Surgery of dynamic resp tract disorders Flashcards

(44 cards)

1
Q

What is alar fold collapse and what is the treatment

A

Where the fold that makes the medial shelf of the false nostril collapses causing loud vibrating noice
Treat via surgical resection of fols

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2
Q

How is respiration in time with locomotor cycle

A

Expiration when leading leg hits ground in canter
Inspiration when it leaves the ground

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3
Q

CLinical signs of cleft palate
What about in those that have survived to adulthood

A

Nasal return of food, cough after suckling, aspiration pneumonia

IF it survived; intermitten coughing/dyphagia, noise when exercising due to palate flapping around, associated with epiglottic entrapment

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4
Q

How to manage adults with cleft palate

A

Feed from floor
Give antibiotics for aspiration pneumonia when needed

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5
Q

What is nasopharyngeal collapse
What horses do we see it in

A

Neuromuscular dysfunction of walls of pharynx where they come in when horse breathes at exercise
Gives whistling noise

Common in racehorses, fat ponies/cobs
Worse wiht neck/neck flexion e.g in dressage

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6
Q

How does dorsal disaplcement of soft palate present

A

Marked respi obstruction so gurgle noise and rough respiratory noise
Horse will pull up abruptly and try and swallow

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7
Q

When do we classically see dorsal dispalcement of soft palate

A

Racehorses at max exertion
Can see in dressage horses associated with head flexion

Fat ponies

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8
Q

What proposed aetiology means we might see DDSP in young racehorses entering training

A

Due to muscular fatigue of the palate in unfit horsess

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9
Q

How do diagnose dorsal displacement of soft palate

A

Exercising endoscope because this happens only at exercise

Can make presumptive diagnosis based on jockey report

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10
Q

Proposed causes of DDSP

A
  • Dysfunction of muscles of soft palate
  • Fatigue of muscles of soft palate in unfit horses
  • URT inflammation/infectino
  • Physical lesions that presipose e.g epiglotti entrapment, cysts etc
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11
Q

Conservative treatment strategies for DDSP

A

Tack changes e.g tongue tie, different nosebands
If young, rest
If unfit, increase fitness
ANti-inflammatories to deal with lwoer rest tract inflammation

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12
Q

Two surgeries that are generally both done for DDSP at once

A

Tie forward to move position of larynx in relation to palate
Palatoplasty to induce fibrous tissue to tighten up the soft palate

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13
Q

When can we get persistent DDSP

A

Rare
May see after surgery for epiglottic entrapment
Usually related to predisposing lesion e.g epiglotic entrapment, sub-epiglottic cyst, epiglottitis

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14
Q

What muscle is responsible for abduction of artenoid cartilages laterally and dorsally in exercise

A

Circoarytenoideus dorsalis

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15
Q

Which are the only two laryngeal cartilages that move

A

Epiglottis
Arytenoids; abduct to open larynx wide during exercise

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16
Q

WHen do we see maximal arytenoid abduction

A

After swallowing
Should indcude this during scoping to assess for degree of laryngeal paralysis

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17
Q

What nerve supplies all the intrinsic laryngeal muscles (including cricoarytenoideus dorsalis)

A

Recurrent laryngeal nerve (branch of vagus)

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18
Q

What is the most common cause of recurrent laryngeal neuropathy

A

Idiopathis
= axonopathy of left laryngeal nerve

19
Q

What horses are affected by idiopathic recurrent laryngeal neuropathy

20
Q

What are some causes of non-idiopathic recurrent laryngeal neuropathy

A

Perivascular injection of irritant material into neck
Trauma
Systemic disease
Guttural pouch disease

21
Q

Pathophysiology of recurrent laryngeal neuropathy

A

Neuropathy of left recurrent laryngeal nerve
Causes atrophy of left CAD muscle so can’t abduct cartilage
So get sucking in of left arytenoid towards midline during inspiration +/- prolapse of left vocal fold

22
Q

what noises do we get with recurrent laryngeal neuropathy depending on severity

A

Inspiratory noise (i.e hear when leading leg leaves ground)

If just vocal fold collapsing hear whistling noise
If whole larynx collapses hear roaring noise

23
Q

Diagnosis of recurrent laryngeal neuropathy

A

ABnormal inspiratory noise during exercise
May be able to palpate muscular process of arytenod cartilage more prominent on the left due to wastage of CAD

24
Q

What grade of recurrent laryngeal neuropathy definitely needs a tie back

A

Grade 4
= complete hemiparesis with no movement

25
how does RLN grading system wokr
= done during quiet breathing and used to predict likelihood to affect exercise 1 = perfect symmetry and syncrhony 4 = complete hemiparesis with no movement
26
Treatment options for recurrent laryngeal neuropathy
Vocal cordectomy + ventriculectomy = using laser to cut out vocal fold --> Done when vocal fold prolapsing but arytenoid cartilage maintains some abduction; generally only in low level work Prostethic laryngoplasty = tie back; treatment of choice for performance horses or severe cases Suture muscular process of arytenoid to back of cricoid to mimic action of CAD; keeps left arytenoid in permanently open position
27
What is arytenoid chondritis and how do we treat
= infection of one/both arytenoid cartilages; get swollen, distorted cartilage which may have granuloma Rare in UK Mostly young male TBs Treat medically with systemic antibiotics and atni-inflammatories long term; can do throat sprays of steroid Surgery = partial arytenoidectomy to resect some of cartilage
28
If we palpate a gap between thyroid and cricoid cartilages what does this mean
4th branchial arch defect Congenital disorder affecting derivatives of emryonic 4th branchial arch
29
What are the derivatives of embryonic 4th branchial arch
Thyroid cartilage, cricoid, cricpharyngeal muscle (upper oes sphincter), crico-thyroideus mm
30
What is the most common cause of right sided laryngeal dysfunction
4th branchial arch defect (can also occur on the left or bilaterally but then other things more common )
31
Signs with 4th branchial arch defect
Abnormal noise at exercise Exercise intlerance Aerophagia since missing upper oesophageal sphincter; can manifest as chronic colic
32
Diagnostic features of 4th branchial arch defect
Palpate gap b/w thyroid and cricoid Endoscopy; reduced arytenoid function, rostral displacement of palatopharyngeal arch Xray: air column in prox oes; aerophagia
33
What is the most common abnromality on exercising endocopy; causes high pitched inspiratory whistle
Medial deviation of ary-epiglottic folds
34
Treatment of medial deviation of ary-epiglottic folds
Trim the folds using endoscopic laser to remove excess tissue
35
Treatment of epiglottic entrapment
Divide membrane iwth hooker knife under standing sedation
36
How can we tell there is epiglottic entrapment
Can't see blood vessels and serated edges as seen on normal epiglottis
37
WHat is epiglottic retroversion
Intermitten sucking back of epiglottis into rima glottis causing intermittent tinspiratory obstruction and gulping noise
38
Treatment of epiglottic retroversion
Epilottic tie down surgery
39
Which animals so we see tracheal collapse in
Small breed horses/pnoes
40
Why do we ge trahceal collapse
Due to instability of dorsal ligament of the trachea usually with chondromalacia of tracheal cartilages
41
Treatment of tracheal collapse
try to manage medically by treating any LRT issues No good surgery
42
What is cobblestone tissue at back of mouth on endoscope mean
Pharyngeal lymphoid hyperplasa Can be normal to see when young racehorses all brought into training together
43
Exercising abduction grades for RLN
A = fine B = vocal fold collapse, gives whistle sound C = laryngeal arytenoid collapse; gives roaring sound
44