URT surgery Flashcards
Which clinical signs may mean URT surgery is required?
- Dyspnoea
- URT noise
- Poor performance (primary cause for URT surgery)
- Dysphagia
Conditions of the external nares?
- Atheromas
- Redundant alar folds
- Lacerations affecting nostrils
What are atheromas?
Cystic structures that sit at the top of the diverticulum
Where does the maxillary sinus open into?
Opens into caudal middle meatus via nasomaxillary opening
Why should you be in the ventral meatus rather than the middle meatus to pass a tube or endoscope?
If you pass up the middle meatus you are close to the ethmoid turbinates and risk profuse epistaxis
Structure of the paranasal sinuses?
- Sphenopalatine, frontal, caudal maxillary, rostral maxillary, dorsal conchal and ventral conchal sinuses (and ethmoidal)
- Horses have two sinus systems that don’t communicate (caudal and rostral), septum in between
- Ventral conchal and rostral maxillary form rostral compartments (completely distinct)
Which tooth roots lie in the maxillary sinus?
- Tooth roots of 4th, 5th and 6th cheek teeth lie within the maxillary sinuses
- infection causes sinusitis
Which tooth root forms the rostral wall of the rostral maxillary sinus?
- Roots of 3rd cheek tooth forms rostral wall of rostral maxillary sinus
- infection may cause sinusitis
Which other structures lie within the maxillary sinuses?
nasolacrimal canal and infra-orbital canal
What conditions might you see in the nasal passages?
- Masses
- Fungal granuloma
- Neoplasia
- Ethmoid hematoma
When is sinus surgery indicated?
- Expansive lesions in paranasal sinus e.g. sinus cyst, neoplasia, ethmoid haematoma, tooth root abscess
- Primary sinusitis
- Severe trauma of facial bones
Why is sinus surgery indicated for primary sinusitis but often not secondary sinusitis?
- Secondary sinusitis will not resolve without sorting the primary disease
- With primary sinusitis flushing it out and treating the sinus should resolve it
5 cartilages of the larynx?
Epiglottis, cricoid, thyroid, paired arytenoids
What is the Rima Glottidis?
The aperture of the larynx which goes down into the trachea
List conditions of the pharynx and larynx.
- Cleft palate
- DDSP
- Laryngeal hemiplegia
- Arytenoid chondropathy
- Subepiglottic cysts
- Epiglottic entrapment
What are the consequences of Cleft palate?
Nasal reflux of milk / food material and aspiration pneumonia
Diagnosis, treatment and prognosis of cleft palate?
- Diagnosed on endoscopy
- Poor prognosis - recurrent infections and poor athletic function
- Tx: surgery - poor success rate
Surgical options for Dorsal Displacement of the Soft Palate (DDSP)?
- Myectomy (sternothyroid +/- sternohyoid)
- Palatal fibrosis (thermocautery or laser)
- Tie forward (prosthesis to replace thyrohyoid muscle)
Which surgical option for DDSP has the best success rate?
- Tie forward – currently most popular and best success rate (80%)
- Most have 60% success rate
What is a Myectomy?
Cutting through some of the muscles that insert onto the larynx
When is arytenoidectomy indicated for laryngeal hemiplegia?
Generally only indicated if other techniques fail.
More commonly indicated for arytenoid chondropathy
How is arytenoid chondritis diagnosed?
- Endoscopy (resting)
- Size—compare to other side (tricky if bilateral)
- Mucosa—loss of “bumps”, breaks in surface
- Drainage, granulation tissue
- Palpation—rounded muscular process
How is arytenoid chondritis treated medically?
- Antimicrobial
- Anti-inflammatories (systemic and local)
- Often improves significantly
How is arytenoid chondritis treated surgically?
- Local excision (via endoscope or laryngotomy)
- Arytenoidectomy—failure of medical management
- Permanent tracheostomy— esp if bilateral
How is intralaryngeal granulation tissue treated?
- Excision—endoscopic, laryngotomy
- W/ concurrent chondritis
- Excision can make worse
- May require arytenoidectomy
- W/ abscessation
- Curettage via laryngotomy
What is the prognosis with all surgical treatments of the pharynx and larynx?
Poor for full athletic function
How are subepiglottic cysts (congenital or acquired) or granulomas treated?
- surgical excision through laryngotomy
- oral removal using Nd:YAG laser or snare wire
- Good prognosis
How are subepiglottic cysts diagnosed?
- URT endoscopy (may not see)
- Oral examination
- Radiographs
Clinical signs of epiglottic entrapment?
- Poor performance?
- Respiratory noise (most common clinical sign)
- +/- cough
- +/- nasal discharge
Diagnosis of epiglottic entrapment?
- Endoscopy
- Lose scalloped border and vascular pattern on dorsal aspect of epiglottis
- +/- mucosal ulceration
- Intermittent entrapment may require exercising endoscopy
Epiglottic entrapment options?
- Resection of aryepiglottic folds
- Axial division per os
- Axial division per nasum
- Transendoscopic laser division
- 3 and 4 no requirement for anaesthesia
What is contained in the medial compartment of the gutteral pouch?
internal carotid, cranial sympathetic nerves, cranial cervical ganglion, and cranial nerves IX (glossopharyngeal), X (vagus)and XII (hypoglossal).
What is contained in the lateral compartment of the gutteral pouch?
external carotid, maxillary artery and cranial nerve VII (facial nerve on the outside of the lateral compartment ).
Which compartment of the gutteral pouch is more likely to be affected by mycotic lesions?
Most mycotic lesions affect the medial compartment.
Which compartment of the gutteral pouch is more likely to be affected by injury and trauma?
Lateral compartment
List conditions of the gutteral pouch.
- Guttural pouch tympany
- Guttural pouch empyema
- Other masses
- Stylohoid fractures
- Guttural pouch mycosis
Why can gutteral pouch mycosis be so serious?
- The fungus will erode through the soft tissues
- Eventually erodes through the carotid which haemorrhages and the horse will bleed out
- If you see a horse with epistaxis should always investigate for this one
How is gutteral pouch mycosis treated?
- Ligation (can safely occlude one of the carotids)
- Balloon catheter
- Transarterial coil embolization
Difference between tracheotomy and tracheostomy?
- TRACHEOTOMY (temporary)
- TRACHEOSTOMY (permanent)
Describe process of placing a tracheotomy.
- Cranial/mid third of neck - midline dissection to trachea
- Incision made between and parallel to cartilage rings
- Tracheotomy tube placed and secured with sutures or bandage
- Aftercare - basic wound management and removing excess discharge
Complications and considerations of a tracheostomy?
- Wound care and aftercare is significant (advise owner)
- Potential complications include pulmonary infection and drowning
- With both techniques there is considerable discharge, and the owner should be advised of the cosmetic appearance beforehand
How are tracheal conditions diagnosed?
Endoscopy, radiographs, fluoroscopy, ultrasound
What treatments are available for tracheal conditions?
- Intraluminal granulation tissue—laser
- Extraluminal compression
- Remove/treat compressing structure
- May need to reconstruct ring
- Collapse
- Intra and extra-luminal stenting has been reported
- Success poor
