E2: Respiratory surgery, Guttural pouch

Question 1

Diagnosis?

Answer 1

Epidermal inclusion cyst

Question 2

What type of noise do you expect from a horse with redundant alar folds? How is the fold stabilized?

Answer 2

Expiratory

Large temporary mattress suture (for diagnosis)

Question 3

A foal presents with stridor, nasal discharge, and facial distortion. What is the likely diagnosis?

Answer 3

Wry nose

Question 4

What should you do preoperatively before nasal septum surgery?

Answer 4

Collect 4-8L of blood

Tracheotomy

Question 5

What is the incsion called that you make to access the nasal septum?

Answer 5

Trephine hole

Question 6

Where is the lesion if there is unilateral epistaxis?

Answer 6

Cranial to the caudal edge of the nasal septum

Question 7

What noise do you expect from a horse with a progressive ethmoid hematoma?

Answer 7

Stridor

Question 8

T/F: The nasal sinuses can be evaluated using an endoscope.

Answer 8

False

Question 9

What is used for transendoscopic chemical ablation? When must it be repeated?

Answer 9

4% formalin

In 2-3 weeks

Question 10

Which surgical approach to the guttural pouches does not provide ventral drainage?

a. Hypovertebrotomy
b. Viborg’s triangle
c. Whitehouse
d. Modified Whitehouse

Answer 10

a. Hypovertebrotomy

Question 11

Which surgical approach is best suited for treating guttural pouch mycosis?

a. Low hyovertebrotomy
b. Viborg’s triangle
c. Whitehouse
d. Modified Whitehouse

Answer 11

a. Low hyovertebrotomy

Question 12

What is the most common complication of guttural pouch surgery?

a. blindness
b. dysphagia
c. facial nerve paralysis
d. abmormal respiratory noises

Answer 12

b. dysphagia

Question 13

Mycotic lesions of the guttural pouch have a propensity for developing in the _____ artery.

a. maxillary
b. external carotid
c. internal carotid
d. palatine

Answer 13

c. internal carotid

Question 14

Which organisms are most commonly grown from diphtheritic plaques in cases of guttural pouch mycosis?

a. A. fumigatus and S. equi
b. E. nidulans and H. capsulatum
c. E. nidulans and A. fumigatus
d. C. albicans and B. dermatitis

Answer 14

c. E. nidulans and A. fumigatus

Question 15

What is the most common presenting sign of guttural pouch mycosis?

a. dysphagia
b. bilateral epistaxis, especially after work
c. Facial nerve paralysis
d. Unilateral epistaxis at rest

Answer 15

d. Unilateral epistaxis at rest

Question 16

Which ancillary procedure is most effective in diagnosing guttural pouch mycosis?

a. endoscopy
b. radiography
c. US
d. Fluroscopy

Answer 16

a. endoscopy

Question 17

What is the recommended therapy for guttural pouch mycosis?

a. scraping the fungal plaque off the guttural pouch membrane
b. irrigiation with antifungal medication
c. surgery
d. systemic antifungal medication

Answer 17

c. surgery

Question 18

Which artery is most likely to cause retrograde blood flow to myocotic lesions in the external carotid and maxillary arteries?

a. linguofacial
b. major palatine
c. infraorbital
d. external ophthalmic

Answer 18

b. major palatine

Question 19

Current surgical techniques for arterial occlusion in treating guttural pouch mycosis include

a. ligation
b. baloon catheterization
c. transarterial coil embolization
d. all of the above

Answer 19

d. all of the above

Question 20

Definitive diagnosis of ethmoid hematoma in horses is made by

a. endoscopic examination
b. history and clinical examination
c. CT
d. histopathologic examination

Answer 20

d. histopathologic examination

Question 21

What is the prognosis for long-term resoluition of progressive ethmoid hematoma?

a. grave no matter what treatment is performed
b. good if treated with intralesional formalin
c. guarded to poor no matter what treatment is performed
d. good if treated with surgical excision and cryotherapy

Answer 21

c. guarded to poor no matter what treatment is performed

Question 22

In what breed have there been no reports of progressive ethmoid hematoma?

Answer 22

Standardbred

Question 23

What causes the color variations of progressive ethmoid hematoma when viewed through a video endoscope?

a. age of the leison
b. fibrosis of the mass
c. type and distribution of hemoglobin pigments
d. none of the above

Answer 23

c. type and distribution of hemoglobin pigments

Question 24

What is the most common clinical sign observed in horses with progressive ethmoid hematoma?

a. coughing
b. epistaxis
c. head pressing
d. respiratory distress

Answer 24

b. epistaxis

Mild, intermittent, unilateral

Question 25

Which survey radiographic view most consistently demonstrates the lesion associated with progressive ethmoid hematoma?

Answer 25

Lateral

Question 26

Diagnostic differentials after visualization of the mass lesion (which looks to be progressive ethmoid hematoma) with the video endoscop should include all of the following except: a. pulmonary neoplasia b. nasal trauma c. nasal neoplasia d. mycotic rhinitis

Answer 26

a. pulmonary neoplasia

Question 27

What is the most substantial complication after surgical excision of a progressive ethmoid hematoma? a. facial deformity b. respiratory distress c. wound dehiscence d. hemorrhage

Answer 27

b. respiratory distress ## Footnote *Most common intra-op complication = hemorrhage*

Question 28

What is the most common cause of noise in a horse?

Answer 28

ILH

Question 29

Formalin (10%) treatment for progressive ethmoid hematoma in the horse is administered via which route? a. intralesional injection b. intravenous injection c. intramuscular injection d. Via NG tube

Answer 29

a. intralesional injection

Question 30

To monitor for recurrence after treatment of a progressive ethmoid hematoma, repeat endoscopic examinations should be performed at ____ intervals for \_\_\_\_. a. 2- week; 2 years b. 1-month; 1 year c. 3- to 6-months; 5 years d. 1-year; 10 years

Answer 30

c. 3- to 6-months; 5 years

Question 31

What are the landmarks for the maxillary sinus? Where do you make your incision?

Answer 31

Medial canthus of the eye = rostral compartment Cranial edge of the facial crest = caudal compatment 1 cm above the line between the 2 landmarks *Alternative 2nd landmark = intraorbital foramen ; then incsion half way between the landmarks*

Question 32

T/F: Trephination sites are usually left open and should be flushed daily (for 1 day past finding flakes in the flush).

Answer 32

True ## Footnote *Also antibiotics and NSAIDs*

Question 33

T/F: Getting your horse a goat buddy may prevent the horse from cribbing.

Answer 33

True

Question 34

The removal of which muscles can be used to treat/prevent cribbing? Which nerve can be removed?

Answer 34

Sternomandibularis Sternothryohyodeus Omohyoideus *Ventral neck muscles* Ventral branch of CN XI (spinal accessory nerve)

Question 35

The modified Forssel's procedure is done to prevent the distortion caused by the surgical treatment of cribbing. In addition to a neurectomy of the ventral branch of CN XI, which muslces are myoectomized for this procedure?

Answer 35

Sternothyrohyoideus Omohyoideus

Question 36

How many tracheal rings worth of muscle is removed in the modified Forssel's procedure?

Answer 36

10

Question 37

Nicking which 2 structures during a modified Forssel's can cause profuse bleeding?

Answer 37

Jugular vein Thyroid gland

Question 38

Which nerve innervates the cricoarytenoideus dorsalis muscle? What is it's parent?

Answer 38

Recurrent laryngeal Vagus

Question 39

Which side is usually aftected in a roarer?

Answer 39

Left

Question 40

What type of noise is roaring?

Answer 40

Inspiratory

Question 41

During a slap test, the withers are slapped during endoscopy and the \_\_\_\_\_of the _________ arytenoid cartilage is observed. a. abduction, contralateral b. abduction, ipsilateral c. adduction, contralateral d. adduction, ipsilateral

Answer 41

c. adduction, contralateral

Question 42

How many grades of ILH are there?

Answer 42

4 | (I - IV)

Question 43

What is the common name for a laryngoplasty?

Answer 43

Tieback *surgery according to Marks*

Question 44

The skin incision for a tieback surgery is ventral to which vein?

Answer 44

Linguofacial

Question 45

Which muscle will be atrophied in a horse with chronic ILH?

Answer 45

Crycoarytenoideus dorsalis

Question 46

Which of these is NOT a complication associated with tieback? a. seroma b. cough c. epistaxis d. dysphagia

Answer 46

c. epistaxis

Question 47

In which position is a venticulectomy performed?

Answer 47

Dorsal recumbency

Question 48

What's this?

Answer 48

Roaring burr

Question 49

How do you know whether you have excised enough of the ventricle during a ventriculectomy? Which ventricle should be removed if the left side is affected?

Answer 49

Place on finger, should cover distal 1/3 Both

Question 50

What can be done to reinnervate the cricoarytenoid muscle?

Answer 50

Neuromusclar pedicle graft

Question 51

What is removed in a total arytenoidectomy? Partial?

Answer 51

Total: Arytenoid body, corniculate, muscular process Partial: Arytenoid body, corniculate *Preferred treatment*

Question 52

What is the vet term for "choking up"

Answer 52

DDSP

Question 53

What is the preferred surgery for DDSP?

Answer 53

Laryngeal tie-forward ## Footnote *Used to be myoectomy of sternothyrohyoideus muscle*

Question 54

What's this and what is it used for? What is the alternative?

Answer 54

Bistoury To transaxially divide the membrane entrapping the epiglottis in case of EE Laser