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Small Animal Surgery > Upper Airway Surgery > Flashcards

Upper Airway Surgery Flashcards

1
Q

Functions of the Upper Airway

A
  1. Warm and humidify inhaled gas
  2. Thermoregulation
  3. Filtration of particulates
  4. Olfaction
  5. Vocalization
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2
Q

You anchor nasal tubles in the _______

A

Alar Groove

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3
Q
A

Epiglottis

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4
Q
A

Arytenoids

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5
Q
A

Corniculate process of the arytenoid

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6
Q

What part of the arytnoids are tied back when treating laryngeal paralysis?

A

Corniculate processes

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7
Q
A

Cuneiform processes of the arytenoids

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8
Q
A

Vocal processes of the arytenoid

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9
Q

The largest cartilage of the larynx - needs to be retracted during laryngeal paralysis surgery

A

Thyroid Cartilage

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10
Q
A

Cricoid cartilage

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11
Q
A

Vestibular Ligaments

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12
Q
A

Vocal ligaments (vocal folds)

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13
Q

In between the vocal folds and the vestibular process.

A

Ventricle

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14
Q

Poster child for Brachycephalic Obstructive Airway Syndrome

A

English Bulldog

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15
Q

Three portions of the upper airway involved in Canine Brachycephalic Obstructive Airway Syndrome

A

Nose, Pharynx, Larynx

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16
Q

Congenital Abnormalities of Brachycephalic Obstructive Airway Syndrome. Which one does not need to be treated?

A
  1. Stenotic nares
  2. Elongated soft palate
  3. Hypoplastic trachea - does not need to be treated
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17
Q

Assessment of nasal breathing - what to use to assess inspriation and expriation?

A
  • Inspiration - use cotton wisp
  • Expriation - microscope slide
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18
Q

Before treating stenotic airs, it is important to complete an ______ first.

A

Upper Airway Examination

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19
Q

It is best to wait to do surgery on stenotic nares until the animal is ___ to ____ months of age if possible. Why?

A

3-4 months of age; animal is closer to adult body, shape, and size

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20
Q
A

Vertical Wedge Resection

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21
Q
A

Horizontal Wedge Resection

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22
Q
A

Dorsolateral Wedge Resection

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23
Q

To treat stenotic nares with lasar amputation, you amputate _______.

A

Redundant alar fold

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24
Q

The soft palate normally overlaps the epiglottis by ___ mm. It helps to occlude the nasopharynx during _____.

A

1-2 mm; swallowing

25
Q

When surgically treating elongated soft palate, it is important to remember to determine resection extent prior to _______.

A

intubation

26
Q

When resecting an elongated soft palate, it is improtant to make sure the soft palate overlaps the epiglottis by 1-2 mm to mimic normal anatomy. It is also improtant to make sure that laterally, the soft palate should extend to the ______ border of the ______.

A

Caudal; tonsillary crypt

27
Q

Elongated soft palate treatment - the crush technique

A

Hemostatic forces crush the soft palate along the line where you want to make the incision. Then incisions are made part of the way, sutured, continue incision, suture, etc.

28
Q

Elongated soft palate tx - freehand technique

A

You are NOT crushing the tissue - instead, put sutures that hold palate out towards you. Start incision, suture, cut, suture, etc.

29
Q

Advantages of laser freehand technique with elongated soft palate treatment.

A
  • Rapid
  • Virtually no blood loss: excellent visualization
  • Minimal postoperative inflammation
  • Reduced postoperative discomfort
30
Q

The laser attachment in lasar freehand technique for soft palate reseciton is _____.

A

LAUP = laser assited uvuloplasty

31
Q

What is the land mark as to where to cut off the extra soft palate?

A

Caudal portion of palatine tonsils

32
Q

Complications of soft palate resection:

A
  • Overshortening:
    • Nasal reflux
    • Aspiration
  • Hemorrhage
  • Post-operative inflammation and dyspnea
33
Q

Bernoulli principle

A

Liquids or gases traveling at higher velocities will have lower pressures.

34
Q

Secondary changes to brachycephalic ariway syndrome:

Restrited airways ____ flow velocity, causing _____ pressure, resulting in collapse of surrounding tissues.

A

lowers flow velocity; increases pressure

35
Q

Everted saccules are _____ changes to brachycephalic airway syndrome. (primary or secondary)

A

secondary

36
Q

Treatment of everted saccules and how does it heal?

A

Resection via grasping with long forceps and cutting with scissors. Heals by second intention.

37
Q

Order of surgical procedures done in Brachycephalic Obstructive Airway Syndrome Patients

A
  1. Scissor excision of everte laryngeal saccules (if present) with patient EXTUBATED
  2. Laser resectino of soft palate using LAUP attachments
  3. Stenotic nares corection by laser amputation of redundant alar folds
38
Q

Laryngeal _____ is a secondary change to brachycephalic obstructive airway syndrome.

A

collapse

39
Q

Stage I Laryngeal Collapse

A

Everted laryngeal saccules

40
Q

Stage II Laryngeal Collapse

A

Aryepiglottic collapse + Cuneiform process collapse

41
Q

Stage III laryngeal collapse

A

Corniculate process collapse

42
Q

Treatment of stage I laryngeal collapse

A

Resect saccules

43
Q

Treatment of stage II laryngeal collapse

A

Partial arytenoidectomy and ventrilochordectomy (or treat like stage III - permanent tracheostomy may be needed)

44
Q

Stage III Laryngeal Collapse

A

Permanent Tracheostomy

45
Q

Complications with arytenoidectomy and ventriculochordectomy and how to avoid

A

Webbing or stricture - can be avoided by NOT cutting to the dorsal and ventral extents of the corniculate processes and vocal folds, respectively.

46
Q

It is important to do a ____ exam with acquired laryngeal paralysis, becuase many times it is present in conjunction with ______ disorders.

A

Neural; neuromuscular disorders

47
Q

Poster Child for Acquired Laryngeal Paralysis

A

Labradors

48
Q

Clinical signs of Bilateral Idiopathic Acquired Laryngeal Paralysis

A
  • Inspiratory stridor that occurs or worsens with exercise
  • Voice change
  • Exercise intolerance
  • Respiratory distress/hyperthermia
  • Coughing while eating or drinking
49
Q

Do we commonly see dogs with unilateral idiopathic accquried laryngeal paralysis? Why or why not?

A

No, becuase clinical signs are very subtle, if any; and surgical treatment may not be necessary

50
Q

Normally, the larynx should ____ with inspiration.

A

Abduct

51
Q

During a laryngoscopy when examining a patient with larygneal parlaysis, a light anesthetic, like ____ is used. It is also important to correlate _____ movement with respiration. If the _____does not open with inspriation, then you can diagnose the dog with laryngeal paralysis.

A

Propofol, arytenoid

52
Q

Avoid a ____ cricoartenoid laryngplasty. (unilateral or bilateral)

A

Bilateral

53
Q

When performing cricoarytenoid laryngoplasty, it is improtant to pass suture from the caudal point of the ______ cartilage to the ______ process of the ______, mimicking the _______ muscle.

A

cricoid cartilage, muscular process of the arytenoid, crycoarytnoid dorsalis muscle

54
Q

A “tie back” is a slang term for stabilizing the larynx in an _____ position. Cricoarytneoid laryngoplasty is one suche procedure.

A

open position

55
Q

Complications of surgical treatment for laryngeal paralysis

A
  • Aspiration pneumonia
  • Dysphagia
  • Dyspnea
  • *however, these complicatoins may also occur in dogs that are not treated surgically.
56
Q

Main reason to surgically treat laryngeal paralysis:

A

Aid in the quality of dogs life

57
Q

Negative prognosticators for laryngeal paralysis:

A

Advanced geriatric age

Concurrent medical conditions

Need for tracheostomy for preoperative stabilization

58
Q

When performing a cricoarytenoid laryngoplasty, we want to _____ the left arytenoid process as cricoarytenoid suture is tied (right handed surgeon).

A

Abduct

Small Animal Surgery (17 decks)

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