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3. Equine 2 > Mouth and upper resp tract > Flashcards

Mouth and upper resp tract Flashcards

1
Q

Primary Complaints with mouth and upper resp tract

A

A. Respiratory Noise &/or exercise intolerance
B. Nasal Discharge
1. Purulent
2. Bloody
3. Food material
C. Difficulty eating &/or swallowing
D. Asymmetry of head or cranial neck

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2
Q

clinical exam for nasal discharge should look at what?

A
  • Character of discharge
  • Unilateral vs bilateral (differentials for both)
  • Malodorous or not
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3
Q

how to assess airflow at clinical exam?

A

Compare both flow at the nostrils

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4
Q

history we should take for resp problem

A
  • Duration
  • Performance
  • Respiratory noise, when, what type and how?
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5
Q

clinical exam for mouth and upper resp tract - what to look for?

A
  • Head or neck deformation?
  • Palpation and sinus percussion
  • Examine teeth and oral cavity
  • Evaluation at rest and exercise if hx of respiratory noise or intolerance
    > at expiration and/or insiration?
    > characterize the noise
    > progressive vs sudden
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6
Q

endoscopy - when should we not sedate? principles?

A
  • Do not sedate if evaluating function of larynx, pharynx….
    > might collapse the upper airway structure
  • do both sides
  • may need to evaluate after exercise, or better is dynamic endoscopy
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7
Q

radiology can be used to evaluate what structures for mouth and resp tract?

A
  • Nasal cavity, sinuses and upper teeth
  • Lower mandible and teeth
  • Pharynx, larynx, guttural pouches
  • Upper neck
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8
Q

what would be abnormal in a radiograph?

A
  • increased (Fluid, soft tissue or mineralized tissue) or decreased (osteomyelitis, bone lysis, fx) density, or abnormal position
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9
Q

Respiratory Noise &/or Exercise Intolerance
- main issues that cause this

A
  1. Laryngeal Hemiplegia
  2. Epiglottic Entrapment by Aryepiglottic Fold
  3. Dorsal Displacement of the soft palate
  4. Pharyngeal Lymphoid Hyperplasia
  5. Other conditions: arytenoid chondritis, axial deviation of the aryepiglottic fold, subepiglottic cyst
    …
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10
Q

Respiratory Noise &/or Exercise Intolerance
- when is ti an emergency?

A
  • if present at rest! probably a severe obstruction, probably needs to be referred
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11
Q

Respiratory Noise &/or Exercise Intolerance
- if it is exersize related, what questions should we investigate?

A

a. Consistent?
b. Intermittent?
c. Related to type of exercise?
d. Head position?
e. Fatigue?

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12
Q

Respiratory Noise &/or Exercise Intolerance
- what diagnostic technique should we employ?

A

endoscopy

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13
Q

why does the soft palate need to be under the epiglottis in a horse?

A

because horses are solely nose breathers

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14
Q

what muscle makes the arytenoid open up?
- function
- innervation

A

cricoarytenoideus dorsalis muscle
> if it is dysfunctional, we have impaired airflow
<><>
the only abductor of arytenoid cartilage(s)
(1) Innervated by recurrent laryngeal nerve (RLN) (branch of vagus nerve)
(2) No crossover innervation between left & right sides

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15
Q

Laryngeal Function

A

(1) Passage for air from nasopharynx to trachea
(2) Must also stop food & water from entering trachea
(3) Therefore, must expand (abduct arytenoids) during exercise & close (adduct arytenoids) during swallowing

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16
Q

laryngeal hemiplasia
- who gets this?
- which sides?
- pathogenesis?

A
  • genetic predisposition for Thb & draft horses
  • most common is left sided paralysis (98%) > left sided nerve travels more superficially and is prone to trauma
    <><><><>
  • Result from progressive loss of nerve fibers in left recurrent laryngeal nerve -> atrophy of muscle cricoarytenoideus dorsalis -> loss of abductor function
  • damage to nerve may be secondary to local trauma (thrombophlebitis, neurological disease…)
  • Loss of abduction result in:
    > collapse of left arytenoid during inspiration
    > saccule in vocal folds protrusion in airway
    > increased inspiratory resistance and pressure
    > turbulence and decrease airflow
    > noise and exercise intolerance
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17
Q

Causes of RLN damage

A

(1) Usually idiopathic neuropathy that affects left side of larynx (microscopically, both left & right RLN often affected)
(2) Also due to trauma, extravascular injections, guttural-pouch infection, &
Strep-equi-equi infection

18
Q

Laryngeal Hemiplegia clinical signs

A
  • Exercise intolerance
  • resp noise at inspiration (roaring or whistling sound) - progressive
  • resp distress
19
Q

Dx for larygeal hemiplegia

A
  • history, palpation, endoscopy
20
Q

Laryngeal Hemiplegia treatment
- when do we need it?
- what are our options?

A
  • Only necessary if causing exercise intolerance (may not be needed for lower-level performance horses or pleasure horses)
  • Sometimes treatment aimed more at eliminating noise (hunters, show horses)
    <><><><><>
  • Ventriculectomy (excise ventricle lining/saccule) ± cordectomy (excise vocal fold/cord)
    > subsequent scar tissue abducts vocal fold, may help prevent collapse of arytenoid cartilage into airway
    <><>
  • Prosthetic laryngoplasty (“tie-back”) > dont tie too tight or food can get into resp tract (tie at 60-70 degrees)
    > Often indicated in performance horses with exercise intolerance
    > Suture(s) placed to abduct the arytenoid cartilage (mimics cricoarytenoideus dorsalis muscle between cricoid cartilage & muscular process of arytenoid cartilage)
    > Often performed in combination with ventriculectomy (ventriculectomy may help eliminate noise), but airway resistance studies question additional benefit of ventriculectomy
    <><>
  • arytenoidectomy
    <><>
  • neuromuscular pedicle graft > this takes time to regenerate, not wanted for racehorses in many cases
21
Q

Chondritis of arytenoid
- what is this?
- clinical signs?
- treatment?

A
  • Inflammatory disease +/- infection
    <><>
  • Clinical Signs:
  • Same as laryngeal hemiplegia
  • Sometimes more severe
    <><>
    Treatment:
  • Conservative
  • arytenoidectomy
  • may have to do tracheotomy in emergency
22
Q

how can we differentiate chondritis of arytenoid from laryngeal hemiplagia?

A
  • chondritis will look thickened, may see discharge and pus
23
Q

Granuloma (chondroma) of larynx / arytenoid
- what is it?
- clinical signs?
- treatment?

A
  • Mass projecting from medial surface of corniculate process of arytenoid.
  • clinical signs:
    > Coughing
    > Exercise intolerance
    > Respiratory noise
  • treatment > ablation
24
Q

Epiglottic entrapment:
- what is this?

A
  • Entrapment by the aryepiglottic folds
  • Occurs when that membrane located ventrally becomes dorsally displaced.
  • May be intermittent or permanent
25
Q

Epiglottic entrapment history, Dx

A
  • Abnormal respiratory noise (on expiration > air catches in membrane)
  • Lack of performance
  • Coughing
  • Nasal discharge
    <><><><>
    Diagnosis
  • Endoscopy > See general shape/outline of epiglottis, but appears “swollen” & do not see vessels on epiglottic surface
  • Radiographs (May be secondary to apiglottic hypoplasia)
26
Q

Epiglottic entrapment
treatment, prognosis?

A

Axial transection (via nose or mouth)
- laser, bistoury, electrocautery
<><>
For intermittent cases, or adhesions:
- Resect (split) entrapping aryepiglottic fold through the nasal cavity, with endoscopic visualization, using:
(1) Transendoscopic laser, OR
(2) Special long instrument with a hooked blade (bistoury)
> or electrocautery
<><>
Prognosis good!
> if not accompanied by a short epiglottis, adhesions between the epiglottis & the aryepiglottic fold, or DDSP

27
Q

Epiglottic Entrapment by Aryepiglottic Fold concurrent issue

A

Sometimes this mucosa also becomes ulcerated &/or adhered to the epiglottis

28
Q

epiglottic Cyst
- what do we see?
- cause?
- clinical signs?

A
  • Possible congenital condition, wont go away
  • Cyst located in the ventral part of the aryepiglottic fold
    <><>
    Clinical signs:
  • Coughing
  • Dysphagia
  • Respiratory distress
  • Respiratory noise
29
Q

Sub epiglottic Cyst
- Diagnosis

A
  • x-ray probably best, as cyst can hide in mouth on endoscopy
  • but also endoscopy and oral palpation if located in the mouth
30
Q

Sub-epiglottic Cyst Treatments:

A
  • Removal of the cyst
  • Snare trough oral approach
  • Laryngotomy
31
Q

Axial deviation of the aryepiglottic fold
treatment

A

Treatments: Resection with laser

32
Q

Epiglottitis
Clinical signs:
Dx:

A
  • Coughing
  • Exercise intolerance
  • Respiratory noise
    <><><><>
    Diagnosis:
  • Endoscopy
    > Edematous, reddening and thickening
33
Q

Epiglottitis
Treatments:

A
  • Rest
  • NSAID
  • Antibiotherapy
  • Pharyngeal spray
34
Q

Intermittent displacement of soft palate or DDSP
- causes

A
  • Anatomical abnormalities
  • Caudal traction by contraction of sternohyoideus sternothyrohyoideus muscles (nervous horses)
  • Can be secondary to another problem!!
  • caudal retraction of the tongue
  • opening the mouth and swallowing during exercise
  • dysfunction of pharyngeal branch of vagus nerve
35
Q

intermittent DDSP clinical signs

A
  • gurgling or snoring noise, & exercise intolerance
  • occurs during intense exercise
  • loud noise during exhalation (fluttering)
  • occurs suddenly
36
Q

intermittent DDSP diagnosis

A
  • history
  • endoscopy at rest and exercise > ulcer on the edge of soft palate
  • radiology > assess epiglottic length
    <><><><>
  • In normal horses, sedation may cause DDSP
37
Q

Intermittent DDSP conservative treatments

A
  • tongue tie > reduce caudal retraction of the tongue
  • correction of primary problem if secondary (eg. inflammation of pharynx, LH)
  • changing head position
  • figure 8 nose band
  • modify training
  • cornell collar
38
Q

intermittent DDSP surgical treatment options

A
  • Sternothyrohyoideus myectomy
  • staphylectomy > can make things worse, or cause dysphagia
  • scarification of soft palate (laser, injection irritant sibstance)
39
Q

intermittent DDSP
- what is the Sternothyrohyoideus myectomy, Llewllyn technique?
- what about combined with tie-forward?

A

strap-muscle myotomy/tenotomy
(a) Most commonly used technique
(b) Minimally invasive (Llewellyn) technique performed at the laryngeal insertion of each muscle on the thyroid cartilage
(c) Reduces caudal retraction of the larynx
(d) “Success rate” may be about 50-60%
<><><><>
Tie-forward +/- Llewellyn technique
> Sutures placed between the basihyoid bone & larynx (thyroid cartilages) to move the larynx rostrally

40
Q

cleft palete
- causes, signs
- Dx, Tx

A
  • genetic, congential
    > Soft palate more commonly affected, but may involve both hard & soft palate
    <><><>
  • Usually recognized in young foals, by regurgitation of milk through nostrils
  • Small defects may not present until foal older, with food material at the nostrils
  • aspiration pneumonia most common sequelae
    <><><><>
    Diagnosis confirmed by:
    (1) Palpation & direct visualization of oral cavity
    (2) Endoscopy, if needed
    <><><><>
  • Treatment: Surgical repair is possible, but prognosis poor due to poor surgical access, tension on surgical site resulting in breakdown of repair, & usually preexisting respiratory disease
41
Q

Lymphoid hyperplasia
- what is this
- why we see it
- signs?
- Dx
- Tx

A

Multiple lymphoid follicles in pharynx, mainly on dorsal & lateral walls
- Inflammation of follicles probably normal immune response in young horses exposed to various antigens (influenza, herpes, dust, etc.)
<><><><>
- Decreased exercise tolerance may be associated with:
(1) Turbulent air flow
(2) Induction of DDSP or epiglottic entrapment
(3) Concurrent lower respiratory tract disease
<><><><>
- Endoscopy
a. Condition graded I to IV, based on size, number & extent of follicles
b. Grades II & III often seen in young horses in training, with no signs of respiratory disease or exercise intolerance
<><><><>
Tx
- conservative
> rest
> antiinflammatory
> pharyngeal spray

3. Equine 2 (16 decks)

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