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Equine Surgery and Medicine 2 > Upper Airway Surgery > Flashcards

Upper Airway Surgery Flashcards

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1
Q

Procedure for guttural pouch mycosis?

A

Occlusion with balloon catheter (ACI, ACE, APM) Coil embolisation

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2
Q

Predisp factors of GP tympany

A

Arabian or paint horse

filly>colt

unilat>bilat

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3
Q

Cause of GP tympany

A

Plica salpingopharyngea one way valve

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4
Q

What age does GP tympany effect?

A

Few days/months up to yearling

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5
Q

GP tympany clinical signs

A

Not painful

Palpation: air-bag

Unilat may look like it’s bilat

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6
Q

Diagnosis of GP tympany

A

Clinical signs

Endoscopy: the pharynx collapses dors– but can decompress during endoscopy

Radio

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7
Q

Treatment of GP tympany

A

Foley catheter for 2-3 weeks

Transencoscopic laser surgery -fenestration of septum -removal of fold from the med plica salpingopharyngea

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8
Q

Clinical exam of the Guttural pouch

A

Visual: bloody dishcarge, xs bleeding

Palpation

Radio: fungal mycosis may be visible

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9
Q

How to solve arterial occlusion

A

Coil embolism

Balloon catheter occlusion

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10
Q

Cause of guttutal pouch mycosis?

A

Aspergillus sp

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11
Q

Symptoms of guttural pouch mycosis

A

Bloody discharge

epitaxis; maybe even liters, could be fatal

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12
Q

Functional disorders of the pharynx

A
  1. DDSP dorsal displacement of the SP- this often leads to number 2 pharyngeal collapse
  2. Pharyngeal collapse
  3. Abnormal head and neck position

Mostly dynamic

30% of horses have multiple disorders

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13
Q

The developmental abnormalitis of the pharynx

A
  1. Palatoschisis
  2. Choana atresia
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14
Q

Function of the pharynx

A
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15
Q

Conservative Treatment of DDSP

A

Tongue tie to fix larynx position

Cornell collar

Training for a year when they are young

If there is pharyngeal muscle weakness:

  • NSAIDs
  • Figure 8 noseband to keep the mouth closed

There is a 60-80% success rate

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16
Q

Treatment for iDDSP

A

I means intermittent and indicates pharyngeal muscle weakness

6-8 months regular exercise

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17
Q

DDSP surgical treatment

A
  1. Laryngeal tie forward (80%)
  2. Myectomy of m.sternothyroideus
  3. staphylectomy
  4. Scarring of SP with laser
  5. Epiglottis augmentation

Can also use combos of any of these treatments

prognosis: 50-60%

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18
Q

Difference between rostral and dors/lat pharyngeal collapse

A

Rostral

  • Noise during EXP

Dors/lat

  • Noise during INSP
    • fatigue
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19
Q

Complication associated with pharyngeal collapse and DDSP

A
  1. Dysphagia– asp pneumonia
  2. Disturbances in wound healing e.g seroma formation
  3. Development of other dynamic disorders

if have iDDSP and do staphylectomy could be left with pDDSP

iDDSP and do tie forward- could lead to vocal cord collapse

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20
Q

What are the 2 main congenital Defects

A

Choana atresia

Palatoschisis

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21
Q

Choana atresia

A

Seldom a malformation

Persistent buccopharyngeal membrane

Usually unilat- can be asymptomatic at rest

Surgery when 1-2yrs

If bilateral- do tracheotomy, use laser-resection to do “stenting”

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22
Q

Palatoschisis

A

Usually malformation (therefore rarely congenital)

Can be HP or SP

Must be recognised in a newborn foal

Milk coming through nose

Cough

Asp pneumonia

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23
Q

Treatment of Palatoschisis

A

Euthanasia- if HP involved- prognosis is poor

Palato-plastica- with minimal tissue loss 50% prognosis

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24
Q

Pharyngeal cysts frequent locations

A

Subepiglottis

Pharyngeal wall

SP

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25
Removal of Pharyngeal cysts
Surgical excision Laser
26
Dynamic disorders of the larynx
1. RLH- recurrent laryngeal hemiplagia 2. Axial deviation of the aryepiglottic fold 3. Collapse of the apex of the corniculate process 4. Retroversion of the epiglottis
27
Permanent disorders of the Larynx
1. Epiglottis entrapment 2. Arytenoid chondritis 3. Subepiglottial cys 4. 4 BAD
28
Innervation of the intrinsic Pharyngeal muscles
Abductor * Cricoarytenoideus dorsalis is innerv by the recurrent laryngeal nerves * Cricothyroideus is innervated by the ext branch of the cranial laryngeal nerve Adductor * transverse arytenoid, lat criciarytenoid innerv by the Recurrent laryngeal nerve
29
Hemiplagia laryngis is also known as/etiology?
RLN recurrent laryngeal neuropathy
30
Pathogenesis of Hemiplagia laryngis/ RLN
Idiopathic!! Progressive degen of dist fibres of the LEFT RLN- by axonopathy Genetics- large horse breeds From few months up to 10 years
31
Other causes of hemiplasia laryngis/ RLN
Accounts for around 6% 1. Strangles 2. Mycosis of guttural pouch 3. Perivasc inj 4. Periphlebitis 5. Lead or organophosphate toxicosis 6. Tumours of the neck or thorax 7. CNS (EMND)
32
Clinical signs of hemiplagia larngis/ RLN
Insp noise during exercise Poor performace
33
What can RLN lead to?
Paresis/ paralysis of RLN--- These leads to: * muscular atrophy * Vocal cord collapse * Arytenoid cartilage collapse All during insp!
34
Diagnosis of RLN
1. Palpation- Dorsal cricoarytenoid atrophy! 2. US 3. Endoscopy at rest: abduction after swallowing/closing the nares 4. Slap test: the cervicolaryngeal reflex: contralat adduction 5. DRE= dynamic endoscopy (treadmill)
35
Endoscopic findings of larynx
Abduction: corniculate processes (of aryt) move away from midline of the rima glottidis Adduction: movement of corniculate towards midline of rima glottidis Full abduction: corniculate lies horizontally (90 degrees to the midline of the rima glottidis) Asymmetry: difference between L and R corn in relation to the rima glott Asynchrony: movement of corn at different times- twitching, shivering, delayed biphasic movement
36
RLN grades at rest Grade I
Arytenoid cart movements are synch and symm Full arytenoid abduction maintained
37
RLN grade II at rest
cart movements asynch! * transient ascynchrony * flutter * delayed Asymmetry * asymm of rima glott due to the affected arytenoid and vocal fold BUT there are times after swallowing or nasal occlusion when full symmetrical occlsuion is maintained
38
RLN grade III at rest
Cart movements asynch and asymm Full arytenoid cart abduction cannot be maintained * Full symm occlusion can be obtained but NOT maintained (after swallowing/closing of nares) * Obvious arytenoid abductor deficit and arytenoid asymm- full abduction is never maintained * Marked (not total) arytenoid deficit and asymmetry with little arytenoid movement, Full abduction never achieved
39
RLN grade IV at rest
Complete immobility of the arytenoid cart and vocal fold
40
Which side does the RLN grading system apply to mostly?
The left side
41
Grading of RLN by DRE/Treadmill A
Full abduction of arytenoids during insp
42
Grading of RLN by DRE/Treadmill B
Partial abduction of LEFT arytenoid cartilages (somewhere btw full ab and rest)
43
Grading of RLN by DRE/Treadmill C
Abduction LESS than resting position!! Collapse into the contralat half of the rimma glott druing INSP
44
Type of correlation between resting and dynamic endoscopy
WEAK
45
Treatment of hemiplagia laryngis
LP= laryngoplasty Ventriculectomy or ventriculocordectomy Arytenoidectomy (if LP is unsucessful) Future? Pacemaker
46
Indications of Cordectomy/ ventriculocordectomy with Laser
If only the noise!! No effect on the performace Should be done bilaterally with 3-4 weeks interface? Standing Transendoscopic
47
Post op of Cordectomy/ ventriculocordectomy
4 weeks: walks on hand then 2 weeks light exercise At 6-8 weeks do a control exam via endoscope
48
Cordectomy/ ventriculocordectomy Complications
Laryngospasms Edema/seroma in 7-30% Wound infections: 0.5-6% Cough will be present in 46% but this should redice to 14% after 6 months LP not holding: 2-20% Dysphagia \<1%
49
Causes of poor performace following a LP or Cordectomy/ ventriculocordectomy
Collapse of arytenoid cartilages (failed tie back) Vocal cord collapse on right side Axial deviation of R aryepiglottic fold * usually dynamic disorder, race or event horses * can treat with transendoscopic laser excision
50
Clinical signs of axial deviation of R aryepiglottic fold
Poor performance that worsens with time (therefore often chronic?) Older horses Dont mix up with RLN Ulceration Kissing lesion Acute: * perichondral edema * Fever, incr WBC's
51
Treatment of axial deviation of R aryepiglottic fold
Acute: * AB's * NSAIDS throat spray Chronic * Partial arytenoidectomy
52
Occurence and of Epiglottic entrapment
Persistent 97% (rarely dynamic) Thinkened (97%) Ulcerated (45%) With epiglottic hypoplasia (31-36%)
53
Epiglottic entrapment Clinical signs
Insp noise Race horses - poor performance Coughing after drinking Nasal discharge Can be just an endoscopic finding !
54
Epiglottic entrapment: treatment
Diode laser
55
Occurrence of subepiglottic cysts
Young race horses May be congenital in foals
56
subepiglottic cysts Clinical signs
Cough Noises durign insp (asphyxia) Dysphagia- asp pneumonia
57
Diagnosis of subepiglottic cysts
Endoscopy Lat-lat X-rays Palpation through the mouth
58
Treatment of subepiglottic cysts
Oral extraction Laryngotomy- submucosal excision Intrathecal inj of 4% formalin Laser
59
What does 4 BAD stand for
4th brachial arch defect
60
What is the take home message
Resting endoscopy is not always the best to diagnose the cause of resp noise Upper airway surgery requires exact anatomical knowledge and experience Most frequent disorders: RLN and DDSP R sided laryngeal paralysis is inidcative of 4 BAD DDSP: noise during EXP For cysts and entrapment minimal tissue loss is advantageous

Equine Surgery and Medicine 2 (15 decks)

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