Surgical Diseases of the Guttural Pouch Flashcards
GS diagnosis of THO
endoscopy
can also do CT or DV rads
signalment for guttural pouch empyema
young > old
G.S. surgical approach to the guttural pouch
modified whitehouse (just caudal to the ramus of the mandible)
cons of using balloon catheter for vessel occlusion of GP mycosis
done without fluoroscopic guidance -> aberrant branches can lead to failed occlusion
old school methods for treating guttural pouch tympany
- fenestration of guttural pouch median septum via laser or open surgery (ONLY effective if unilateral)
- surgical enlargement of pharyngeal opening via open approach
signs of THO
- head shaking
- ear rubbing
- discomfort when pressure applied to base of ear or basihyoid bone
- CNS deficits (KCS and vestibular signs)
- skull fracture, edema
most common isolate of guttural pouch empyema
strep
guttural pouch mycosis is caused by…
aspergillus fumigates (opportunistic)
diagnosis of guttural pouch empyema
- 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
what’s found in the lateral compartment of the guttural pouch
CN VII, external carotid a., maxillary a.
temporohyoid osteoarthopathy (THO): cause
DJD of temporohyoid bone (old theory thought it was secondary to otitis)
what’s found in the medial compartment of the guttural pouch
CN IX-XII (glossopharyngeal, vagus, accessory, hypoglossal)
internal carotid a.
prognosis for THO
fair for athletic performance; some CNS signs may improve
treatment for guttural pouch empyema
- 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
preferred treatment methods for guttural pouch tympany (2)
- 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)
sequelae to THO
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
dividing structures in guttural pouch
stylohyoid bone and temporomandibular joint
diagnosis of guttural pouch mycosis
endoscopy
size of lesion NOT related to severity
signs of guttural pouch empyema
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
which CNs are found in the guttural pouch
CN VII-XII but NOT CN VIII
pathogenesis of guttural pouch tympany
salpingopharyngeal plica creates a one way seal
recurrence rate for guttural pouch tympany
40%
treatment for THO
ceratohyoidectomy to prevent fracture
also antimicrobials, NSAIDs, DMSO
signs of guttural pouch tympany
NON painful swelling in parotid area
opening to guttural pouch is called…
salpingopharyngeal opening
which is better for transarterial embolization for GP mycosis: nitrinol plug or stainless steel coil
nitrinol plug because occlusion immediate and can reposition if needed
signs of guttural pouch mycosis (4)
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)
treatment for guttural pouch mycosis
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
signalment for THO (temporohyoid osteoarthropathy)
- QH
- cribbers
- middle age most common
causes of guttural pouch empyema
- ruptured retropharyngeal abscess
- secondary to tympany (usually resolves once tympany treated)
- pharyngeal perforation by NG tube
signalment for guttural pouch tympany
<1yo
ARABIANS, paints
3x females > males
