Laryngeal Disease Flashcards

1
Q

In what 3 ways does the larynx of cats differ from dogs?

A
  1. arytenoid cartilage lacks cuneiform and corniculate processes
  2. aryepiglottic folds are absent
  3. sids of the epiglottis connect directly to the cricoid lamina by laryngeal mucosa
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2
Q

What are the major manifestations of laryngeal disease?

A
  • nasal, pharyngeal, and laryngeal stridor (high pitched)
  • inspiratory/expiratory wheeze
  • inspiratory dyspnea, loud snoring, gagging
  • dry, raw cough
  • cyanosis, syncope, collapse
  • changes in voice/sound of bark
  • painful swallowing
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3
Q

What is laryngeal paralysis?

A

dysfunction of the recurrent laryngeal nerve impairs the function of the cricoarytenoideus dorsalis muscle, which causes impairment of artytenoid cartilage abduction during inspiration —> stridor, respiratory distress

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4
Q

What causes the stridor associated with laryngeal paralysis?

A

vocal folds oscillate, which causes a roaring noise

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5
Q

What is the most common signalment for congenital, early onset, and acquired laryngeal paralysis? What causes each?

A

CONGENITAL = Bouvier des Flanders, Siberian Husky; neuronal degeneration

EARLY ONSET = Dalmatian, Rottweiler, Bullterrier, Leonberger; generalized neurologic disease

ACQUIRED = Labradors*, St. Bernard, Irish Setter, Newfoundland, Brittany Spaniels; idiopathic age-related decline in nerve or muscle function

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6
Q

What neuromuscular disease, accidental trauma, and iatrogenic surgical trauma are proposed etiologies to acquired laryngeal paralysis?

A

NEURO = geriatric-onset larygneal paralysis polyneuropathy syndrome (GOLP)***

ACCIDENTAL TRAUMA = chronic tugging on collars

SURGERY = tracheal surgery, thyroidectomy, parathyroidectomy

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7
Q

What is the most common presentation of laryngeal paralysis in dogs?

A

BILATERAL DISEASE

  • inspiratory stridor worsens with exercise
  • exercise intolerance
  • respiratory distress
  • voice change
  • cyanosis
  • coughing while eating or drinking
  • hyperthermia, collapse
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8
Q

How does unilateral presentation of laryngeal paralysis compare?

A

tends to be subtle and surgery is not necessary

  • conservative management: keeping cool, decrease exercise, weight control
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9
Q

What are the 3 general steps to emergency stabiilzation of patients in acute respiratory stress due to laryngeal paralysis? What can be performed if nothing is working?

A
  1. improve ventilation with oxygen supplementation, sedation, or intubation
  2. reduce laryngeal edema with short-acting steroids, like Dexamethasone
  3. minimize stress - cool down, sedate with Butorphanol, Acepromazine, Gabapentin, or Hydromorphone

emergency tracheostomy —> poor long term outcome

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10
Q

What is thought to be the etiology of laryngeal paralysis in cats? How do they present?

A

polyneuropathy

SAME AS DOGS

  • tachypnea
  • stridor
  • change in phonation
  • cough
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11
Q

What is the best way to diagnose laryngeal paralysis? What else can be part of the plan?

A

airway examination by laryngoscopy

  • neurologic exam: commonly cause by geriatric polyneuropathy, so other nerves may be affected (commonly muscle atrophy)
  • CBC, chem, UA, thyroid evaluation
  • thoracic radiographs/US
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12
Q

How are laryngoscopies performed to diagnose laryngeal paralysis?

A

light anesthesia AND Doxapram to exaggerate respiratory action

  • arytenoid should abduct with inspiration
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13
Q

What surgery is recommended for patients with laryngeal paralysis? What is the goal?

A

unilateral lateralization of the arytenoid with sutures to mimic the action of cricoarytenoideus dorsalis muscle (UNILATERAL to minimize risk of aspiration)

double the size of the laryngeal opening to provide enough area to relieve clinical signs, but minimize complications

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14
Q

What are the 3 most common complications associated with arytenoid lateralization?

A
  1. dysphagia - commonly resolves in a few days
  2. aspiration - can cause pneumonia, most common in dogs with underlying neurologic disease
  3. implant failure - suture breaks, tears out, fractures muscular processes (esp. in old dogs with brittle cartilage)
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15
Q

Other than unilateral arytenoid lateralization (tie back), what are 3 other options for surgeries?

A
  1. partial laryngectomy - vocal cord and partial artytenoid excision
  2. bilateral ventriculocordectomy - lowers rate of pneumonia, but there is a higher recurrence of clinical signs due to narrowing of the rima glottis
  3. laryngeal stents
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16
Q

What is laryngeal collapse a consequence of? What dogs typically develop this?

A

chronic upper airway obstruction

associated with BOAS: English Bulldogs, Pugs, Boston Terriers, Cavalier King Charles Spaniels

17
Q

Why is immediate surgery recommended in patients with laryngeal collapse?

A

it is highly likely to progress

  • stage 1 = very good prognosis
  • stage 2 = good prognosis, likely to retain symptoms and require ongoing management
  • stage 3 = severe and life-threatening end-stage change (permanent tracheostomy recommended)
18
Q

What are the most common clinical signs associated with laryngeal masses? What are the most common masses in cats and dogs?

A
  • increased respiratory end expiratory effort
  • stridor
  • severe respiratory distress

CATS = lymphoma, SCC

DOGS = SCC, adenocarcinoma, sarcoma

19
Q

How do laryngeal cysts compare to neoplasia? What are they commonly caused by?

A

can be benign —> do not condemn the animal without testing

chronic inflammation, commonly from foreign body penetration

20
Q

What is laryngitis? What are 4 common etiologies?

A

acute inflammation and irritation of the larynx, resulting in raw dry coughs and a soft voice

  1. bacterial/viral infection
  2. continuous barking or panting
  3. inhalation of toxic fumes
  4. after intubation