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LAS > Surgical Diseases of the Guttural Pouch > Flashcards

Surgical Diseases of the Guttural Pouch Flashcards

1
Q

GS diagnosis of THO

A

endoscopy

can also do CT or DV rads

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2
Q

signalment for guttural pouch empyema

A

young > old

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3
Q

G.S. surgical approach to the guttural pouch

A

modified whitehouse (just caudal to the ramus of the mandible)

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4
Q

cons of using balloon catheter for vessel occlusion of GP mycosis

A

done without fluoroscopic guidance -> aberrant branches can lead to failed occlusion

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5
Q

old school methods for treating guttural pouch tympany

A
  • fenestration of guttural pouch median septum via laser or open surgery (ONLY effective if unilateral)
  • surgical enlargement of pharyngeal opening via open approach
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6
Q

signs of THO

A
  • head shaking
  • ear rubbing
  • discomfort when pressure applied to base of ear or basihyoid bone
  • CNS deficits (KCS and vestibular signs)
  • skull fracture, edema
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7
Q

most common isolate of guttural pouch empyema

A

strep

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8
Q

guttural pouch mycosis is caused by…

A

aspergillus fumigates (opportunistic)

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9
Q

diagnosis of guttural pouch empyema

A
  • endoscope: pus at opening of GP
  • rads: fluid line, chondroids
  • aspirate and culture to check for strangles
  • PCR of GP wash to ID carriers of strangles
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10
Q

what’s found in the lateral compartment of the guttural pouch

A

CN VII, external carotid a., maxillary a.

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11
Q

temporohyoid osteoarthopathy (THO): cause

A

DJD of temporohyoid bone (old theory thought it was secondary to otitis)

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12
Q

what’s found in the medial compartment of the guttural pouch

A

CN IX-XII (glossopharyngeal, vagus, accessory, hypoglossal)

internal carotid a.

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13
Q

prognosis for THO

A

fair for athletic performance; some CNS signs may improve

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14
Q

treatment for guttural pouch empyema

A
  • daily irrigation with saline/LRS through indwelling foley catheter (effective if not inspissated; NO antiseptics because risk for neuritis)
  • topical antimicrobials rarely effective
  • if chronic may have adhesions -> may need to make salpingopharyngeal fistula larger
  • open surgery to remove chondroids
  • systemic antimicrobials if severe
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15
Q

preferred treatment methods for guttural pouch tympany (2)

A
  • transnasal foley catheter placement for 4-6 weeks (leads to remodeling of opening via pressure necrosis)
  • salpingopharyngeal fistula using laser to create hold in wall caudal to opening -> foley catheter for 1 wk (potential complication: nerve damage)
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16
Q

sequelae to THO

A

peri-articular new bone formation -> dysfunction of CN VII and CN VIII (vestibulocochlear) most commonly + ankylosis/fracture of stylohyoid bone or part of temporal bone

17
Q

dividing structures in guttural pouch

A

stylohyoid bone and temporomandibular joint

18
Q

diagnosis of guttural pouch mycosis

A

endoscopy

size of lesion NOT related to severity

19
Q

signs of guttural pouch empyema

A

PAINFUL swelling in parotid region (in contrast to tympany alone)

intermittent unilateral nasal discharge

extended head

pharyngeal collapse -> dyspnea, dysphagia, respiratory noise

cranial neuropathy

chondroids in 20% of cases (NOT related to duration of issue)

inspissated pus

20
Q

which CNs are found in the guttural pouch

A

CN VII-XII but NOT CN VIII

21
Q

pathogenesis of guttural pouch tympany

A

salpingopharyngeal plica creates a one way seal

22
Q

recurrence rate for guttural pouch tympany

A

40%

23
Q

treatment for THO

A

ceratohyoidectomy to prevent fracture

also antimicrobials, NSAIDs, DMSO

24
Q

signs of guttural pouch tympany

A

NON painful swelling in parotid area

25
Q

opening to guttural pouch is called…

A

salpingopharyngeal opening

26
Q

which is better for transarterial embolization for GP mycosis: nitrinol plug or stainless steel coil

A

nitrinol plug because occlusion immediate and can reposition if needed

27
Q

signs of guttural pouch mycosis (4)

A

moderate/severe epistaxis (unilateral or bilateral)

  • dysphagia due to damage of CN IX + CNX
  • recurrent laryngeal neuropathy (DDSP)
  • horners (damage to cranial cervical ganglion in medial compartment)
28
Q

treatment for guttural pouch mycosis

A

surgical occlusion of vessel (GS): must occlude both proximal and distal to lesion

if unable to ID the vessels needed to occlude then occlude ICA and Maxillary/ECA on affected side

methods for occlusion: balloon catheter or transarterial embolization using stainless steel coil or nitinol plug

29
Q

signalment for THO (temporohyoid osteoarthropathy)

A
  • QH
  • cribbers
  • middle age most common
30
Q

causes of guttural pouch empyema

A
  • ruptured retropharyngeal abscess
  • secondary to tympany (usually resolves once tympany treated)
  • pharyngeal perforation by NG tube
31
Q

signalment for guttural pouch tympany

A

<1yo

ARABIANS, paints

3x females > males

LAS (51 decks)

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