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Tucker ML, Wilson DG, Bergstrom DJ, Carmalt JL. Computational fluid dynamic analysis of upper airway procedures in equine larynges. Front Vet Sci 2023; 10:1139398. [PMID: 37138910 PMCID: PMC10149674 DOI: 10.3389/fvets.2023.1139398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Computational fluid dynamics (CFD) has proven useful in the planning of upper airway surgery in humans, where it is used to anticipate the influence of the surgical procedures on post-operative airflow. This technology has only been reported twice in an equine model, with a limited scope of airflow mechanics situations examined. The reported study sought to widen this application to the variety of procedures used to treat equine recurrent laryngeal neuropathy (RLN). The first objective of this study was to generate a CFD model of an ex-vivo box model of ten different equine larynges replicating RLN and four therapeutic surgeries to compare the calculated impedance between these procedures for each larynx. The second objective was to determine the accuracy between a CFD model and measured airflow characteristics in equine larynges. The last objective was to explore the anatomic distribution of changes in pressure, velocity, and turbulent kinetic energy associated with the disease (RLN) and each surgical procedure performed. Methods Ten equine cadaveric larynges underwent inhalation airflow testing in an instrumented box while undergoing a concurrent computed tomographic (CT) exam. The pressure upstream and downstream (outlet) were measured simultaneously. CT image segmentation was performed to generate stereolithography files, which underwent CFD analysis using the experimentally measured outlet pressure. The ranked procedural order and calculated laryngeal impedance were compared to the experimentally obtained values. Results and discussion The CFD model agreed with the measured results in predicting the procedure resulting in the lowest post-operative impedance in 9/10 larynges. Numerically, the CFD calculated laryngeal impedance was approximately 0.7 times that of the measured calculation. Low pressure and high velocity were observed around regions of tissue protrusion within the lumen of the larynx. RLN, the corniculectomy and partial arytenoidectomy surgical procedures exhibited low pressure troughs and high velocity peaks compared to the laryngoplasty and combined laryngoplasty/corniculectomy procedures. CFD modeling of the equine larynx reliably calculated the lowest impedance of the different surgical procedures. Future development of the CFD technique to this application may improve numerical accuracy and is recommended prior to consideration for use in patients.
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Affiliation(s)
- Michelle L. Tucker
- Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- *Correspondence: Michelle L. Tucker
| | - David G. Wilson
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Donald J. Bergstrom
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - James L. Carmalt
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Gray SM, Gutierrez‐Nibeyro SD, Horn GP, McCoy AM, Schaeffer DJ, Stewart M. The effect of repeated freezing and thawing on the suture pull-out strength in equine arytenoid and cricoid cartilages. Vet Surg 2022; 51:1106-1110. [PMID: 35815735 PMCID: PMC9796672 DOI: 10.1111/vsu.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 06/18/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the effect of repeated freezing and thawing on the suture pull-out strength in arytenoid and cricoid cartilages subjected to the laryngoplasty (LP) procedure. STUDY DESIGN Ex vivo experimental study. SAMPLE POPULATION Ten grossly normal equine cadaveric larynges. METHODS Bilateral LP constructs were created using a standard LP technique. One hemilarynx was randomly allocated to the single freeze and thaw group and the other allocated to the repeated freeze and thaw (3 complete cycles) group. The suture ends of each LP construct were attached to a load frame and subjected to monotonic loading until construct failure. Mean load (N) and displacement (mm) at LP construct failure were compared between groups. RESULTS All LP constructs failed by suture pull through the arytenoid cartilage. The mean load at failure was similar between groups (118.9 ± 25.5 N in the single freeze and thaw group and 113.4 ± 20.5 N in the repeated freeze and thaw group, P = .62). The mean displacement at failure was similar between groups (54.4 ± 15.1 mm in the single freeze and thaw group and 54.4 ± 15.4 mm in the repeated freeze and thaw group, P = .99). CONCLUSION Repeated freezing and thawing did not affect the suture pullout strength of the arytenoid and cricoid cartilages. CLINICAL SIGNIFICANCE Laryngeal specimens that have been subjected to repeated freezing and thawing can be utilized in the experimental evaluation of LP procedures because there is no alteration of the suture pull-out strength of the relevant cartilages.
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Affiliation(s)
- Sarah M. Gray
- Department of Clinical Veterinary Medicine, College of Veterinary MedicineUniversity of IllinoisUrbana‐ChampaignIllinoisUSA
| | - Santiago D. Gutierrez‐Nibeyro
- Department of Clinical Veterinary Medicine, College of Veterinary MedicineUniversity of IllinoisUrbana‐ChampaignIllinoisUSA
| | - Gavin P. Horn
- Illinois Fire Service InstituteUniversity of IllinoisChampaignIllinoisUSA
| | - Annette M. McCoy
- Department of Clinical Veterinary Medicine, College of Veterinary MedicineUniversity of IllinoisUrbana‐ChampaignIllinoisUSA
| | - David J. Schaeffer
- Department of Clinical Veterinary Medicine, College of Veterinary MedicineUniversity of IllinoisUrbana‐ChampaignIllinoisUSA
| | - Matt Stewart
- Department of Clinical Veterinary Medicine, College of Veterinary MedicineUniversity of IllinoisUrbana‐ChampaignIllinoisUSA
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Lean NE, Bertin FR, Ahern BJ. Influence of unilateral and bilateral vocal cordectomy on airflow across cadaveric equine larynges at different Rakestraw grades of arytenoid abduction. Vet Surg 2022; 51:974-981. [PMID: 35608018 PMCID: PMC9546136 DOI: 10.1111/vsu.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/20/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
Objective To assess the effect of vocal cordectomy on airflow across equine larynges at different Rakestraw grades of arytenoid abduction using a unidirectional airflow model. Study design Ex vivo, repeated measures. Sample population Twenty cadaveric equine larynges. Methods The right arytenoid cartilage was maximally abducted in all larynges. Each larynx was assigned a Rakestraw grade A or B, and the left arytenoid was abducted accordingly. Each larynx was tested under 3 conditions: intact, left vocal cordectomy (LVC), and bilateral vocal cordectomy (BVC). Translaryngeal pressure and airflow were measured, and digital video footage was obtained. Translaryngeal impedance (TLI) was calculated, and the arytenoid left‐to‐right quotient angle (LRQ) and rima glottis cross‐sectional area (CSA) were measured from standardized still images. Results Vocal cordectomy reduced TLI by 14.5% in LVC in comparison with intact larynges at Rakestraw grade B (P = .014). In Rakestraw grade A position, neither unilateral nor bilateral vocal cordectomy had any effect on TLI. Regardless of Rakestraw allocation, both LVC and BVC increased CSA in comparison with intact larynges (P < .005), with BVC larynges experiencing a greater effect than LVC (P < .0001). Conclusion Using a unilateral airflow model, LVC improved TLI in larynges where arytenoid position approximated Rakestraw grade B. However, when the arytenoid position approximated Rakestraw grade A, there was no effect on TLI following LVC or BVC. Clinical significance Surgeons considering a vocal cordectomy should take into account the degree of arytenoid abduction before performing the procedure, as it may not be warranted from a TLI point of view.
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Affiliation(s)
- Natasha E Lean
- School of Veterinary Science, University of Queensland, Gatton, Queensland
| | - Francois R Bertin
- School of Veterinary Science, University of Queensland, Gatton, Queensland
| | - Benjamin J Ahern
- School of Veterinary Science, University of Queensland, Gatton, Queensland
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Tucker ML, Wilson DG, Reinink SK, Carmalt JL. Computed tomographic geometrical analysis of surgical treatments for equine recurrent laryngeal neuropathy. Am J Vet Res 2022; 83:443-449. [PMID: 35143413 DOI: 10.2460/ajvr.21.03.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions. Secondly, to use fluid mechanic principles of flow through a constriction to establish the relationship between measured airflow geometries with impedance for each surgical procedure. SAMPLE 10 cadaveric horse larynges. PROCEDURES While CT scans were performed, inhalation during exercise conditions was replicated for each of the following 5 conditions: laryngeal hemiplegia, left laryngoplasty with ventriculocordectomy, left laryngoplasty with ipsilateral ventriculocordectomy and arytenoid corniculectomy, corniculectomy, and partial arytenoidectomy for each larynx while CT scans were performed. Laryngeal impedance was calculated, and selected cross-sectional areas were measured along each larynx for each test. Measured areas and constriction characteristics were analyzed with respect to impedance using a multilevel, mixed-effects model. RESULTS Incident angle, entrance coefficient, outlet coefficient, friction coefficient, orifice thickness, and surgical procedure were significantly associated with upper airway impedance in the bivariable model. The multivariate model showed a significant influence of incident angle, entrance coefficient, and surgical procedure on impedance; however, the orifice thickness became nonsignificant within the model. CLINICAL RELEVANCE Laryngeal impedance was significantly associated with the entrance configuration for each procedure. This suggested that the equine upper airway, despite having a highly complex geometry, adheres to fluid dynamic principles applying to constrictions within pipe flow. These underlying flow characteristics may explain the clinical outcomes observed in some patients, and lead to areas of improvement in the treatment of obstructive upper airway disease in horses.
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Affiliation(s)
- Michelle L Tucker
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - David G Wilson
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shawn K Reinink
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - James L Carmalt
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Gray SM, Gutierrez-Nibeyro SD, Couëtil LL, Horn GP, Kesler RM, McCoy AM, Stewart MC, Schaeffer DJ. Evaluation of the airway mechanics of modified toggle laryngoplasty constructs using a vacuum chamber airflow model. Vet Surg 2021; 50:1409-1417. [PMID: 34309058 DOI: 10.1111/vsu.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the airway mechanics of modified toggle LP constructs in an airflow chamber model and compare these to the airway mechanics of standard LP constructs. STUDY DESIGN Ex-vivo experimental study. SAMPLE POPULATION Fifty-one equine cadaveric larynges. METHODS Bilateral LP constructs were performed using a modified toggle (n = 23) or a standard (n = 21) LP technique. Constructs were tested in an airflow model before and after cyclic loading which was designed to mimic postoperative swallowing. The cross-sectional area (CSA), peak translaryngeal airflow (L/s), and impedance (cmH2 0/L/s) were determined and compared between LP constructs before and after cycling. RESULTS The mean CSA of the rima glottidis of the modified toggle LP constructs was 15.2 ± 2.6 cm2 before and 14.7 ± 2.6 cm2 after cyclic loading, and the mean CSA of the rima glottidis of the standard LP constructs was 16.4 ± 2.9 cm2 before and 15.7 ± 2.8 cm2 after cyclic loading. The modified toggle LP constructs had similar peak translaryngeal impedance before and after cyclic loading (p = .13); however, the standard LP constructs had higher peak translaryngeal impedance after cyclic loading (p = .02). CONCLUSION The modified toggle and standard LP constructs had comparable airway mechanics in an ex-vivo model. CLINICAL SIGNIFICANCE Further investigation is warranted to determine the extent to which the modified toggle LP technique restores normal airway function in horses with RLN.
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Affiliation(s)
- Sarah M Gray
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Santiago D Gutierrez-Nibeyro
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Laurent L Couëtil
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Gavin P Horn
- Illinois Fire Service Institute, University of Illinois, Champaign, Illinois, USA
| | - Richard M Kesler
- Illinois Fire Service Institute, University of Illinois, Champaign, Illinois, USA
| | - Annette M McCoy
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Matt C Stewart
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| | - David J Schaeffer
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
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Lynch NP, Jones SA, Bazley-White LG, Wilson ZF, Raffetto J, Pfau T, Cheetham J, Perkins JD. Ex vivo modeling of the airflow dynamics and two-and three-dimensional biomechanical effects of suture placements for prosthetic laryngoplasty in horses. Am J Vet Res 2020; 81:665-672. [PMID: 32700998 DOI: 10.2460/ajvr.81.8.665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify the degree of left arytenoid cartilage (LAC) abduction that allows laryngeal airflow similar to that in galloping horses, assess 2-D and 3-D biomechanical effects of prosthetic laryngoplasty on LAC movement and airflow, and determine the influence of suture position through the muscular process of the arytenoid cartilage (MPA) on these variables. SAMPLE 7 equine cadaver larynges. PROCEDURES With the right arytenoid cartilage maximally abducted and inspiratory airflow simulated by vacuum, laryngeal airflow and translaryngeal pressure and impedance were measured at 12 incremental LAC abduction forces (0% to 100% [maximum abduction]) applied through laryngoplasty sutures passed caudocranially or mediolaterally through the left MPA. Cross-sectional area of the rima glottis and left-to-right angle quotient were determined from photographs at each abduction force; CT images were obtained at alternate forces. Arytenoid and cricoid cartilage markers allowed calculation of LAC roll, pitch, and yaw through use of Euler angles on 3-D reconstructed CT images. RESULTS Translaryngeal pressure and impedance decreased, and airflow increased rapidly at low abduction forces, then slowed until a plateau was reached at approximately 50% of maximum abduction force. The greatest LAC motion was rocking (pitch). Suture position through the left MPA did not significantly affect airflow data. Approximately 50% of maximum abduction force, corresponding to a left arytenoid angle of approximately 30° and left-to-right angle quotient of 0.79 to 0.84, allowed airflow of approximately 61 ± 6.5 L/s. CONCLUSIONS AND CLINICAL RELEVANCE Ex vivo modeling results suggested little benefit to LAC abduction forces > 50%, which allowed airflow similar to that reported elsewhere for galloping horses.
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Tucker ML, Sumner D, Reinink SK, Wilson DG, Carmalt JL. Ex vivo evaluation of arytenoid corniculectomy, compared with three other airway interventions, performed on cadaveric equine larynges with simulated recurrent laryngeal neuropathy. Am J Vet Res 2020; 80:1136-1143. [PMID: 31763941 DOI: 10.2460/ajvr.80.12.1136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare laryngeal impedance, in terms of air flow and pressure, following arytenoid corniculectomy (COR) versus 3 other airway interventions (left-sided laryngoplasty with ipsilateral ventriculocordectomy [LLP], LLP combined with COR [LLPCOR], and partial arytenoidectomy [PA]) performed on cadaveric equine larynges with simulated left recurrent laryngeal neuropathy (RLN) and to determine whether relative laryngeal collapse correlated with the interventions performed. SAMPLE 28 cadaveric equine larynges. PROCEDURES Each larynx in states of simulated left RLN alone and with airway interventions in the order LLP, LLPCOR, COR, and PA was evaluated in a box model construct that replicated upper airway flow mechanics consistent with peak exercise in horses. Results for impedance, calculated from airflow and pressure changes, were compared between states for each larynx. Multivariable mixed-effects analysis controlling for repeated measures within larynx was performed to calculate the predicted mean impedance for each state. RESULTS Results indicated that tracheal adapter diameter, individual larynx properties, airway intervention, and relative laryngeal collapse affected laryngeal impedance. The LLP and LLPCOR interventions had the lowest impedance, whereas the COR and PA interventions did not differ substantially from the simulated left RLN state. Residual intraclass correlation of the model was 27.6 %. CONCLUSIONS AND CLINICAL RELEVANCE Although impedance was higher for the simulated left RLN with the COR intervention state than with the LLP intervention state, given the clinical success of PA for treating RLN in horses and the similar results for the COR and PA intervention states in the present study, the use of COR warrants further investigation. The residual interclass correlation suggested that individual laryngeal variation affected impedance and may have a clinical effect.
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Chesworth M, Brandenberger O, Cheetham J, Windley Z, Schumacher J, Cochran K, Piercy RJ, Perkins JD. Ex vivo investigation of the effect of the transverse arytenoid ligament on abduction of the arytenoid cartilage when performing equine laryngoplasty. N Z Vet J 2019; 67:264-269. [PMID: 31234719 DOI: 10.1080/00480169.2019.1635538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: To investigate the effect of the transverse arytenoid ligament (TAL) on abduction of the arytenoid cartilage when performing laryngoplasty. Methods: Modified prosthetic laryngoplasty was performed on right and left sides of 13 cadaver larynges. Increasing force was sequentially applied to the left arytenoid cartilage at 3 N intervals from 0-24 N, when the force on the right arytenoid cartilage was either 0 or 24 N, before and after TAL transection. Digital photographs of the rostral aspect of the larynx were used to determine the left arytenoid abduction angles for these given force combinations and results compared before and after TAL transection. Longitudinal and transverse sections of the TAL from seven other equine larynges were also examined histologically. Results: Increasing force on the left arytenoid cartilage from 0-24 N produced a progressive increase in the angle of the left arytenoid cartilage (p < 0.001) and increasing force on the right arytenoid cartilage from 0-24 N reduced the angle of the left arytenoid cartilage (p < 0.001). Following transection of the TAL the mean angle of the left arytenoid increased from 36.7 (95% CI = 30.5-42.8)° to 38.4 (95% CI = 32.3-44.5)°. Histological examination showed that the TAL was not a discrete ligament between the arytenoid cartilages but was formed by the convergence of the ligament and the left and right arytenoideus transversus muscles. Conclusions: Transection of the TAL in ex vivo equine larynges enabled greater abduction of the left arytenoid cartilage for a given force. These results indicate that TAL transection in conjunction with prosthetic laryngoplasty may have value, but the efficacy and safety of TAL transection under load in vivo, and in horses clinically affected with recurrent laryngeal neuropathy must be evaluated. Abbreviations: Fmax: Force needed to maximally abduct the left or right arytenoid; TAL: Transverse arytenoid ligament.
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Affiliation(s)
- M Chesworth
- a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK
| | - O Brandenberger
- a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK
| | - J Cheetham
- b Department of Clinical Sciences , College of Veterinary Medicine, Cornell University , Ithaca , NY , USA
| | - Z Windley
- a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK
| | - J Schumacher
- a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK
| | - K Cochran
- a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK
| | - R J Piercy
- a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK
| | - J D Perkins
- a Department of Veterinary Clinical Sciences , Royal Veterinary College , Hatfield , UK
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Ahern BJ, Lukas E, Lam K, Wilke E, Bertin FR, Van Eps A, Franklin S. Evaluation of a prototype dynamic laryngoplasty system in vitro with an equine vacuum airflow system. Vet Surg 2018; 48:173-179. [PMID: 30569487 DOI: 10.1111/vsu.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 04/09/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate a prototype dynamic laryngoplasty system (DLPS) in a static airflow model. STUDY DESIGN Experimental. SAMPLE POPULATION Ten equine larynges. METHODS The right arytenoid was fixed in abduction in all specimens. A left-sided laryngoplasty was performed with No. 2 Fiberwire and a FASTakII anchor. Each larynx was tested in a static airflow model. The system was adjusted to a flow rate of 55 L/s and prelaryngeal pressure of 12 mm Hg prior to testing in maximal arytenoid abduction. In phase 1, the left suture was loosened, shortened, and tested in 3-mm steps from 0 to 30 mm. In phase 2, the suture was tied with the DLPS in position at a target left-to-right quotient angle (LRQ) of 0.5. The DLPS was activated to target psi of 0, 25, and 50 for testing. Translaryngeal impedance (TLI), LRQ, cross-sectional areas (CSA), and resultant change in LRQ and CSA between, before, and during airflow testing were calculated. RESULTS In phase 1, TLI was reduced by suture shortening up to 6 mm (P = .001) but not by additional shortening (P > .05). In phase 2, activation of the DLPS reduced the TLI from 0 psi (0.43 ± 0.08 mm Hg/L/s) to 25 psi (0.16 ± 0.04 mm Hg/L/s, P < .001), but no further reduction was detected at maximal psi (P = .10). CONCLUSION Activation of the DLPS effectively reduced TLI. CLINICAL SIGNIFICANCE These results justify further investigation of the DLPS to assess its clinical applicability.
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Affiliation(s)
- Benjamin J Ahern
- Equine Specialist Hospital, School of Veterinary Science, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Emily Lukas
- Equine Specialist Hospital, School of Veterinary Science, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Kimberly Lam
- Equine Specialist Hospital, School of Veterinary Science, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Emma Wilke
- Equine Specialist Hospital, School of Veterinary Science, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Francois-Rene Bertin
- Equine Specialist Hospital, School of Veterinary Science, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Andrew Van Eps
- Equine Specialist Hospital, School of Veterinary Science, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Samantha Franklin
- Equine Health and Performance Centre, University of Adelaide, Roseworthy, South Australia, Australia
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McGivney CL, Sweeney J, Gough KF, Hill EW, Katz LM. Serial evaluation of resting and exercising overground endoscopic examination results in young Thoroughbreds with no treatment intervention. Equine Vet J 2018; 51:192-197. [DOI: 10.1111/evj.12994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 07/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C. L. McGivney
- UCD School of Agriculture and Food Science University College Dublin Belfield, Dublin Ireland
| | - J. Sweeney
- UCD School of Business University College Dublin Belfield, Dublin Ireland
| | - K. F. Gough
- UCD School of Agriculture and Food Science University College Dublin Belfield, Dublin Ireland
| | - E. W. Hill
- UCD School of Agriculture and Food Science University College Dublin Belfield, Dublin Ireland
| | - L. M. Katz
- UCD, School of Veterinary Medicine University College Dublin Belfield, Dublin Ireland
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Ahern BJ, Lim YW, van Eps A, Franklin S. In vitro evaluation of the effect of a prototype dynamic laryngoplasty system on arytenoid abduction. Vet Surg 2018; 47:837-842. [PMID: 30084499 DOI: 10.1111/vsu.12933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 05/11/2018] [Accepted: 05/30/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the effect of a prototype dynamic laryngoplasty system (DLPS) on arytenoid abduction. STUDY DESIGN In vitro experimental. STUDY POPULATION Ten equine larynges. METHODS Dissected larynges were mounted, and the right arytenoid was maximally abducted for testing. A left-sided laryngoplasty (LP) was performed by using a strand of No. 2 FiberWire and a FASTakII anchor. Phase 1 involved tightening the suture, without the DLPS device in place, in 1-mm increments and acquiring a digital image of the rima glottidis at each increment. Phase 2 involved tying the suture with the DLPS in place at a left to right quotient (LRQ) of 0.7. Digital images were subsequently taken at 3 stages of DLPS activation (0, 25, and 50 or maximal psi) and analysed to calculate LRQ. RESULTS All tests were completed for 9 larynges. In phase 1, a total shortening of 25.89 ± 1.27 mm was possible, which increased the LRQ from 0.59 ± 0.02 to 1.07 ± 0.12. In phase 2, activation of the DLPS increased the LRQ from 0.70 ± 0.05 to 0.97 ± 0.09. This change in LRQ equated to 18.7 mm of shortening on the basis of phase 1 results. The maximum psi of the DLPS achieved was 37.33 ± 5.96. CONCLUSION The DLPS increased the degree of arytenoid abduction in vitro. This change in LRQ equated to 18.7 mm of shortening of the LP suture based on phase 1 results. CLINICAL IMPACT These results support further evaluation of the DLPS to determine the effect of changes in DLPS on airway resistance.
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Affiliation(s)
- Benjamin J Ahern
- Equine Specialist Hospital, University of Queensland, Gatton Campus, Gatton, Queensland, Australia
| | - Yee-Wei Lim
- Equine Specialist Hospital, University of Queensland, Gatton Campus, Gatton, Queensland, Australia
| | - Andrew van Eps
- Equine Specialist Hospital, University of Queensland, Gatton Campus, Gatton, Queensland, Australia
| | - Samantha Franklin
- Equine Health and Performance Centre, University of Adelaide, Roseworthy, South Australia, Australia
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Davis E, Salinardi B, Spina J, Sharp C. Effect of Cricoarytenoid Joint Preservation and Suture Tension on Arytenoid Lateralization. J Am Anim Hosp Assoc 2017; 53:252-257. [PMID: 28792793 DOI: 10.5326/jaaha-ms-6460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this experimental study was to evaluate the effects of cricoarytenoid (CA) joint preservation versus disarticulation on rima glottidis (RG) area with the epiglottis open and closed under both low and high suture tension. Canine cadaver larynges were used. A unilateral arytenoid lateralization (UAL) was performed with low or high suture tension and with the CA joint preserved or disarticulated. Rima glottidis area was measured with the epiglottis in an open and closed position. Results indicated that RG area was increased over baseline when UAL was performed with both low and high suture tension when the epiglottis was in an open position. High suture tension resulted in a greater increase in RG area compared to low suture tension, both when the CA was preserved and disarticulated. There was no difference in RG area when the CA was disarticulated versus preserved at either suture tension. Rima glottidis area was not significantly increased over baseline when the epiglottis was in a closed position except in the group with CA joint preservation and high suture tension. Although this study suggests that UAL can be performed with or without CA disarticulation, further studies are warranted before UAL without CA disarticulation can be recommended clinically.
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Affiliation(s)
- Elizabeth Davis
- From the New England Animal Medical Center, West Bridgewater, Massachusetts (E.D.); Tufts Veterinary Emergency and Treatment Specialties (B.S.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts (C.S.); and BluePearl Veterinary Partners, Seattle, Washington (J.S.)
| | - Brenda Salinardi
- From the New England Animal Medical Center, West Bridgewater, Massachusetts (E.D.); Tufts Veterinary Emergency and Treatment Specialties (B.S.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts (C.S.); and BluePearl Veterinary Partners, Seattle, Washington (J.S.)
| | | | - Claire Sharp
- From the New England Animal Medical Center, West Bridgewater, Massachusetts (E.D.); Tufts Veterinary Emergency and Treatment Specialties (B.S.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts (C.S.); and BluePearl Veterinary Partners, Seattle, Washington (J.S.)
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13
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Brandenberger O, Rossignol F, Perkins JD, Lechartier A, Mespoulhès-Rivière C, Vitte A, Rossignol A, Ducharme N, Boening KJ. Ex vivo biomechanical stability of 5 cricoid-suture constructs for equine laryngoplasty. Vet Surg 2017; 46:705-713. [DOI: 10.1111/vsu.12671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/13/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Olivier Brandenberger
- Clinique Vétérinaire de Grosbois; Boissy St. Leger France
- Hanseklinik für Pferde; Sittensen Germany
| | | | - Justin D. Perkins
- Department of Veterinary Clinical Sciences; Royal Veterinary College; North Mymms United Kingdom
| | | | | | | | | | - Norm Ducharme
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca New York
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14
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Ahern BJ, Van Eps AW, Boston RC, Franklin SH. In vitro comparison of 3 techniques of prosthesis attachment to the muscular process of the equine arytenoid cartilage. Vet Surg 2017; 46:700-704. [PMID: 28462516 DOI: 10.1111/vsu.12659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/17/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the degree and ease of arytenoid abduction achieved with abaxial placement of a FASTak II suture anchor compared to 2 suture patterns with different directions of insertion-caudomedial to craniolateral and medial to lateral. STUDY DESIGN Ex vivo experimental. STUDY POPULATION Cadaveric larynges from 10 Standardbred racehorses. METHODS Each larynx was sequentially instrumented with all 3 arytenoid suture attachment in random order: (1) abaxial placement of a FASTak II suture, (2) caudomedial to craniolateral suture, and (3) medial to lateral suture placement. Each construct was abducted at 5N increments from 0 to 25N and the left to right quotient angle ratio (LRQ) measured from digital pictures acquired at each sequential increment. RESULTS Arytenoid abduction (higher LRQ) was greater with FASTak II construct than either of the suture patterns. The largest difference occurred at 5N. Approximately 50% less force was required to achieve an LRQ of 1.0 with the FASTak II anchor compared to the suture patterns. No difference was detected between the 2 suture constructs throughout the study. CONCLUSION Use of the FASTak II suture anchor improved arytenoid abduction compared to 2 suture patterns and minimized the suture loads required to achieve maximum arytenoid abduction. CLINICAL RELEVANCE Use of the FASTak II anchor may decrease the suture load required to achieve arytenoid abduction in clinical cases. This may reduce the load placed on the laryngoplasty, thereby, minimizing postoperative loss of abduction.
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Affiliation(s)
- Benjamin J Ahern
- Equine Specialist Hospital, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Andrew W Van Eps
- Equine Specialist Hospital, University of Queensland, UQ Gatton Campus, Gatton, Queensland, Australia
| | - Raymond C Boston
- University of Pennsylvania, Clinical Studies, New Bolton Center, Kennett Square, Pennsylvania
| | - Samantha H Franklin
- Equine Health and Performance Centre, University of Adelaide, Roseworthy, South Australia, Australia
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15
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Leutton JL, Lumsden JM. Dynamic respiratory endoscopic findings pre- and post laryngoplasty in Thoroughbred racehorses. Equine Vet J 2014; 47:531-6. [DOI: 10.1111/evj.12331] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. L. Leutton
- Perth Equine Hospital; Ascot Western Australia Australia
| | - J. M. Lumsden
- Randwick Equine Centre; Randwick New South Wales Australia
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16
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Grevemeyer B, Bogdanovic L, Canton S, St Jean G, Cercone M, Ducharme NG, Brown BN. Regenerative medicine approach to reconstruction of the equine upper airway. Tissue Eng Part A 2014; 20:1213-21. [PMID: 24160675 DOI: 10.1089/ten.tea.2013.0217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Airway obstruction is a common cause of poor performance in horses. Structural abnormalities (insufficient length, rigidity) can be a cause for the obstruction. Currently, there are a few effective clinical options for reconstruction of the equine larynx. A regenerative medicine approach to reconstruction may provide the capability to stabilize laryngeal structures and to encourage restoration of site-appropriate, functional, and host-derived tissue. The purpose of this study was the histopathological evaluation of (1) decellularization of equine (horse) laryngeal cartilages (epiglottis and arytenoids); (2) the host response to decellularized laryngeal cartilages implanted subcutaneously in a donkey model as a test of biocompatibility; and (3) the use of decellularized laryngeal cartilages in a clinically relevant pilot study in the horse larynx. Equine laryngeal cartilages were found to be sufficiently decellularized and were subsequently implanted subcutaneously in donkeys to test biocompatibility. After 4 weeks, the implanted cartilage was harvested. In the subcutaneous model, the samples did not elicit a rejection or foreign body type reaction and were judged suitable for implantation in a clinically relevant equine model. Implants were placed in the upper airway (arytenoids and epiglottis) of one horse. At 4 weeks, the implants were observed to remodel rapidly and were replaced by dense connective tissue with signs of new hyaline cartilage formation in the arytenoids and by connective tissue containing glandular structures and an epithelial covering in the epiglottis. The results of the present study demonstrate the feasibility of a scaffold-based regenerative medicine approach to reconstruction of the equine upper airway; however, further studies investigating long-term integration, formation of new cartilage, and mechanical properties are needed.
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Affiliation(s)
- Bernard Grevemeyer
- 1 Department of Clinical Sciences, Ross University , School of Veterinary Medicine, Basseterre, St.Kitts
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17
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Hawkins J, Couetil L, Miller M. Maintenance of arytenoid abduction following carbon dioxide laser debridement of the articular cartilage and joint capsule of the cricoarytenoid joint combined with prosthetic laryngoplasty in horses: An in vivo and in vitro study. Vet J 2014; 199:275-80. [DOI: 10.1016/j.tvjl.2013.11.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 11/05/2013] [Accepted: 11/30/2013] [Indexed: 11/26/2022]
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18
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Hardcastle MR, Pauwels FET, Collett MG. Clinicopathologic Observations on Laryngoplasty Failure in a Horse. Vet Surg 2012; 41:649-53. [DOI: 10.1111/j.1532-950x.2012.00975.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Michael Robert Hardcastle
- Pathobiology Section, FET Pauwels to Massey Equine,; Institute of Veterinary; Animal and Biomedical Sciences, Massey University; Palmerston North,; New Zealand
| | - Frederik Ekhart Theo Pauwels
- Massey Equine,; Institute of Veterinary,; Animal and Biomedical Sciences; Massey University; Palmerston North,; New Zealand
| | - Mark Grey Collett
- Pathobiology Section, FET Pauwels to Massey Equine,; Institute of Veterinary; Animal and Biomedical Sciences, Massey University; Palmerston North,; New Zealand
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19
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Perkins JD, Meighan H, Windley Z, Troester S, Piercy R, Schumacher J. In Vitro Effect of Ventriculocordectomy Before Laryngoplasty on Abduction of the Equine Arytenoid Cartilage. Vet Surg 2011; 40:305-10. [DOI: 10.1111/j.1532-950x.2011.00796.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Parente EJ, Birks EK, Habecker P. A Modified Laryngoplasty Approach Promoting Ankylosis of the Cricoarytenoid Joint. Vet Surg 2011; 40:204-10. [DOI: 10.1111/j.1532-950x.2010.00773.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Perkins JD, Raffetto J, Thompson C, Weller R, Piercy RJ, Pfau T. Three-dimensional biomechanics of simulated laryngeal abduction in horses. Am J Vet Res 2010; 71:1003-10. [DOI: 10.2460/ajvr.71.9.1003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Effect of magnitude and direction of force on laryngeal abduction: Implications for the nerve-muscle pedicle graft technique. Equine Vet J 2010; 41:328-33. [DOI: 10.2746/042516409x388208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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23
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SASAKI N, MORITA Y, MORIYAMA T, YAMADA H. Evaluation of the cranial cruciate ligament repair system(®) in surgery for laryngeal hemiplegia in heavy draft horses. J Equine Sci 2009; 20:19-22. [PMID: 24833966 PMCID: PMC4013960 DOI: 10.1294/jes.20.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2009] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the effect of the canine cranial cruciate ligament repair system on laryngeal hemiplegia in heavy draft horses. Twenty-four heavy draft horses diagnosed with grade 4 laryngeal hemiplegia were allocated to either the prosthetic laryngoplasty (PL) group (n=14) or a canine cranial cruciate ligament repair system (CCCLRS) group (n=10). Right to left angle quotients (RLQs) of abductions of the arytenoid cartilages were endoscopically evaluated before and after surgery. Post-operative RLQs in the CCCLRS group were significantly lower than those of the PL group (P<0.01). The canine cranial cruciate ligament repair system was revealed to be a good surgical procedure for laryngeal hemiplegia in heavy draft horses.
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Affiliation(s)
- Naoki SASAKI
- Department of Clinical Veterinary Science,
Obihiro University of Agriculture and Veterinary Medicine, Nishi 2–11, Inadacho,
Obihiro-shi, Hokkaido 080-8555, Japan
| | - Yoshinori MORITA
- Banei Draft Racehorse Owners’ Association, Nishi
13 Minami 9–1, Obihiro city, Hokkaido 080-0023, Japan
| | - Tomoe MORIYAMA
- Banei Draft Racehorse Owners’ Association, Nishi
13 Minami 9–1, Obihiro city, Hokkaido 080-0023, Japan
| | - Haruo YAMADA
- Department of Clinical Veterinary Science,
Obihiro University of Agriculture and Veterinary Medicine, Nishi 2–11, Inadacho,
Obihiro-shi, Hokkaido 080-8555, Japan
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24
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DART ANDREW, TEE ELIZABETH, BRENNAN MOSES, DART CHRISTINA, PERKINS NIGEL, CHAPMAN STELLA, DEBNEY SALLY. Effect of Prosthesis Number and Position on Rima Glottidis Area in Equine Laryngeal Specimens. Vet Surg 2009; 38:452-6. [DOI: 10.1111/j.1532-950x.2009.00525.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Abstract
Left laryngeal hemiplegia is a frustrating condition for the equine athlete and equine veterinarian. Treatment for the past 30 years has centered on the prosthetic laryngoplasty ("tie-back") with or without ventriculectomy. Laryngeal reinnervation has been used successfully in people and has been shown experimentally to benefit affected horses. This article reviews equine laryngeal reinnervation using the nerve muscle pedicle graft and describes the surgical technique, its complications, and the follow-up in 146 cases treated over the past 10 years. Also discussed is ongoing research into stimulation studies to improve the success of equine laryngeal reinnervation.
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Affiliation(s)
- Ian C Fulton
- Ballarat Veterinary Practice, 1410 Sturt Street, Ballarat, Victoria 3350, Australia.
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26
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Bureau S, Monnet E. Effects of suture tension and surgical approach during unilateral arytenoid lateralization on the rima glottidis in the canine larynx. Vet Surg 2002; 31:589-95. [PMID: 12415529 DOI: 10.1053/jvet.2002.34671] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the effect of abduction suture tension and cricothyroid (CT) joint disarticulation on the area, height, and width of the rima glottidis (RG) during unilateral arytenoid lateralization. STUDY DESIGN Experimental study. ANIMALS Nine canine cadaver larynges. METHODS Left arytenoid lateralization was performed with high or low abduction suture tension. RG area, height, and width were measured by computerized planimetric analysis with the epiglottis in an open and closed position. The experiment was performed with the CT joint intact and disarticulated. The effects of suture tension, CT disarticulation, and their interaction on RG area with the epiglottis closed or open were evaluated by repeated measures analysis of variance (ANOVA). RESULTS RG area increased by 82% and 129% (P <.0001) with low and high suture tension, respectively. The aperture not covered by the epiglottis in a closed position was 467% larger with high suture tension than with low tension (P <.0001). CT disarticulation had no significant effect on RG geometry with either low or high suture tension (P =.4970). CONCLUSIONS Low suture tension increased RG area when the epiglottis was in an open position without increasing RG aperture when the epiglottis was closed. Suture tension had a significant effect on RG opening when the epiglottis was closed. CT disarticulation did not modify the geometry of the RG. CLINICAL RELEVANCE Use of a low-suture tension should be considered during arytenoid lateralization because it has the potential to reduce the risk of aspiration pneumonia.
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Affiliation(s)
- Stephane Bureau
- College of Veterinary Medicine and Biomedical Sciences, Department of Clinical Sciences, Colorado State University, Fort Collins 80253, USA
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