Upper Airway Surgery

Question 1

Functions of the Upper Airway

Answer 1

1. Warm and humidify inhaled gas
2. Thermoregulation
3. Filtration of particulates
4. Olfaction
5. Vocalization

Question 2

You anchor nasal tubles in the _______

Answer 2

Alar Groove

Question 3

Answer 3

Epiglottis

Question 4

Answer 4

Arytenoids

Question 5

Answer 5

Corniculate process of the arytenoid

Question 6

What part of the arytnoids are tied back when treating laryngeal paralysis?

Answer 6

Corniculate processes

Question 7

Answer 7

Cuneiform processes of the arytenoids

Question 8

Answer 8

Vocal processes of the arytenoid

Question 9

The largest cartilage of the larynx - needs to be retracted during laryngeal paralysis surgery

Answer 9

Thyroid Cartilage

Question 10

Answer 10

Cricoid cartilage

Question 11

Answer 11

Vestibular Ligaments

Question 12

Answer 12

Vocal ligaments (vocal folds)

Question 13

In between the vocal folds and the vestibular process.

Answer 13

Ventricle

Question 14

Poster child for Brachycephalic Obstructive Airway Syndrome

Answer 14

English Bulldog

Question 15

Three portions of the upper airway involved in Canine Brachycephalic Obstructive Airway Syndrome

Answer 15

Nose, Pharynx, Larynx

Question 16

Congenital Abnormalities of Brachycephalic Obstructive Airway Syndrome. Which one does not need to be treated?

Answer 16

1. Stenotic nares
2. Elongated soft palate
3. Hypoplastic trachea - does not need to be treated

Question 17

Assessment of nasal breathing - what to use to assess inspriation and expriation?

Answer 17

• Inspiration - use cotton wisp
• Expriation - microscope slide

Question 18

Before treating stenotic airs, it is important to complete an ______ first.

Answer 18

Upper Airway Examination

Question 19

It is best to wait to do surgery on stenotic nares until the animal is ___ to ____ months of age if possible. Why?

Answer 19

3-4 months of age; animal is closer to adult body, shape, and size

Question 20

Answer 20

Vertical Wedge Resection

Question 21

Answer 21

Horizontal Wedge Resection

Question 22

Answer 22

Dorsolateral Wedge Resection

Question 23

To treat stenotic nares with lasar amputation, you amputate _______.

Answer 23

Redundant alar fold

Question 24

The soft palate normally overlaps the epiglottis by ___ mm. It helps to occlude the nasopharynx during _____.

Answer 24

1-2 mm; swallowing

Question 25

When surgically treating elongated soft palate, it is important to remember to determine resection extent prior to \_\_\_\_\_\_\_.

Answer 25

intubation

Question 26

When resecting an elongated soft palate, it is improtant to make sure the soft palate overlaps the epiglottis by 1-2 mm to mimic normal anatomy. It is also improtant to make sure that laterally, the soft palate should extend to the ______ border of the \_\_\_\_\_\_.

Answer 26

Caudal; tonsillary crypt

Question 27

Elongated soft palate treatment - the crush technique

Answer 27

Hemostatic forces crush the soft palate along the line where you want to make the incision. Then incisions are made part of the way, sutured, continue incision, suture, etc.

Question 28

Elongated soft palate tx - freehand technique

Answer 28

You are NOT crushing the tissue - instead, put sutures that hold palate out towards you. Start incision, suture, cut, suture, etc.

Question 29

Advantages of laser freehand technique with elongated soft palate treatment.

Answer 29

* Rapid * Virtually no blood loss: excellent visualization * Minimal postoperative inflammation * Reduced postoperative discomfort

Question 30

The laser attachment in lasar freehand technique for soft palate reseciton is \_\_\_\_\_.

Answer 30

LAUP = laser assited uvuloplasty

Question 31

What is the land mark as to where to cut off the extra soft palate?

Answer 31

Caudal portion of palatine tonsils

Question 32

Complications of soft palate resection:

Answer 32

* Overshortening: * Nasal reflux * Aspiration * Hemorrhage * Post-operative inflammation and dyspnea

Question 33

Bernoulli principle

Answer 33

Liquids or gases traveling at higher velocities will have lower pressures.

Question 34

Secondary changes to brachycephalic ariway syndrome: Restrited airways ____ flow velocity, causing _____ pressure, resulting in collapse of surrounding tissues.

Answer 34

lowers flow velocity; increases pressure

Question 35

Everted saccules are _____ changes to brachycephalic airway syndrome. (primary or secondary)

Answer 35

secondary

Question 36

Treatment of everted saccules and how does it heal?

Answer 36

Resection via grasping with long forceps and cutting with scissors. Heals by second intention.

Question 37

Order of surgical procedures done in Brachycephalic Obstructive Airway Syndrome Patients

Answer 37

1. Scissor excision of everte laryngeal saccules (if present) with patient EXTUBATED 2. Laser resectino of soft palate using LAUP attachments 3. Stenotic nares corection by laser amputation of redundant alar folds

Question 38

Laryngeal _____ is a secondary change to brachycephalic obstructive airway syndrome.

Answer 38

collapse

Question 39

Stage I Laryngeal Collapse

Answer 39

Everted laryngeal saccules

Question 40

Stage II Laryngeal Collapse

Answer 40

Aryepiglottic collapse + Cuneiform process collapse

Question 41

Stage III laryngeal collapse

Answer 41

Corniculate process collapse

Question 42

Treatment of stage I laryngeal collapse

Answer 42

Resect saccules

Question 43

Treatment of stage II laryngeal collapse

Answer 43

Partial arytenoidectomy and ventrilochordectomy (or treat like stage III - permanent tracheostomy may be needed)

Question 44

Stage III Laryngeal Collapse

Answer 44

Permanent Tracheostomy

Question 45

Complications with arytenoidectomy and ventriculochordectomy and how to avoid

Answer 45

Webbing or stricture - can be avoided by NOT cutting to the dorsal and ventral extents of the corniculate processes and vocal folds, respectively.

Question 46

It is important to do a ____ exam with acquired laryngeal paralysis, becuase many times it is present in conjunction with ______ disorders.

Answer 46

Neural; neuromuscular disorders

Question 47

Poster Child for Acquired Laryngeal Paralysis

Answer 47

Labradors

Question 48

Clinical signs of Bilateral Idiopathic Acquired Laryngeal Paralysis

Answer 48

* Inspiratory stridor that occurs or worsens with exercise * Voice change * Exercise intolerance * Respiratory distress/hyperthermia * Coughing while eating or drinking

Question 49

Do we commonly see dogs with unilateral idiopathic accquried laryngeal paralysis? Why or why not?

Answer 49

No, becuase clinical signs are very subtle, if any; and surgical treatment may not be necessary

Question 50

Normally, the larynx should ____ with inspiration.

Answer 50

Abduct

Question 51

During a laryngoscopy when examining a patient with larygneal parlaysis, a light anesthetic, like ____ is used. It is also important to correlate _____ movement with respiration. If the \_\_\_\_\_does not open with inspriation, then you can diagnose the dog with laryngeal paralysis.

Answer 51

Propofol, arytenoid

Question 52

Avoid a ____ cricoartenoid laryngplasty. (unilateral or bilateral)

Answer 52

Bilateral

Question 53

When performing cricoarytenoid laryngoplasty, it is improtant to pass suture from the caudal point of the ______ cartilage to the ______ process of the \_\_\_\_\_\_, mimicking the _______ muscle.

Answer 53

cricoid cartilage, muscular process of the arytenoid, crycoarytnoid dorsalis muscle

Question 54

A "tie back" is a slang term for stabilizing the larynx in an _____ position. Cricoarytneoid laryngoplasty is one suche procedure.

Answer 54

open position

Question 55

Complications of surgical treatment for laryngeal paralysis

Answer 55

* Aspiration pneumonia * Dysphagia * Dyspnea * \*however, these complicatoins may also occur in dogs that are not treated surgically.

Question 56

Main reason to surgically treat laryngeal paralysis:

Answer 56

Aid in the quality of dogs life

Question 57

Negative prognosticators for laryngeal paralysis:

Answer 57

Advanced geriatric age Concurrent medical conditions Need for tracheostomy for preoperative stabilization

Question 58

When performing a cricoarytenoid laryngoplasty, we want to _____ the left arytenoid process as cricoarytenoid suture is tied (right handed surgeon).

Answer 58

Abduct