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Large Animal Surgery > Equine Guttural Pouch > Flashcards

Equine Guttural Pouch Flashcards

1
Q

What is the guttural pouch?

A

air-filled diverticulum of the auditory (Eustachian) tube that communicates with the nasopharynx and opens routinely during swallowing

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2
Q

Guttural pouch, radiograph:

A
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3
Q

Where is the guttural pouch found? Where does the floor lie? What bone is found within?

A

extends from the roof of the pharynx to the base of the skull and from the atlantooccipital joint to the dorsal pharyngeal recess

on the pharynx

stylohyoid - divides it into medial and lateral compartments (medial is larger)

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4
Q

Guttural pouch, ventral view

A
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5
Q

Guttural pouch:

A

ostia = cartilaginous opening into pharynx

plica salpingopharyngeum = mucosal flap

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6
Q

What are the components of the medial compartment of the guttural pouch?

A
  • internal carotid a.
  • vagus n. (X)
  • glossopharyngeal n. (IX)
  • hypoglossal n. (XII)
  • spinal accessory n. (XI)
  • cranial laryngeal
  • cranial cervical ganglion
  • cervical sympathetic trunk
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7
Q

What are the components of the lateral compartment of the guttural pouch?

A
  • external carotid a.
  • facial n. (VII)
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8
Q

Guttural pouch compartments:

A
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9
Q

What is guttural pouch tympany? What causes it?

A

air distension in the guttural pouch

congenital abnormality that causes the pharyngeal opening (ostia, plica salpingopharyngeum) to malfunction and act as a one-way valve

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10
Q

When is guttural pouch tympany most commonly seen? What horses are overrepresented?

A

shortly after birth to 1 year —> usually unilateral, but may be bilateral

Arabian* and Paint foals

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11
Q

What is the most common clinical sign associated with guttural pouch tympany?

A

swelling in the parotid region, usually non-painful, elastic, and bilateral despite unilateral lesion —> swelling spreads and compresses the contralateral side

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12
Q

What are 2 possibly complications associated with guttural pouch tympany?

A
  1. respiratory distress - swelling compresses pharynx and trachea dorsally
  2. interference with deglutition (swallowing) - aspiration pneumonia (milk, mucopurulent)
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13
Q

How is guttural pouch tympany diagnosed?

A
  • clinical signs
  • endoscopy (can’t see larynx due to swelling)
  • radiographs (enlarged pouch, radiolucency)
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14
Q

What is seen on radiographs in cases of guttural pouch tympany?

A

gas distension causes radiolucent margins of the guttural pouch to extend down the neck

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15
Q

What are 3 options for treating guttural pouch tympany?

A
  1. needle compression - short term
  2. indwelling foley catheter for 4-6 weeks - creates a better opening
  3. make a permanent hole to deflate
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16
Q

What are the 2 options for permanent fenestration when treating guttural pouch tympany? What is prognosis like?

A
  1. median septum - air trapped in the right side can move to the left and be dispelled
  2. salpingopharyngeal fistula - hole through pharynx into GP for better airflow

good with surgery

17
Q

What is guttural pouch empyema? What are the 2 most common etiologies?

A

purulent exudate in the guttural pouch

  1. secondary to Streptococcus equi (Strangles)* or zooepidemicus URT infection
  2. secondary to rupture of the retropharyngeal LN abscess into GP
18
Q

What clinical signs are most commonly associated with guttural pouch empyema?

A
  • chronic unilateral mucopurulent nasal discharge lacking discharge noticed when head is lowered
  • NO external swelling of GP
  • swelling of adjacent LNs
  • extended head carriage
  • excessive respiratory noise
  • difficulty swallowing/breathing due to inflamed CN in the GP
19
Q

How is guttural pouch empyema diagnosed?

A
  • clinical signs
  • endoscopy - purulent exudate observed
  • radiographs - dependent fluid lines, generalized ST swelling
  • culture and sensitivity - confirmation of causative agent
20
Q

Guttural pouch empyema, endoscopy:

A
  • exudate can compress airway
  • purulent material dries out and accumulated into chondroids
21
Q

How is guttural pouch empyema treated?

A

flush GP with physiologic saline

+/- place indwelling catheter
+/- local antibiotics (KPen) for refractory cases

22
Q

What flush is thought to be able to dissolve guttural pouch chondroids? What is the preferred treatment option?

A

acetylcysteine (debatable)

physical removal - endoscopically with a snare or surgically

23
Q

What is prognosis of guttural pouch empyema/chondroids?

A
  • good once resolved
  • neurological signs generally resolve
24
Q

What are the 4 general approaches for accessing the guttural pouch?

A
  1. hyovertebrotomy - caudal vertical excision
  2. Viborg’s triangle
  3. modified Whitehouse
  4. Whitehouse - ventral, must pass larynx
25
Q

What are the 3 outlines of Viborg’s triangle?

A
  1. tendon of the sternocephalicus
  2. linguofacial vein
  3. vertical ramus of the mandible
26
Q

What is the most common etiology of guttural pouch mycosis? How does it affect the guttural pouch?

A

Aspergillus fumigatus

  • formation of a diphtheritic membrane (black/yellow)
  • necrosis of underlying structures, like carotid and stylohyoid
27
Q

What is the most common sign of guttural pouch mycosis? What 3 signs occur with cranial nerve damage?

A

epistaxis - mild to intermittent initially, but can quickly lead to rapid hemorrhage, causing the horse to bleed to death

  1. dysphagia
  2. respiratory noise
  3. Horner’s syndrome
28
Q

How is guttural pouch mycosis diagnosed?

A
  • clinical signs
  • endoscopy
29
Q

When is medical treatment for guttural pouch mycosis recommended? What topical and systemic antifungals are used? What other type of treatment is done?

A

no arterial involvement

  • TOPICAL via indwelling catheter - Enilconazole, Fluconazole
  • SYSTEMIC - Itraconazole
  • treat for months!

remove diphtheritic membrane endoscopy

30
Q

What surgical treatment is recommended for guttural pouch mycosis?

A

arterial occlusion with balloon catheter or transarterial coil embolization* proximal and distal to lesion (enter through common carotid) under fluoroscopic guidance

  • Circle of Willis provides collateral circulation to the brain, allowing for bleeds from both sides of the lesion
31
Q

What is prognosis of guttural pouch mycosis like?

A
  • 80% survival if surgery is timely
  • 50% of horses with hemorrhage bleed to death
  • neurologic deficits may not resolve or take months
32
Q

What is temporohyoid osteopathy?

A

progressive disease of the middle ear causes the TH joint to fuse and eventually fracture the petrous part of the temporal bone, resulting in CN VII and CN VIII damage (+/- CN IX or CN X)

33
Q

What is the most common etiology of temporohyoid osteopathy? What are the 3 parts of the temporohyoid joint?

A

inner or middle ear infection with hematogenous spread

  1. stylohyoid
  2. tympanohyoid cartilage
  3. squamous part of temporal bone
34
Q

What are the most common early and advances signs of temporohyoid osteopathy?

A

EARLY - behavioral issues (due to pain), including head tossing, shaking, ear rubbing, and resistance under asddle

ADVANCED (TH joint fusion) - fractured petrous temporal bone alters the movement of the tongue and larynx, commonly with swallowing, vocalizing, and head/neck movement or oral exams/floating

35
Q

What 3 sets of neurological signs are associated with temporohyoid osteoarthropathy?

A
  1. vestibulocochlear (VIII) - asymmetric ataxia, head tilt with pull toward affected side, spontaneous nystagmus slowly toward affected side
  2. facial (V) - facial paralysis, decreased tear production, inability to close eye
  3. glossopharyngeal (IX), vagus (X) - dysphagia (rare)
36
Q

How is THO diagnosed?

A
  • clinical signs - neuro/behavioral signs
  • endoscopy - thickened stylohyoid bone within GP
  • radiographs
  • CT
37
Q

What treatments are recommended for THO? What is prognosis like?

A
  • mild = systemic antibiotics, NSAIDs
  • advanced = surgical

fair - neuro signs can persist > 1 year

38
Q

What is the purpose for surgical treatment of THO? What are the 2 options?

A

relieve pressure on temporal bone

  1. partial stylohyoidectomy - bone can regrow
  2. ceratohyoidectomy - remove ceratohyoid bone, more successful

Large Animal Surgery (32 decks)

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