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Equine Surgery and Medicine 2 > Upper Airway Surgery > Flashcards

Upper Airway Surgery Flashcards

1
Q

Procedure for guttural pouch mycosis?

A

Occlusion with balloon catheter (ACI, ACE, APM) Coil embolisation

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2
Q

Predisp factors of GP tympany

A

Arabian or paint horse

filly>colt

unilat>bilat

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3
Q

Cause of GP tympany

A

Plica salpingopharyngea one way valve

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4
Q

What age does GP tympany effect?

A

Few days/months up to yearling

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5
Q

GP tympany clinical signs

A

Not painful

Palpation: air-bag

Unilat may look like it’s bilat

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6
Q

Diagnosis of GP tympany

A

Clinical signs

Endoscopy: the pharynx collapses dors– but can decompress during endoscopy

Radio

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7
Q

Treatment of GP tympany

A

Foley catheter for 2-3 weeks

Transencoscopic laser surgery -fenestration of septum -removal of fold from the med plica salpingopharyngea

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8
Q

Clinical exam of the Guttural pouch

A

Visual: bloody dishcarge, xs bleeding

Palpation

Radio: fungal mycosis may be visible

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9
Q

How to solve arterial occlusion

A

Coil embolism

Balloon catheter occlusion

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10
Q

Cause of guttutal pouch mycosis?

A

Aspergillus sp

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11
Q

Symptoms of guttural pouch mycosis

A

Bloody discharge

epitaxis; maybe even liters, could be fatal

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12
Q

Functional disorders of the pharynx

A
  1. DDSP dorsal displacement of the SP- this often leads to number 2 pharyngeal collapse
  2. Pharyngeal collapse
  3. Abnormal head and neck position

Mostly dynamic

30% of horses have multiple disorders

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13
Q

The developmental abnormalitis of the pharynx

A
  1. Palatoschisis
  2. Choana atresia
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14
Q

Function of the pharynx

A
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15
Q

Conservative Treatment of DDSP

A

Tongue tie to fix larynx position

Cornell collar

Training for a year when they are young

If there is pharyngeal muscle weakness:

  • NSAIDs
  • Figure 8 noseband to keep the mouth closed

There is a 60-80% success rate

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16
Q

Treatment for iDDSP

A

I means intermittent and indicates pharyngeal muscle weakness

6-8 months regular exercise

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17
Q

DDSP surgical treatment

A
  1. Laryngeal tie forward (80%)
  2. Myectomy of m.sternothyroideus
  3. staphylectomy
  4. Scarring of SP with laser
  5. Epiglottis augmentation

Can also use combos of any of these treatments

prognosis: 50-60%

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18
Q

Difference between rostral and dors/lat pharyngeal collapse

A

Rostral

  • Noise during EXP

Dors/lat

  • Noise during INSP
    • fatigue
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19
Q

Complication associated with pharyngeal collapse and DDSP

A
  1. Dysphagia– asp pneumonia
  2. Disturbances in wound healing e.g seroma formation
  3. Development of other dynamic disorders

if have iDDSP and do staphylectomy could be left with pDDSP

iDDSP and do tie forward- could lead to vocal cord collapse

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20
Q

What are the 2 main congenital Defects

A

Choana atresia

Palatoschisis

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21
Q

Choana atresia

A

Seldom a malformation

Persistent buccopharyngeal membrane

Usually unilat- can be asymptomatic at rest

Surgery when 1-2yrs

If bilateral- do tracheotomy, use laser-resection to do “stenting”

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22
Q

Palatoschisis

A

Usually malformation (therefore rarely congenital)

Can be HP or SP

Must be recognised in a newborn foal

Milk coming through nose

Cough

Asp pneumonia

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23
Q

Treatment of Palatoschisis

A

Euthanasia- if HP involved- prognosis is poor

Palato-plastica- with minimal tissue loss 50% prognosis

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24
Q

Pharyngeal cysts frequent locations

A

Subepiglottis

Pharyngeal wall

SP

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25
Q

Removal of Pharyngeal cysts

A

Surgical excision

Laser

26
Q

Dynamic disorders of the larynx

A
  1. RLH- recurrent laryngeal hemiplagia
  2. Axial deviation of the aryepiglottic fold
  3. Collapse of the apex of the corniculate process
  4. Retroversion of the epiglottis
27
Q

Permanent disorders of the Larynx

A
  1. Epiglottis entrapment
  2. Arytenoid chondritis
  3. Subepiglottial cys
  4. 4 BAD
28
Q

Innervation of the intrinsic Pharyngeal muscles

A

Abductor

  • Cricoarytenoideus dorsalis is innerv by the recurrent laryngeal nerves
  • Cricothyroideus is innervated by the ext branch of the cranial laryngeal nerve

Adductor

  • transverse arytenoid, lat criciarytenoid innerv by the Recurrent laryngeal nerve
29
Q

Hemiplagia laryngis is also known as/etiology?

A

RLN recurrent laryngeal neuropathy

30
Q

Pathogenesis of Hemiplagia laryngis/ RLN

A

Idiopathic!!

Progressive degen of dist fibres of the LEFT RLN- by axonopathy

Genetics- large horse breeds

From few months up to 10 years

31
Q

Other causes of hemiplasia laryngis/ RLN

A

Accounts for around 6%

  1. Strangles
  2. Mycosis of guttural pouch
  3. Perivasc inj
  4. Periphlebitis
  5. Lead or organophosphate toxicosis
  6. Tumours of the neck or thorax
  7. CNS (EMND)
32
Q

Clinical signs of hemiplagia larngis/ RLN

A

Insp noise during exercise

Poor performace

33
Q

What can RLN lead to?

A

Paresis/ paralysis of RLN— These leads to:

  • muscular atrophy
  • Vocal cord collapse
  • Arytenoid cartilage collapse

All during insp!

34
Q

Diagnosis of RLN

A
  1. Palpation- Dorsal cricoarytenoid atrophy!
  2. US
  3. Endoscopy at rest: abduction after swallowing/closing the nares
  4. Slap test: the cervicolaryngeal reflex: contralat adduction
  5. DRE= dynamic endoscopy (treadmill)
35
Q

Endoscopic findings of larynx

A

Abduction: corniculate processes (of aryt) move away from midline of the rima glottidis

Adduction: movement of corniculate towards midline of rima glottidis

Full abduction: corniculate lies horizontally (90 degrees to the midline of the rima glottidis)

Asymmetry: difference between L and R corn in relation to the rima glott

Asynchrony: movement of corn at different times- twitching, shivering, delayed biphasic movement

36
Q

RLN grades at rest

Grade I

A

Arytenoid cart movements are synch and symm

Full arytenoid abduction maintained

37
Q

RLN grade II at rest

A

cart movements asynch!

  • transient ascynchrony
  • flutter
  • delayed

Asymmetry

  • asymm of rima glott due to the affected arytenoid and vocal fold BUT there are times after swallowing or nasal occlusion when full symmetrical occlsuion is maintained
38
Q

RLN grade III at rest

A

Cart movements asynch and asymm

Full arytenoid cart abduction cannot be maintained

  • Full symm occlusion can be obtained but NOT maintained (after swallowing/closing of nares)
  • Obvious arytenoid abductor deficit and arytenoid asymm- full abduction is never maintained
    • Marked (not total) arytenoid deficit and asymmetry with little arytenoid movement, Full abduction never achieved
39
Q

RLN grade IV at rest

A

Complete immobility of the arytenoid cart and vocal fold

40
Q

Which side does the RLN grading system apply to mostly?

A

The left side

41
Q

Grading of RLN by DRE/Treadmill

A

A

Full abduction of arytenoids during insp

42
Q

Grading of RLN by DRE/Treadmill

B

A

Partial abduction of LEFT arytenoid cartilages (somewhere btw full ab and rest)

43
Q

Grading of RLN by DRE/Treadmill

C

A

Abduction LESS than resting position!!

Collapse into the contralat half of the rimma glott druing INSP

44
Q

Type of correlation between resting and dynamic endoscopy

A

WEAK

45
Q

Treatment of hemiplagia laryngis

A

LP= laryngoplasty

Ventriculectomy or ventriculocordectomy

Arytenoidectomy (if LP is unsucessful)

Future? Pacemaker

46
Q

Indications of Cordectomy/ ventriculocordectomy with Laser

A

If only the noise!! No effect on the performace

Should be done bilaterally with 3-4 weeks interface?

Standing

Transendoscopic

47
Q

Post op of Cordectomy/ ventriculocordectomy

A

4 weeks: walks on hand then 2 weeks light exercise

At 6-8 weeks do a control exam via endoscope

48
Q

Cordectomy/ ventriculocordectomy Complications

A

Laryngospasms

Edema/seroma in 7-30%

Wound infections: 0.5-6%

Cough will be present in 46% but this should redice to 14% after 6 months

LP not holding: 2-20%

Dysphagia <1%

49
Q

Causes of poor performace following a LP or Cordectomy/ ventriculocordectomy

A

Collapse of arytenoid cartilages (failed tie back)

Vocal cord collapse on right side

Axial deviation of R aryepiglottic fold

  • usually dynamic disorder, race or event horses
  • can treat with transendoscopic laser excision
50
Q

Clinical signs of axial deviation of R aryepiglottic fold

A

Poor performance that worsens with time (therefore often chronic?)

Older horses

Dont mix up with RLN

Ulceration

Kissing lesion

Acute:

  • perichondral edema
  • Fever, incr WBC’s
51
Q

Treatment of axial deviation of R aryepiglottic fold

A

Acute:

  • AB’s
  • NSAIDS throat spray

Chronic

  • Partial arytenoidectomy
52
Q

Occurence and of Epiglottic entrapment

A

Persistent 97% (rarely dynamic)

Thinkened (97%)

Ulcerated (45%)

With epiglottic hypoplasia (31-36%)

53
Q

Epiglottic entrapment Clinical signs

A

Insp noise

Race horses - poor performance

Coughing after drinking

Nasal discharge

Can be just an endoscopic finding !

54
Q

Epiglottic entrapment: treatment

A

Diode laser

55
Q

Occurrence of subepiglottic cysts

A

Young race horses

May be congenital in foals

56
Q

subepiglottic cysts Clinical signs

A

Cough

Noises durign insp (asphyxia)

Dysphagia- asp pneumonia

57
Q

Diagnosis of subepiglottic cysts

A

Endoscopy

Lat-lat X-rays

Palpation through the mouth

58
Q

Treatment of subepiglottic cysts

A

Oral extraction

Laryngotomy- submucosal excision

Intrathecal inj of 4% formalin

Laser

59
Q

What does 4 BAD stand for

A

4th brachial arch defect

60
Q

What is the take home message

A

Resting endoscopy is not always the best to diagnose the cause of resp noise

Upper airway surgery requires exact anatomical knowledge and experience

Most frequent disorders: RLN and DDSP

R sided laryngeal paralysis is inidcative of 4 BAD

DDSP: noise during EXP

For cysts and entrapment minimal tissue loss is advantageous

Equine Surgery and Medicine 2 (15 decks)

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