. adenocarcinomas or osteogenic sarcomas and usually affect older animals.

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22
Q

Clinical signs of nasal neoplasia

A

initially reflect local inflammation and secondary infection on and around the tumour

i.e. chronic unilateral purulent nasal discharge, which may progress to a bilateral discharge, malodourous breath, unilateral submandibular lymph node enlargement, nasal airflow obstruction, facial swelling.

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23
Q

Diagnosis of nasal neoplasia

A

Endoscopy + biopsy + radiographs (either transendoscopic or via trephine hole/flap).

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24
Q

Treament of nasal neoplasia

A

Unless detected very early, most equine nasal tumours are very difficult to effectively treat surgically (nasal flap surgery).

Radiotherapy can be considered but often is cost prohibitive.

Euthanasia is indicated if the tumour is large/advanced.

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25
Q

Incidence of nasal mycosis

A

Mycotic rhinitis

rare in UK, more common in USA

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26
Q

Aetiology of nasal rhinitis

A

Equine mycotic rhinitis in USA is usually caused by Phycomycosis, Cryptococcosis or Coccidioidmycosis, which have regional distributions.

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27
Q

Clinical signs of nasal mycosis

A

Unilateral, malodorous, mucopurulent nasal discharge and unilateral lymphadenitis

Epistaxis occasionally present

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28
Q

Diagnosis of nasal mycosis

A

On endoscopy, mycotic rhinitis resembles a ‘mouldy cheese’-like white, yellow or black coloured fungal plaque on the nasal conchae (turbinates) or ethmoturbinates, with underlying deep red ulcers visible if the mycotic plaque is removed.

nasal swabs -> heavy pure growth of potentially pathogenic fungus.

However, fungi may be cultured from the nasal cavities of healthy horses.

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29
Q

Treatment of nasal mycosis

A

endoscopic removal if possible + topical therapy with natamycin or enilconazole solutions.

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30
Q

Rostral maxillary cheek tooth apical abscessation

A

Common

Usually younger horses

Infection of the first 2-3 maxillary cheek teeth usually results in external maxillary bone swelling

But most infections of 06/07 tooth drain laterally -> facial swelling +/- tract

Occasionally drain medially into nasal cavity

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31
Q

Oro-nasal fistula

A

Rare

Food and inspissated pus in nasal cavity after dental infection

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32
Q

Wry nose

A

In neonates

Nasal septum and facial bone deformity

If severe euthanase

Major surgery to correct

BUT many horses can survive fine - if mild and foal can suckle successfully

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33
Q

How many pairs of paranasal sinuses are there in the horse?

A

7

But can be considered as two compartments

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34
Q

What does the caudal paranasal sinus compartment contain?

A

the caudal 2-3 cheek teeth apices, and:
- caudal maxillary sinus
- dorsal conchal sinus
- frontal sinus
- ethmoidal sinus
- sphenopalatine sinus

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35
Q

What does the rostral paranasal sinus compartment contain?

A

Rostral maxillary sinus
Ventral conchal sinus
Apices of the two middle cheek teeth

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36
Q

Sphenopalatine sinus

A

Causo-medial extension of CMS via sphenopalatine foramen

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37
Q

What is the sphenopalatine sinus closely related to?

A

Brain
Pituitary gland
Optic chiasm
Cranial nerves II and V

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38
Q

Clinical signs of disease in sphenopalatine sinus

A

As for sinusitis +

Blindness

Trigeminal neuritis

Exophthalmus

Meningitis

Head shaking

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39
Q

Maxillaty sinus septum

A

Separates rostral maxillary sinus and caudal maxillary sinus

From lateral aspect of maxilla -> plate of bone beneath infra-orbital canal

Extends dorsally and medially as maxillary sinus Bulla (MSSB)

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40
Q

Maxillary sinus bulla

A

A continuation of the maxillary sinus septum

the easiest part to break through surgically to make the rostral and caudal compartments communicate

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41
Q

Incidence of sinusitis

A

(paranasal sinus empyaema)

Very common

The most common cause of unilateral discharge in the horse

Secondayr bacterial infection can occur with any other primary intra-sinus lesion

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42
Q

Aetiology of sinusitis (in order of frequency)

A
  1. Primary (bacterial) sinusitis
  2. Dental infection
  3. Maxillary (sinus) cysts
  4. Intra-sinus ethmoidal haematoma
  5. Sinus neoplasia
  6. Mycotic sinusitis
  7. other rare lesions
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43
Q

Clinical signs of sinusitis

A

usually unilateral and often non-specific for the type of sinusitis present

Muco-purulent nasal discharge (can be malodorous)

Submandibular lymph node enlargement

No coughing

Facial swelling (maxilla or frontal regions)

Epiphora

Nasal airflow obstruction and stertorous breathing

Unilateral epistaxis (ethmoidal heamatoma)

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44
Q

Diagnosis of sinusitis

A

Oral exam

Nasal endoscopy may show discharge emanating from the sino-nasal ostium at the caudal aspect of the middle meatus (“sinus drainage angle”).
- cannot pass the scope into the sinuses in a normal horse

Radiographs of the sinuses and teeth are then indicated

CT if more info needed

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45
Q

Treatment of sinusitis

A

Obviour space occupying lesion?
- biopsy/bone flap

Dental disease?
- treat that

Primary sinusitis?
- likely to resolve with sinus lavage

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46
Q

Direct sinoscopy (endocopy of sinuses)

A

Visualisation of the caudal compartment is possible through a small trephine hole made in the frontal (or maxillary) bone made under local anaesthesia, through which the scope is passed.

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47
Q

Technique of making a trephine hole into the caudal sinus compartment

A

Sedation

Skin is clipped and prepped

Portal sites infiltrated with 1-2ml of LA

Incision 1.5x diameter of trephine

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48
Q

How can you access the rostral sinus compartment for treatment

A

removal of part of the maxillary sinus septal bulla with a narrow forceps, under endoscopic guidance.

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49
Q

Normal sinus drainage

A

Slit like ostia

RMS and CMS drain separately
- paths converge just before they enter the nasal cavity

Easily occluded

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50
Q

Diagnosis of obstructed middle meatus

A

Endoscope - you won’t be able to see the Y shape or pass the scope if something is blocking the passage

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51
Q

Primary sinusitis incidence

A

Very common

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52
Q

Aetiopathogenesis of primary sinusitis

A

Presence of bacteria in sinus cavity +

Obstructed ostium (mucosal oedema

Blockage of outflow

Failure of mucociliary clearance

Accumulation of secretions -> bacterial growth

52
Q

Diagnosis of primary sinusitis

A

radiography +/- CT +/- sinoscopy to rule out other causes of sinusitis.

53
Q

Treatment of primary sinusitis

A

May clear spontaneously

Remove purulent material
- liquid
- insippated

Re-establish sinus drainage

Feed from ground
Antibiotics, NSAIDs
Continuing exercise

54
Q

Which antibiotics should be used for primary sinusitis?

A

Normal sinus microbiota includes aerobic bacteria and fungus

Sinusitis: anaerobic bacteria common

Penicillin i/m
Doxycycline p/o

55
Q

When are antibiotics likely to be efficaious in sinusitis?

A

Facial swelling

Epiphora

Significant dental abnormality

Chronic duration of nasal discharge

Bloody nasal discharge

56
Q

Multi-resistant bacteria in primary sinusitis

A

Pseudomonas, Bacteroides, E. coli spp

Surgical site infection
- trephine hole
- sinus flap site

Persistent sinusitis

57
Q

Treatment for chronic sinusitis

A

surgical lavage via a trephine opening (usually into the frontal sinus), followed by irrigation for several days with large volumes (2-3L BID or TID) of lukewarm water or very dilute antiseptics using an indwelling tube/foley catheter.

58
Q

CT for imaging of sinusitis

A

Useful for:

Ruling in/out dental infection

Outlining extent of space occupying lesions for pre-op planning

Cases with dental dysplasia

Evaluating trauma cases with skull fractures

Post surgical complications

59
Q

Potential pitfalls of CT for sinusitis

A

Sometimes cannot differentiate between different soft tissue masses or fluid material

PEH/Cyst/pus/inspissated pus

60
Q

Indications for sinus osteotomy

A

No response to lavage (or recurs)

No/poor drainage from nostril when lavaging (blocked nasomaxillary ostium)

Inspissated pus seen on sinoscopy

Ventral conchal sinus involvement

Mass/other specific lesion suspected

61
Q

Requirements for standing sinus surgery

A

(referral)

Flunixin

Penicillin/doxycycline
- or based on culture

Alpha 2 + butorphanol/morphine

Local infiltration lidocaine
- nasal cavity
- skin
- intrasinus

Maxillary nn block

62
Q

Surgically creating a sino-nasal fistula

A

Improves drainage if natural ostium is blocked

Caudodorsal aspect of ventral concha

Close to natural ostium

Causes haemorrhage ++++ so do last

63
Q

Complications of sinus flap surgery

A

HAEMORRHAGE

Premature loss of nasal packing

‘Dirty surgery’ (gross infection present)

64
Q

Dental sinusitis incidence

A

Very common

65
Q

Aetiopathogenesis of dental sinusitis

A

Maxillary 08-11 periapical infection

66
Q

Clinical signs of dental sinusitis

A

Infection will cause purulent sinusitis

Unilateral nasal discharge

Unilateral submandibular LN swellings

Possibly unilateral epiphora

Facial swellings rare

67
Q

DIignosis of dental sinusitis

A

Oral exam

Radiography – oblique lateral

If unsure –
CT/scintigraphy

68
Q

Sinus cyst

A

Common

Fluid filled cysts of varying size often with areas of bony material within their lining
- respiratory mucosa and bright yellow fluid inside

If enlarge sufficiently, they can cause occlusion of normal sinus drainage, pressure changes in the surrounding bones, inflammation, secondary sinus infection and obstruction of the nasal cavity.

Can occur in all age groups, including foals

69
Q

Clinical signs of maxillary sinus cysts

A

Very marked facial swelling and epiphora is a feature of many cases.

Nasal discharge is usually less purulent than with other types of sinusitis and there is minimal smell.

Complete nasal obstruction including contralateral side

Massive remodelling of nasal conchae - extension into SPS and calvarium

70
Q

Diagnosis of maxillary sinus cysts

A

radiography, CT sinoscopy or direct sinus centesis (needle through bone) which may yield bright yellow cyst fluid.

71
Q

Treatment of maxillary sinus cysts

A

Surgically remove the cyst using a bone flap surgery.

Excellent prognosis

72
Q

Incidence of sinus neoplasia

A

Infrequent

usually affect older animals

73
Q

Sinus neoplasia

A

usually very malignant growths, most commonly SCC

Tumour types and signs almost identical to nasal neoplasia

Malignant carcinomas causing extensive invasion and tissue damage

Poor prognosis except with benign tumours

Even these often recur as difficult to get complete excision

Radiation therapy in valuable horses

74
Q

Clinical signs of sinus neoplasia

A

nasal discharge, facial swelling, epiphora, SMLN.

75
Q

Intra-sinus ethmoidal haematomas

A

Haemorrhagic polyps

Start small -> slow enlargement

Can be single or in multiple sites/bilateral

Can cause complete nasal obstruction

76
Q

Treatment of Intra-sinus ethmoidal haematomas

A

Formalin injection not advised
- retention of large amount in sinus -> necrosis of mucosa

Increased risk of haemorrhage at surgery

77
Q

Incidence of mycotic sinusitis

A

Infrequent

78
Q

Aetiopathogenesis of mycotic sinusitis

A

Common post-sinus osteotomy

Can occur as a primary lesion

Often lots of secondary inspissated pus

79
Q

Diagnosis of mycotic sinusitis

A

usually on sinoscopy, (radiography and CT often not that useful for this)

80
Q

Treatment of mycotic sinusitis

A

Physical removal of the plaque (sinoscopy or sinus flap surgery) + local irrigation of the affected sinus with enilconazole, immaverol, or natamycin using an indwelling catheter is usually successful.

81
Q

Guttural pouch anatomy

A

Mucosa lined outpouchings of the auditory (eustachian) tubes

Connect to nasopharynx rostrally

Naso-pharyngeal entrance to eustachian tubes are under cartilaginous flaps - the guttural pouch ostia
- ostia dilate during swallowing

82
Q

Clinical examination of guttural pouch

A

Palpation
- immediately caudal to mandible

Endoscopy!!

Radiography

Examine other systems than may be affected as a result
- nares (discharge)
- neuro exam (cranial nerves)
- cardiovascular status

83
Q

Endoscopy of the guttural pouch

A

Swallowing induced by flushing the endoscope in the nasopharynx will make the guttural pouch ostia transiently open and discharge may then be seen flowing from the ostia.

GP endoscopy can be aided by using a guide wire or biopsy forceps inserted through its biopsy channel, inserted into the auditory tube to act as a ‘leader’ for the scope.

84
Q

Guttural pouch mycosis incidence

A

uncommon BUT important to know as potentially life-threatening

85
Q

Aetiology of guttural pouch mycosis

A

Aspergillus fumigatus is an opportunist pathogen present in the URT (including the GPs) that can occasionally colonise the guttural pouch mucosa

tends to grow on the roof of the pouch often overlying the internal carotid artery (ICA) and associated 9th,10th and 11th cranial nerves

As the fungal plaque spreads, it can also cover and erode the cranial sympathetic nerve, 7th +12th cranial nerves, and large blood vessels in the lateral compartment

86
Q

Clinical signs of guttural pouch mycosis

A

Unilateral muco-purulent (often malodorous) nasal discharge followed by a couple of small volume epistaxis episodes that precede a major haemorrhage, plus dysphagia +/- other neurological signs.

87
Q

Cause of haemorrhage in guttural pouch mycosis

A

Erosion of wall of internal carotid artery -> epistaxis

Often 1 or 2 smaller bleeds precede massive (often fatal) haemorrhage

88
Q

Clinical signs caused by haemorrhage

A

> 5L = significant blood loss

High HR

Pale MM

weak/ataxic

89
Q

Neurological signs in guttural pouch mycosis

A

Dysphagia
- pharyngeal paralysis (IX, X, XI)

Recurrent laryngeal neuropathy
- left or right sided
- recurrent laryngeal branch of X

Horners syndrome
- cranial sympathetic trunk

Persistent DDSP
- pharyngeal branch of X

Facial paralysis
- VII

Tongue paralysis
- XII

90
Q

Diagnosis of guttural pouch mycosis

A

Endoscopically, blood or mucopurulent material may be seen flowing from the GP ostium.

Within the guttural pouch see classic fungal plaques, usually in the dorsal aspect of the medial compartment.

91
Q

Treatment of guttural pouch mycosus

A

If haemorrhage has occurred, the internal carotid artery should be surgically ligated/occluded with a balloon catheter or embolization coil.

Local antimycotic treatment with natamycin or enilconazole, sprayed onto the roof of the pouch can also help resolve the plaque if repeated on several occasions.

92
Q

Prognosis of guttural pouch mycosis

A

If the artery is not surgically occluded in cases with epistaxis, 50% of horses will experience a fatal haemorrhage.

Prognosis post-op often depends on the degree and severity of nerve damage.

Cases with severe pharyngeal dysphagia have the poorest prognosis.

93
Q

DDx for blood in the guttural pouch if no fungal plaque seen

A

rupture of the rectus capitus muscle (on medial wall of pouch - occurs after horse has reared and fallen over backwards. (rare).

94
Q

Supportive treatment for dysphagia

A

Poor prognosis if severey dysphagic

IV fluids

Nasogastric feeding of slurry pr parenteral (drip) feeding

Antibiotics + anti-inflammatories to tx aspiration pneumonia

95
Q

Guttural pouch empyaema/chondroids

A

common
Nearly always a sequel to strangles

96
Q

Clinical signs of acute guttural pouch empyema/chrondroids

A

in the acute phase, liquid pus in the pouch drains -> nasal discharge.
- May also be pyrexic and dull
- swelling of parotid region
- submandibular lymphadenopathy
- dyspnoea and dysphagia

97
Q

Diagnosis of Guttural pouch empyema/chrondroids

A

Guttural pouch endoscopy will show, pus or chondroids in its lumen.

Enlarged LNs within pouch

98
Q

Treatment of Guttural pouch empyema/chrondroids

A

For empyema only, medical treatment (lavage and antibiotics) is effective.

For chondroids, transendoscopic removal or surgical removal using a ventral (modified Whitehouse) approach to the GP (sx usually done standing now). Stenosis of the auditory tube can cause reduced drainage in some cases.

99
Q

Clinical signs of chronic guttural pouch empyema/chrondroids

A

Chronic cases -> unilateral or bilateral chronic low grade purulent nasal discharge or sometimes no nasal discharge in long term carriers with chondroids and no liquid pus

100
Q

Guttural pouch tympany

A

rare
Congenital condition where air can enter but not freely exit one or both guttural pouches.

Young foals <6 weeks

Fillys>colts

101
Q

Clinical signs of guttural pouch tympany

A

The affected pouch (in foals and yearlings) becomes very distended, and a resonant, drum-like swelling develops caudal and caudo-ventral to the mandible.

The swollen pouch can cause dysphagia and stridor (nasopharyngeal collapse)

Secondary empyema is also common due to restricted drainage.

102
Q

Diagnosis of guttural pouch tympany

A

Radiography shows enlarged, air-filled pouch +/- fluid line

103
Q

Treatment of guttural pouch tympany

A

transendoscopic laser fenestration of the midline septum in unilateral cases (so air can drain via the normal pouch) or laser creation of a salipingo-pharyngeal fistula for bilateral cases.

104
Q

GUttural pouch melanosis

A

Melanosis of the internal GP wall is very common in older grey horses – often an extension of melanomas from the parotid region- rarely the tumours can cause dysphagia and stridor.

No specific tx indicated.

105
Q

Guttural pouch neoplasia

A

Melanomas - common

Other tumours - rare
- lymphosarcoma
- SCC

106
Q

Clinical signs of guttural opuch neoplasia

A

Swelling of parotid region

Nasal discharge

Dyspnoea/dysphagia

Neurological signs

107
Q

Prognosis of guttural pouch neoplasia

A

Poor

Inaccessibility of the site for surgery

Need to preserve vital structures contained in GP

108
Q

Rupture of rectus/longus capitus mms

A

Rare

Flexor muscles of the head

Damaged when horse rears over backwards

Present with epistaxis + neurological signs

Prognosis guarded if neuro signs present

109
Q

Cleft palate/palatal hypoplasia

A

rare

Cleft palate - minimal tissue missing, just cleft in midline

Hypoplasia = tissue defect (more common in horses)

Can involve soft palate only or soft and hard palates

110
Q

Aetiology of Cleft palate/palatal hypoplasia

A

failure of closure of embryonic palatal folds
Severity related to size of defect

111
Q

Clinical signs of Cleft palate/palatal hypoplasia

A

Foals; usually caudal aspect of the soft palate, occasionally hard palate too.

CS = nasal discharge containing food (milk), cough immediately after suckling +/- signs of aspiration pneumonia - can commonly be fatal.

CS in adults (if they survive into adulthood): intermittent coughing/dysphagia, nasal return of food (usually mild), noise when exercising

112
Q

Diagnosis of Cleft palate/palatal hypoplasia

A

endoscopy (small diameter scope)
-> defect in caudal soft palate.

If hard palate involved, see during oral examination.

Radiography: check lungs for changes associated with pneumonia

113
Q

Treatment of Cleft palate/palatal hypoplasia

A

if foal is coping and no significant pneumonia, tx conservatively (abios as required).

If pneumonia present, can attempt surgical correction (v. difficult, often unsuccessful) or euthanasia = other option.

114
Q

Permanently dorsally displaced soft palate (pDDSP)

A

Permanent DDSP = very rare compared to intermittent DDSP that occurs at exercise

Often 2ry to other disease e.g. epiglottic entrapment, sub-epiglottic fibrosis/ulceration, sub-epiglottic cyst, palatal cyst, epiglottitis.

Idiopathic pDDSP presumably due to acquired neuromuscular dysfunction of the soft palate or epiglottic muscles.

115
Q

Cinical signs of Permanently dorsally displaced soft palate (pDDSP)

A

loud and continuous gurgling noises at rest or at low level of exercise.

May be mildly dysphagic.

116
Q

Diagnosis of Permanently dorsally displaced soft palate (pDDSP)

A

endoscopy -> soft palate is permanently displaced above the epiglottis.

Oropharyngeal endoscopy should be performed to examine sub-epiglottic area.

117
Q

Treatment of Permanently dorsally displaced soft palate (pDDSP)

A

if no obvious predisposing lesion = tie- forward +/- laser staphylectomy –successful in 80% of cases

118
Q

Epiglottic entrapment

A

Seen particularly in Standardbreds (high incidence epiglottic hypoplasia) and occasionally in TB.

Rostral (free) aspect of the epiglottis becomes trapped in a pouch of mucosa that develops from the mobile sub-epiglottic mucosa.

Entrapment is usually evident at rest, particularly after a swallow.
○ Rarely entrapment is only induced by exercise.

If permanent, entrapping membrane +/- epiglottic cartilage can become swollen and ulcerated over time -> longer healing time post-op.

Permanent or intermittent DDSP is seen as secondary disorder to EE.

119
Q

Clinical signs of epiglottic entrapment

A

airflow obstruction and abnormal expiratory noises as air fills the entrapment during expiration.

Sometimes coughing when eating if entrapment very swollen.

120
Q

Diagnosis of epiglottic entrapment

A

endoscopy: entrapped epiglottis loses normal flat, serrated appearance and become rounded, thickened +/- hyperaemic or ulcerated.

Additionally, the normally prominent blood vessels on its dorsal aspect of epiglottic cartilage -> not visible.

If pDDSP present -> endoscopy per os under sedation.

121
Q

Treatment of epiglottin entrapment

A

Section entrapping membrane using hooked bistoury (long curved hook knife) per nasum or per os or using transendoscopic laser.

Most surgery performed standing.

Alternatively, resection or axial division of entrapping membrane via laryngotomy under GA (this tx -> higher incidence of permanent DDSP after).

122
Q

Subepiglottic cysts

A

Rare congenital structures, usually obvious on endoscopy as discrete rounded mucosa-covered mass under the epiglottis.

They can deviate epiglottis dorsally -> airflow obstruction +/- dysphagia, depending on the degree of epiglottic distortion.

Secondary epiglottic entrapment +DDSP = common.

123
Q

Diagnosis of subepiglottic cysts

A

endoscopy: see cyst, occasionally cyst may be hidden under soft palate – induce multiple swallows to make it appear.

Oral endoscopy may be required to confirm the diagnosis.

124
Q

Treatment of subepiglottic cysts

A

Surgical excision - many options available but commonly using diode laser (standing) or via laryngotomy under GA

125
Q

Tracheal collapse

A

Often small pony breeds with CS worsening in hot weather.

Caused by a cartilage deformity and/or degeneration of dorsal trachealis ligament and tracheal cartilage degeneration.

Intracervical location -> inspiratory obstruction (inspiratory ‘honk’), intrathoracic location -> expiratory obstruction.

126
Q

Clinical signs of tracheal collapse

A

stridor, dyspnoea, exercise intolerance or may be undiagnosed due to the low workload of these animals.

Intracervical location -> inspiratory obstruction (inspiratory ‘honk’),

intrathoracic location -> expiratory obstruction

127
Q

Diagnosis of tracheal collapse

A

classic honking respiratory noise in small pony + endoscopic observation of collapse.

Radiography during inspiration can be useful but sometimes the trachea is also rotated -> rad not useful.

128
Q

Treatment of tracheal collapse

A

Tracheal collapse is worse with LRT disease so improve environment first.

Tracheal stenting – intra or extra-luminal
§ V. complicated surgery with major complications
§ Only possible for cervical trachea, not intra-thoracic

May be unnecessary if pony has sedentary lifestyle
§ Manage medically

Treat concurrent LRT disease

Equine II (28 decks)

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