Surgical Diseases Of The Upper Airway

Question 1

Term for soft palate resection?

Answer 1

Staphylectomy

Question 2

What is the most likely complication of overshortening in a staphylectomy?

Answer 2

Nasal reflux, then not as common: aspiration

Question 3

T or F:

When performing excision of Everette’s laryngeal saccules, the patient should be intubated.

Answer 3

False; should be extubated and use propofol for this SHORT procedure

Question 4

Differentials for disease of the Nasal cavity would be …?

Answer 4

Dental disease

Nasopharyngeal polyp

Question 5

Most sensitive imaging for the nasal cavity?

Answer 5

CT: lots of bone and provides good definition and delineation

Question 6

What surgery would be indicated for nasal SCC, along with potentially LSA, melanoma, malignant histiocytosis, basal cell carcinoma, MCT, HAS?

Answer 6

Nasal planum resection

Question 7

As a result of brachycephalic anatomy, local chondrodysplasia results in early ankylosis of what bones?

Answer 7

Basioccipital and basisphenoid

Question 8

What are the most commonly recognized brachycephalic dog breeds? (7)

Answer 8

English bulldog
French bulldog
Pug
Shih Tzu
Pekingese
Boston terrier
Boxer

Question 9

What are the less commonly recognized brachycephalic dog breeds?

Answer 9

Chihuahua
Cavalier King Charles Spaniel
Maltese
Chow chow
Yorkshire Terrier
MIn Pins
Shar Peis

Question 10

Brachycephalic cat breeds?

Answer 10

Persian

Himalayan

Question 11

What are the primary disease components of Brachycephalic Airway Syndrome?

Answer 11

-Stenotic nares
-Elongated soft palate
-Everted laryngeal saccules/Stage I Laryngeal
Collapse
- (+/-) Hypoplastic trachea (could be a secondary change)

Question 12

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.

Answer 12

TRUTH

Question 13

How can an elongated soft palate cause severe obstruction and/or loss of protective laryngeal function?

Answer 13

By the extension into the rima glottidis

Question 14

Collapse of cuneiform cartilage is classified as?

Answer 14

Stage 2 Laryngeal Collapse

Question 15

Collapse of corniculate cartilage is classified as?

Answer 15

Stage 3 Laryngeal Collapse

Question 16

How can a hiatal hernia result as a comorbidity of BAS?

Answer 16

Increased airway resistance—> gastroesophageal sphincter issue where portions of stomach are herniating toward esophagus

Question 17

In BAS, what heart abnormality might we see on thoracic radiograph?

Answer 17

Right heart enlargement

Question 18

Drugs to AVOID in upper airway exam due to their affect on laryngeal function…

Answer 18

Ketamine
Diazepam (midazolam?)
Large doses of pure mu agonists
Acepromazine

Question 19

What drug do we use to stimulate respiration?

Answer 19

Doxapram 1.1 mg/kg IV

General CNS stimulant

Question 20

What is key in understanding Upper Airway Obstructive Disease in general?

Answer 20

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

Question 21

Why do we give GI protectants/promotility agents as pre-op therapy?

Answer 21

Decrease the risk of vomiting and secondary pneumonia
(ex: famotidine, pantaprazole, metoclopramide)

if patient is symptomatic, treat for 10-14 days prior to surgery

Question 22

In staphylectomy, what landmarks are used to determine level of excision?

Answer 22

1. Tonsils

2. Epiglottis

Question 23

How could we treat Stage II Laryngeal Collapse?

Answer 23

Partial arytenoidectomy and ventriculochordectomy (removing part of the arytenoid cartilage and the ventricular fold)

Question 24

When would we consider unilateral arytenoid lateralization?

Answer 24

ONLY in cases of laryngeal paralysis and IF adequate cartilage rigidity is present!

Question 25

Intrinsic muscles responsible for laryngeal abduction?

Answer 25

Crycoarytenoideus dorsalis (opening larynx):
Comes from the crycoid to the arytenoid cartilage

Question 26

Three functions of the larynx?

Answer 26

1. Swallowing
   - rima glottidis pulled forward and occluded by epiglottis
2. Abduction
   - decreases airway resistance during inhalation
   - adduction during exhalation is passive
3. Voice production
   - occurs via changing tension on vocal cords

Question 27

In general, what pathological process is responsible for congenital laryngeal paralysis, whether afflicting bouvier de Flanders, huskies, Dalmatians, or Rottweilers…?

Answer 27

Degeneration (generalized/neurogenic)

Question 28

How many thoracic radiograph views should we take when diagnosing suspected laryngeal paralysis and what do we want to be on the lookout for?

Answer 28

3; look for aspiration pneumonia, megaesophagus, cranial mediastinal masses (thymoma), non-cardiogenic pulmonary edema

Question 29

What is the surgery of choice for moderate to severe clinical signs associated with unilateral laryngeal paralysis?

Answer 29

Unilateral arytenoid lateralization

Question 30

What is a unilateral arytenoid lateralization?

Answer 30

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