Upper Airway Surgery Flashcards
Functions of the Upper Airway
- Warm and humidify inhaled gas
- Thermoregulation
- Filtration of particulates
- Olfaction
- Vocalization
You anchor nasal tubles in the _______
Alar Groove
Epiglottis
Arytenoids
Corniculate process of the arytenoid
What part of the arytnoids are tied back when treating laryngeal paralysis?
Corniculate processes
Cuneiform processes of the arytenoids
Vocal processes of the arytenoid
The largest cartilage of the larynx - needs to be retracted during laryngeal paralysis surgery
Thyroid Cartilage
Cricoid cartilage
Vestibular Ligaments
Vocal ligaments (vocal folds)
In between the vocal folds and the vestibular process.
Ventricle
Poster child for Brachycephalic Obstructive Airway Syndrome
English Bulldog
Three portions of the upper airway involved in Canine Brachycephalic Obstructive Airway Syndrome
Nose, Pharynx, Larynx
Congenital Abnormalities of Brachycephalic Obstructive Airway Syndrome. Which one does not need to be treated?
- Stenotic nares
- Elongated soft palate
- Hypoplastic trachea - does not need to be treated
Assessment of nasal breathing - what to use to assess inspriation and expriation?
- Inspiration - use cotton wisp
- Expriation - microscope slide
Before treating stenotic airs, it is important to complete an ______ first.
Upper Airway Examination
It is best to wait to do surgery on stenotic nares until the animal is ___ to ____ months of age if possible. Why?
3-4 months of age; animal is closer to adult body, shape, and size
Vertical Wedge Resection
Horizontal Wedge Resection
Dorsolateral Wedge Resection
To treat stenotic nares with lasar amputation, you amputate _______.
Redundant alar fold
The soft palate normally overlaps the epiglottis by ___ mm. It helps to occlude the nasopharynx during _____.
1-2 mm; swallowing
When surgically treating elongated soft palate, it is important to remember to determine resection extent prior to _______.
intubation
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 ______.
Caudal; tonsillary crypt
Elongated soft palate treatment - the crush technique
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.
Elongated soft palate tx - freehand technique
You are NOT crushing the tissue - instead, put sutures that hold palate out towards you. Start incision, suture, cut, suture, etc.
Advantages of laser freehand technique with elongated soft palate treatment.
- Rapid
- Virtually no blood loss: excellent visualization
- Minimal postoperative inflammation
- Reduced postoperative discomfort
The laser attachment in lasar freehand technique for soft palate reseciton is _____.
LAUP = laser assited uvuloplasty
What is the land mark as to where to cut off the extra soft palate?
Caudal portion of palatine tonsils
Complications of soft palate resection:
- Overshortening:
- Nasal reflux
- Aspiration
- Hemorrhage
- Post-operative inflammation and dyspnea
Bernoulli principle
Liquids or gases traveling at higher velocities will have lower pressures.
Secondary changes to brachycephalic ariway syndrome:
Restrited airways ____ flow velocity, causing _____ pressure, resulting in collapse of surrounding tissues.
lowers flow velocity; increases pressure
Everted saccules are _____ changes to brachycephalic airway syndrome. (primary or secondary)
secondary
Treatment of everted saccules and how does it heal?
Resection via grasping with long forceps and cutting with scissors. Heals by second intention.
Order of surgical procedures done in Brachycephalic Obstructive Airway Syndrome Patients
- Scissor excision of everte laryngeal saccules (if present) with patient EXTUBATED
- Laser resectino of soft palate using LAUP attachments
- Stenotic nares corection by laser amputation of redundant alar folds
Laryngeal _____ is a secondary change to brachycephalic obstructive airway syndrome.
collapse
Stage I Laryngeal Collapse
Everted laryngeal saccules
Stage II Laryngeal Collapse
Aryepiglottic collapse + Cuneiform process collapse
Stage III laryngeal collapse
Corniculate process collapse
Treatment of stage I laryngeal collapse
Resect saccules
Treatment of stage II laryngeal collapse
Partial arytenoidectomy and ventrilochordectomy (or treat like stage III - permanent tracheostomy may be needed)
Stage III Laryngeal Collapse
Permanent Tracheostomy
Complications with arytenoidectomy and ventriculochordectomy and how to avoid
Webbing or stricture - can be avoided by NOT cutting to the dorsal and ventral extents of the corniculate processes and vocal folds, respectively.
It is important to do a ____ exam with acquired laryngeal paralysis, becuase many times it is present in conjunction with ______ disorders.
Neural; neuromuscular disorders
Poster Child for Acquired Laryngeal Paralysis
Labradors
Clinical signs of Bilateral Idiopathic Acquired Laryngeal Paralysis
- Inspiratory stridor that occurs or worsens with exercise
- Voice change
- Exercise intolerance
- Respiratory distress/hyperthermia
- Coughing while eating or drinking
Do we commonly see dogs with unilateral idiopathic accquried laryngeal paralysis? Why or why not?
No, becuase clinical signs are very subtle, if any; and surgical treatment may not be necessary
Normally, the larynx should ____ with inspiration.
Abduct
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.
Propofol, arytenoid
Avoid a ____ cricoartenoid laryngplasty. (unilateral or bilateral)
Bilateral
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.
cricoid cartilage, muscular process of the arytenoid, crycoarytnoid dorsalis muscle
A “tie back” is a slang term for stabilizing the larynx in an _____ position. Cricoarytneoid laryngoplasty is one suche procedure.
open position
Complications of surgical treatment for laryngeal paralysis
- Aspiration pneumonia
- Dysphagia
- Dyspnea
- *however, these complicatoins may also occur in dogs that are not treated surgically.
Main reason to surgically treat laryngeal paralysis:
Aid in the quality of dogs life
Negative prognosticators for laryngeal paralysis:
Advanced geriatric age
Concurrent medical conditions
Need for tracheostomy for preoperative stabilization
When performing a cricoarytenoid laryngoplasty, we want to _____ the left arytenoid process as cricoarytenoid suture is tied (right handed surgeon).
Abduct
