Surgical Diseases Of The Upper Airway Flashcards
Term for soft palate resection?
Staphylectomy
What is the most likely complication of overshortening in a staphylectomy?
Nasal reflux, then not as common: aspiration
T or F:
When performing excision of Everette’s laryngeal saccules, the patient should be intubated.
False; should be extubated and use propofol for this SHORT procedure
Differentials for disease of the Nasal cavity would be …?
Dental disease
Nasopharyngeal polyp
Most sensitive imaging for the nasal cavity?
CT: lots of bone and provides good definition and delineation
What surgery would be indicated for nasal SCC, along with potentially LSA, melanoma, malignant histiocytosis, basal cell carcinoma, MCT, HAS?
Nasal planum resection
As a result of brachycephalic anatomy, local chondrodysplasia results in early ankylosis of what bones?
Basioccipital and basisphenoid
What are the most commonly recognized brachycephalic dog breeds? (7)
English bulldog French bulldog Pug Shih Tzu Pekingese Boston terrier Boxer
What are the less commonly recognized brachycephalic dog breeds?
Chihuahua Cavalier King Charles Spaniel Maltese Chow chow Yorkshire Terrier MIn Pins Shar Peis
Brachycephalic cat breeds?
Persian
Himalayan
What are the primary disease components of Brachycephalic Airway Syndrome?
-Stenotic nares
-Elongated soft palate
-Everted laryngeal saccules/Stage I Laryngeal
Collapse
- (+/-) Hypoplastic trachea (could be a secondary change)
T or F:
Normal Palate and Larynx anatomy involves the epiglottis overlapping the palate by 1-2mm at midline, as well as its extension (the epiglottis) to mid-ventral 1/3 of tonsil are crypt, laterally.
TRUTH
How can an elongated soft palate cause severe obstruction and/or loss of protective laryngeal function?
By the extension into the rima glottidis
Collapse of cuneiform cartilage is classified as?
Stage 2 Laryngeal Collapse
Collapse of corniculate cartilage is classified as?
Stage 3 Laryngeal Collapse
How can a hiatal hernia result as a comorbidity of BAS?
Increased airway resistance—> gastroesophageal sphincter issue where portions of stomach are herniating toward esophagus
In BAS, what heart abnormality might we see on thoracic radiograph?
Right heart enlargement
Drugs to AVOID in upper airway exam due to their affect on laryngeal function…
Ketamine
Diazepam (midazolam?)
Large doses of pure mu agonists
Acepromazine
What drug do we use to stimulate respiration?
Doxapram 1.1 mg/kg IV
General CNS stimulant
What is key in understanding Upper Airway Obstructive Disease in general?
If possible, early intervention is key….BECAUSE:
It’s the secondary soft tissue changes (EDEMA, HYPERPLASIA, and COLLAPSE) that perpetuate the cycle of decreased air flow with increased obstruction, leading to higher negative pressures to overcome obstruction
Why do we give GI protectants/promotility agents as pre-op therapy?
Decrease the risk of vomiting and secondary pneumonia
(ex: famotidine, pantaprazole, metoclopramide)
if patient is symptomatic, treat for 10-14 days prior to surgery
In staphylectomy, what landmarks are used to determine level of excision?
- Tonsils
2. Epiglottis
How could we treat Stage II Laryngeal Collapse?
Partial arytenoidectomy and ventriculochordectomy (removing part of the arytenoid cartilage and the ventricular fold)
When would we consider unilateral arytenoid lateralization?
ONLY in cases of laryngeal paralysis and IF adequate cartilage rigidity is present!
Intrinsic muscles responsible for laryngeal abduction?
Crycoarytenoideus dorsalis (opening larynx): Comes from the crycoid to the arytenoid cartilage
Three functions of the larynx?
- Swallowing
- rima glottidis pulled forward and occluded by epiglottis - Abduction
- decreases airway resistance during inhalation
- adduction during exhalation is passive - Voice production
- occurs via changing tension on vocal cords
In general, what pathological process is responsible for congenital laryngeal paralysis, whether afflicting bouvier de Flanders, huskies, Dalmatians, or Rottweilers…?
Degeneration (generalized/neurogenic)
How many thoracic radiograph views should we take when diagnosing suspected laryngeal paralysis and what do we want to be on the lookout for?
3; look for aspiration pneumonia, megaesophagus, cranial mediastinal masses (thymoma), non-cardiogenic pulmonary edema
What is the surgery of choice for moderate to severe clinical signs associated with unilateral laryngeal paralysis?
Unilateral arytenoid lateralization
What is a unilateral arytenoid lateralization?
Cryco-arytenoid lateralization: access larynx, place 2 sutures from cryco-cartilage into the arytenoid (at a small muscular process) and tie - need to make sure opening isn’t too dramatic