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Pisano SRR, Stoffel MH, Bodó G. Ex vivo study of vagal branches at risk for iatrogenic injury during laryngoplasty in horses. Vet Surg 2020; 50:425-434. [PMID: 33264429 DOI: 10.1111/vsu.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/22/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To localize vagal branches within the surgical field of laryngoplasty and identify potentially hazardous surgical steps. STUDY DESIGN Observational cadaveric study. SAMPLE POPULATION Five equine head-neck specimens and four entire equine cadavers. METHODS Dissection of the pharyngeal region from a surgical perspective. Neuronal structures were considered at risk if touched or if the distance to instruments was less than 5 mm. RESULTS The branches of the pharyngeal plexus (PP) supplying the cricopharyngeal muscle (PPcr), the thyropharyngeal muscle (PPth), and the esophagus (PPes) were identified in the surgical field in nine of nine, five of nine, and one of nine specimens, respectively. The internal branch of the cranial laryngeal nerve (ibCLN) was identified within the carotid sheath in six of nine specimens. The external branch of the cranial laryngeal nerve (ebCLN) was identified close to the septum of the caudal constrictors in nine of nine specimens. The blade of the tissue retractor compressed the ibCLN in six of six, the ebCLN in four of six, the PPcr in six of six, the PPth in two of three, and the PPes in two of two specimens in which the respective nerves were identified after further dissection. Surgical exploration of the dorsolateral aspect of the pharynx and the incision of the septum of the caudal constrictors harmed the ebCLN in nine of nine, PPcr in seven of nine, and PPth in four of eight specimens. CONCLUSION Several vagal branches were located in the surgical field and must be considered at risk because of their location. CLINICAL SIGNIFICANCE Use of the tissue retractor, dissection over the pharynx, and dissection of the septum of the caudal constrictors involve a risk to damage vagal branches.
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Affiliation(s)
- Simone R R Pisano
- Department of Clinical Veterinary Science, Swiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Michael H Stoffel
- Department of Clinical Research and Veterinary Public Health, Division of Veterinary Anatomy, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Gábor Bodó
- Department of Clinical Veterinary Science, Swiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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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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Fitzharris LE, Lane JG, Allen KJ. Outcomes of horses treated with removal of a laryngoplasty prosthesis. Vet Surg 2019; 48:465-472. [DOI: 10.1111/vsu.13150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022]
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Elliott S, Cheetham J. Meta‐analysis evaluating resting laryngeal endoscopy as a diagnostic tool for recurrent laryngeal neuropathy in the equine athlete. Equine Vet J 2018; 51:167-172. [DOI: 10.1111/evj.12987] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- S. Elliott
- Cornell University College of Veterinary Medicine Ithaca New York USA
- University of Georgia College of Veterinary Medicine Athens Georgia USA
| | - J. Cheetham
- Cornell University College of Veterinary Medicine Ithaca New York USA
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Vidovic A, Delling U. Aryepiglottic fold augmentation as treatment for late-onset dysphagia following surgical treatment of recurrent laryngeal neuropathy. Tierarztl Prax Ausg G Grosstiere Nutztiere 2017; 45:219-225. [PMID: 28745776 DOI: 10.15653/tpg-160712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/19/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Coughing and dysphagia have been described following prosthetic laryngoplasty (LP) with or without ventriculectomy/ventriculocordectomy (VE/VCE) for the treatment of recurrent laryngeal neuropathy. All previous case descriptions include patients with acute onset of clinical signs after surgery that persisted. The authors observed a late-onset of dysphagia and coughing months to years after LP ± VE/VCE. The condition was always associated with an abnormality of the aryepiglottic fold (AEF). Treatment options for those patients are limited. We suggest augmentation of the AEF as treatment for affected horses. The goal of the study was two-fold: Firstly, to describe a new condition of late-onset dysphagia in horses following LP ± VE/VCE associated with an abnormal appearance of the AEF, and secondly, to offer a minimally invasive and successful treatment for those patients. MATERIAL AND METHODS Six horses were presented because of dysphagia and coughing with an onset of months to years after LP ± VE/VCE. Endoscopically, the AEF always appeared thinner and more flaccid to a varying degree. The food path was traceable along the AEF into the trachea using dyed molasses. An initial injection of hyaluronic acid (HA) into the AEF led to immediate improvement of the dysphagia. The procedure was performed in the standing sedated horse. The needle was placed through the cricothyroid ligament and the injection performed under endoscopic guidance. RESULTS All horses tolerated the injection well. Injection of HA was successful only in the short term in all cases and repeated injections were needed for permanent resolution using either cross-linked HA, polyacrylamide hydrogel or platelet rich plasma. CONCLUSION AND CLINICAL RELEVANCE Horses may develop dysphagia and coughing months to years after LP ± VE/VCE as a late-onset complication. The condition seems to be associated with an abnormal appearance and function of the AEF. Successful treatment is possible by augmenting the AEF. However, careful patient selection is mandatory.
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Affiliation(s)
- Aleksandar Vidovic
- Dr. Aleksandar Vidovic, Pferdeklinik St. Georg in Trier, Metternichstraße 9, 54292 Trier, Germany,
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Biasutti S, Dart AJ, Jeffcott LB. A review of recent developments in the clinical application of prosthetic laryngoplasty for recurrent laryngeal neuropathy: Indications, complications and outcome. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Biasutti
- Research and Clinical Training Unit; University Veterinary Teaching Hospital; The University of Sydney; Camden New South Wales Australia
| | - A. J. Dart
- Research and Clinical Training Unit; University Veterinary Teaching Hospital; The University of Sydney; Camden New South Wales Australia
| | - L. B. Jeffcott
- Research and Clinical Training Unit; University Veterinary Teaching Hospital; The University of Sydney; Camden New South Wales Australia
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Bischofberger AS, Hadidane I, Wereszka MM, Perkins NR, Jeffcott LB, Dart AJ. Effect of Age and Prostheses Location on Rima Glottidis Area in Equine Cadaveric Larynges. Vet Surg 2015; 42:286-90. [DOI: 10.1111/j.1532-950x.2013.01101.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 02/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea S. Bischofberger
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney; Camden Australia
| | - Ines Hadidane
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney; Camden Australia
| | - Marta M. Wereszka
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney; Camden Australia
| | | | - Leo B. Jeffcott
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney; Camden Australia
| | - Andrew J. Dart
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney; Camden Australia
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Barnett TP, O'Leary JM, Parkin TD, Dixon PM, Barakzai SZ. Long-Term Maintenance of Arytenoid Cartilage Abduction and Stability During Exercise After Laryngoplasty in 33 Horses. Vet Surg 2015; 42:291-5. [DOI: 10.1111/j.1532-950x.2013.01109.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 11/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy P. Barnett
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, University of Edinburgh; Roslin UK
| | - John Mark O'Leary
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, University of Edinburgh; Roslin UK
| | - Timothy D.H. Parkin
- Boyd Orr Centre for Population and Ecosystem Health, School of Veterinary Medicine, University of Glasgow; Glasgow UK
| | - Padraic M. Dixon
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, University of Edinburgh; Roslin UK
| | - Safia Z. Barakzai
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, University of Edinburgh; Roslin UK
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Willsallen H, Heller J, Kark L, Hilbert BJ. In VitroMechanical Testing of Braided Polyurethane Elastic Fiber and Braided Polyester for Equine Laryngoplasty. Vet Surg 2014; 44:223-30. [DOI: 10.1111/j.1532-950x.2014.12184.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Hadley Willsallen
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga Australia
| | - Jane Heller
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering; University of New South Wales; Sydney Australia
| | - Bryan J. Hilbert
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga Australia
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McClellan NR, Santschi EM, Hurcombe SDA, Litsky AS. An ex vivo model to evaluate the effect of cyclical adductory forces on maintenance of arytenoid abduction after prosthetic laryngoplasty performed with and without mechanical arytenoid abduction. Vet Surg 2014; 43:598-605. [PMID: 24702612 DOI: 10.1111/j.1532-950x.2014.12178.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 05/20/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To (1) develop a model of cyclical adduction force on an abducted left arytenoid cartilage that mimics swallowing or coughing; (2) determine if arytenoid abduction by a clamp before knot tying will improve the maintenance of abduction under cyclical adduction testing. STUDY DESIGN Experimental. SAMPLE POPULATION Cadaveric equine larynges (n = 14). METHODS Left laryngoplasty performed using a single suture of #5 Ethibond with (n = 7) and without (n = 7) abducting the arytenoid with a clamp before knot tying. Each laryngoplasty was loaded cyclically from 2 to 26 N at 0.5 Hz for 5000 cycles in a servohydraulic test frame. Arytenoid displacement data were collected at 1 Hz intervals and median percent loss of abduction compared between groups. Significance was set at P < .05. RESULTS Median left arytenoid abduction distance was 16.9 mm (range, 9.8-19.8 mm). One larynx in each group failed at <1000 cycles. Loss of abduction was determined by progressive displacement of the testing actuator and confirmed by measurement. There was no difference in loss of abduction between clamped and non-clamped larynges after 5000 cycles. This model of cyclical adduction resulted in arytenoid displacements similar to those seen in the 1st week postoperatively. CONCLUSIONS Ex vivo cyclical adductory forces produced a significant loss of laryngoplasty abduction. The use of a clamp to abduct the arytenoid cartilage before knot tying did not reduce the loss of abduction.
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Affiliation(s)
- Nathaniel R McClellan
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
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Bienert‐Zeit A, Roetting A, Reichert C, Ohnesorge B. Laryngeal fistula formation after laryngoplasty in two
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armblood mares. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Bienert‐Zeit
- Clinic for HorsesUniversity of Veterinary Medicine Hannover, Foundation Germany
| | - A. Roetting
- Clinic for HorsesUniversity of Veterinary Medicine Hannover, Foundation Germany
| | - C. Reichert
- Clinic for HorsesUniversity of Veterinary Medicine Hannover, Foundation Germany
| | - B. Ohnesorge
- Clinic for HorsesUniversity of Veterinary Medicine Hannover, Foundation Germany
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Barnett TP, O'Leary JM, Parkin TDH, Dixon PM, Barakzai SZ. Long-term exercising video-endoscopic examination of the upper airway following laryngoplasty surgery: A prospective cross-sectional study of 41 horses. Equine Vet J 2013; 45:593-7. [DOI: 10.1111/evj.12020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 10/19/2012] [Indexed: 11/27/2022]
Affiliation(s)
- T. P. Barnett
- Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Midlothian UK
| | - J. M. O'Leary
- Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Midlothian UK
| | - T. D. H. Parkin
- Boyd Orr Centre for Population and Ecosystem Health; School of Veterinary Medicine; University of Glasgow; Glasgow UK
| | - P. M. Dixon
- Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Midlothian UK
| | - S. Z. Barakzai
- Royal (Dick) School of Veterinary Studies; The University of Edinburgh; Midlothian UK
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Abstract
PURPOSE OF REVIEW The pathophysiology of bilateral vocal fold immobility includes two broad categories: mechanical fixation and neurogenic paralysis. A mobile arytenoid can be surgically abducted, and this procedure has been reported as a treatment for patients with bilateral neurogenic laryngeal paralysis. This article reviews the theoretical basis and clinical outcomes of this procedure. RECENT FINDINGS Two concepts form the theoretical basis for arytenoid abduction. First, in most cases of neurogenic paralysis, laryngeal muscles are not denervated; there is considerable residual or regenerated function of adductor muscles. The vocal fold lies near the midline, because there is inadequate force to abduct the vocal fold. Second, the cricoarytenoid joint is multiaxial. The posterior cricoarytenoid (PCA) muscle rotates the arytenoid about an oblique axis to pull the vocal process laterally and superiorly, while the axis of adduction is nearly vertical. Thus, surgical abduction of the arytenoid, by simulating contraction of the PCA muscle, should not preclude active adduction during phonation or swallow. Surgical arytenoid abduction has been reported to improve the airway in many patients with bilateral laryngeal paralysis, with little or no impairment of vocal function. It is less successful in patients with inspiratory adductor muscle activity, long-term immobility, or previous procedures to statically enlarge the glottis. SUMMARY Arytenoid abduction is a promising treatment for selected patients with bilateral neurogenic laryngeal paralysis.
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Passman SN, Cheetham J, Bonassar LJ, Ducharme NG, Rawlinson JJ. Biomechanical characterisation of equine laryngeal cartilage. Equine Vet J 2011; 43:592-8. [PMID: 21545513 DOI: 10.1111/j.2042-3306.2010.00315.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
REASONS FOR PERFORMING THE STUDY Upper airway obstruction is a common problem in the performance horse as the soft tissues of the larynx collapse into the airway, yet there is a paucity of information on biomechanical properties for the structural cartilage components. OBJECTIVE To measure the geometry and compressive mechanical properties of the hyaline cartilage to improve understanding of laryngeal function and morphology. METHODS A total of 11 larynges were harvested from Thoroughbred and Standardbred racehorses. During gross dissection, linear dimensions of the cricoid were obtained. From both the cricoid and arytenoid, specimens were cored to obtain 6 mm disc samples from 3 sites within the dorsal cricoid (caudal, middle and rostral) and 2 central sites in the arytenoids (inner, outer). The specimens were mechanically tested using radial confined compression to calculate the aggregate modulus and permeability of the tissue. The biomechanical data were analysed using a nested mixed effects model. RESULTS Geometrically, the cricoid has relatively straight walls compared to the morphology of human, ovine and canine larynges. There were significant observations of higher modulus with increasing age (0.13 MPa per year; P = 0.007) and stiffer cricoid cartilage (2.29 MPa) than the arytenoid cartilage (0.42 MPa; P<0.001), but no difference was observed between the left and right sides. Linear contrasts showed that the rostral aspect (2.51 MPa) of the cricoid was 20% stiffer than the caudal aspect (2.09 MPa; P = 0.025), with no difference between the arytenoid sites. CONCLUSIONS The equine larynx is a well supported structure due to both the geometry and material properties of the cricoid cartilage. The hyaline structure is an order of magnitude higher in compressive modulus compared to the arytenoids and other hyaline-composed tissues. POTENTIAL RELEVANCE These characterisations are important to understand the biomechanics of laryngeal function and the mechanisms involved with surgical interventions.
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Davidson EJ, Martin BB, Rieger RH, Parente EJ. Exercising Videoendoscopic Evaluation of 45 Horses with Respiratory Noise and/or Poor Performance After Laryngoplasty. Vet Surg 2010; 39:942-8. [DOI: 10.1111/j.1532-950x.2010.00746.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Witte TH, Cheetham J, Soderholm LV, Mitchell LM, Ducharme NG. Equine Laryngoplasty Sutures Undergo Increased Loading During Coughing and Swallowing. Vet Surg 2010; 39:949-56. [DOI: 10.1111/j.1532-950x.2010.00742.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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DUCHARME NG, CHEETHAM J, SANDERS I, HERMANSON JW, HACKETT RP, SODERHOLM LV, MITCHELL LM. Considerations for pacing of the cricoarytenoid dorsalis muscle by neuroprosthesis in horses. Equine Vet J 2010; 42:534-40. [DOI: 10.1111/j.2042-3306.2010.00115.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES Mechanical evaluation of the equine laryngoplasty. STUDY DESIGN Experimental. ANIMAL POPULATION Cadaveric cricoid (n=36) and arytenoid (46) cartilages. METHODS Arytenoid and cricoid cartilage specimens were embedded for testing. Suture material (2 Ethilon, 5 Ethibond, or 5 Fiberwire) was inserted simulating laryngoplasty procedures. Constructs were evaluated in single or cyclic loading. Single cycle tests recorded load at failure and stiffness. Cyclical tests recorded displacement after 10,000 cycles. ANOVA and t-tests were used (significance P<.05). RESULTS The arytenoid Ethibond (241.10+/-47.67 N) constructs were stronger in single cycle than Ethilon (133.85+/-27.89 N) and Fiberwire (142.67+/-32.40 N). The cricoid Ethibond (220.39+/-49.11 N) constructs were stronger than Ethilon (171.93+/-21.19). The stiffness of Ethilon constructs was lower in both the arytenoid and cricoid compared with Ethibond and Fiberwire. The arytenoids failed at a lower load than the cricoids for Ethilon and Fiberwire but not Ethibond constructs. In cyclic testing complete failure of either cartilage did not occur. Arytenoid Ethibond constructs (0.43+/-0.21 mm) had less distraction than Ethilon (0.92+/-0.41 mm) and a trend for less compared with Fiberwire (0.83+/-0.43 mm; P=.0513). Cricoid Ethibond constructs (0.45+/-0.18 mm) had less distraction compared with Ethilon (1.04+/-0.30 mm) and Fiberwire (0.97+/-0.45 mm). CONCLUSIONS Ethibond was superior to Ethilon and Fiberwire constructs in vitro. CLINICAL RELEVANCE Abduction loss after laryngoplasty is a common complication. The results of this study suggest that the use of Ethibond should minimize abduction loss after surgery relative to the other materials tested.
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Affiliation(s)
- Benjamin J Ahern
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA.
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BARAKZAI SAFIAZ, BODEN LISAA, DIXON PADRAICM. Postoperative Race Performance is Not Correlated with Degree of Surgical Abduction After Laryngoplasty in National Hunt Thoroughbred Racehorses. Vet Surg 2009; 38:934-40. [DOI: 10.1111/j.1532-950x.2009.00605.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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BARAKZAI SAFIAZ, BODEN LISAA, DIXON PADRAICM. Race Performance After Laryngoplasty and Ventriculocordectomy in National Hunt Racehorses. Vet Surg 2009; 38:941-5. [DOI: 10.1111/j.1532-950x.2009.00600.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Witte TH, Mohammed HO, Radcliffe CH, Hackett RP, Ducharme NG. Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 Thoroughbred racehorses competing at less than 2400 m (1997-2007). Equine Vet J 2009; 41:70-5. [PMID: 19301585 DOI: 10.2746/042516408x343163] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY The success of combined prosthetic laryngoplasty with ipsilateral ventriculocordectomy (LPVC) has not been compared to that of partial arytenoidectomy (PA) in a clinical population. HYPOTHESES In Thoroughbred (TB) racehorses: (1) earnings after LPVC are unaffected by the severity of recurrent laryngeal neuropathy (RLN) (laryngeal grade III vs. grade IV); (2) LPVC and PA yield similar results in the treatment of grade III RLN; (3) performance outcome following PA is independent of diagnosis (RLN vs. unilateral arytenoid chondritis [UAC]); and (4) neither LPVC nor PA returns horses to the level of performance of controls. METHODS Medical and racing records of 135 TB racehorses undergoing LPVC or PA for the treatment of grade III or IV RLN or UAC were reviewed. Racing records of age and sex matched controls were also reviewed. RESULTS After LPVC, horses with grade III RLN performed better compared to those with grade IV RLN. Furthermore, horses treated for grade III RLN by LPVC showed post operative earnings comparable to controls. Rate of return to racing were similar for PA and LPVC, although LPVC resulted in higher post operative earnings. Performance after PA was similar regardless of diagnosis (UAC or RLN). Finally, neither LPVC when performed for grade IV RLN, nor PA performed for either diagnosis restored post operative earnings to control levels. CONCLUSIONS Thoroughbred racehorses treated by LPVC for grade III RLN show significantly better post operative earnings compared to horses treated for grade IV disease. In grade III RLN, LPVC returns earning potential to control levels. PA and LPVC lead to similar success in terms of rate of return to racing, but PA leads to inferior earnings after surgery. POTENTIAL RELEVANCE Laryngoplasty should be recommended for all TB racehorses with grade III RLN to maximise return to racing at a high level. This contradicts the common approach of waiting for complete paralysis.
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Affiliation(s)
- T H Witte
- Cornell University Hospital for Animals, Equine Performance Testing Clinic, Ithaca, New York 14853, USA
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Surgical Complications of the Equine Upper Respiratory Tract. Vet Clin North Am Equine Pract 2008; 24:465-84, vii. [DOI: 10.1016/j.cveq.2008.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cheetham J, Radcliffe CR, Ducharme NG, Sanders I, Mu L, Hermanson JW. Neuroanatomy of the equine dorsal cricoarytenoid muscle: surgical implications. Equine Vet J 2008; 40:70-5. [PMID: 18083663 DOI: 10.2746/042516407x240465] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASON FOR PERFORMING STUDY Studies are required to define more accurately and completely the neuroanatomy of the equine dorsal cricoarytenoid muscle as a prerequisite for developing a neuroprosthesis for recurrent laryngeal neuropathy. OBJECTIVES To describe the anatomy, innervation, fibre types and function of the equine dorsal cricoarytenoid muscle. METHODS Thirty-one larynges were collected at necropsy from horses with no history of upper airway disease and 25 subjected to gross dissection. Thereafter, the following preparations were made on a subset of larynges: histochemical staining (n = 5), Sihler's and acetylcholinesterase staining for motor endplates (n = 2). An additional 6 larynges were collected and used for a muscle stimulation study. RESULTS Two neuromuscular compartments (NMC), each innervated by a primary nerve branch of the recurrent laryngeal nerve, were identified in all larynges. Stimulation of the lateral NMC produced more lateral displacement of the arytenoid cartilage than the medial NMC (P<0.05). The medial NMC tended to rotate the arytenoid cartilage dorsally. Motor endplates were identified at the junction of the middle and caudal thirds of each NMC. If fibre type grouping was present it was always present in both NMCs. CONCLUSIONS The equine dorsal cricoarytenoid muscle has 2 distinct muscle NMCs with discrete innervation and lines of action. The lateral NMC appears to have a larger role in increasing cross-sectional area of the rima glottidis. POTENTIAL RELEVANCE This information should assist in planning surgical reinnervation procedures and development of a neuroprosthesis for recurrent laryngeal neuropathy.
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Affiliation(s)
- J Cheetham
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Rossignol F, Perrin R, Desbrosse F, Elie C. In Vitro Comparison of Two Techniques for Suture Prosthesis Placement in the Muscular Process of the Equine Arytenoid Cartilage. Vet Surg 2006; 35:49-54. [PMID: 16409409 DOI: 10.1111/j.1532-950x.2005.00111.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare in vitro the load necessary for a partial and complete rupture of the muscular process arytenoid cartilage when a suture prosthesis is positioned by a bone trocar versus a trocar point needle and to compare failure mode. STUDY DESIGN Experimental using cadaver specimens. SAMPLE POPULATION Larynges from 18 Thoroughbred race horses, aged 2-20 years. METHODS Arytenoid cartilages were separated randomly into 2 groups: group 1-suture prosthesis inserted directly through the muscular process using a curved trocar point needle and group 2-suture passed through a hole predrilled with a 3 mm bone trocar. Distracting force (constant rate, 1 mm/s) was applied to the suture until failure of the muscular process. Partial failure load, maximum load at complete failure, and force-time curve were recorded. Each arytenoid cartilage was examined, radiographed, and classified as having a linear or curved failure plane. RESULTS No significant differences in mechanical test variables were detected. Failure mode followed the fissures occurring at the beginning of failure and then followed the tension axis. Significantly more linear failures occurred in group 2 (trocar) and more curved failures occurred in group 1 (needle). CONCLUSION Use of a bone trocar for tunneling through the muscular process may reduce fissure formation. CLINICAL RELEVANCE Use of bone trocar to create a hole in the muscular process of the arytenoid cartilage for suture passage in laryngoplasty may reduce fissure formation and decrease the risk of cartilage failure from suture pullout.
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Affiliation(s)
- Fabrice Rossignol
- Clinique de Grosbois, Domaine de Grosbois, Boissy Saint Léger, France.
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Dixon RM, McGorum BC, Railton DI, Hawe C, Tremaine WH, Dacre K, McCann J. Long-term survey of laryngoplasty and ventriculocordectomy in an older, mixed-breed population of 200 horses. Part 1: Maintenance of surgical arytenoid abduction and complications of surgery. Equine Vet J 2003; 35:389-96. [PMID: 12880007 DOI: 10.2746/042516403776014172] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Laryngoplasty (LP) is currently the most common surgical treatment for equine laryngeal paralysis, however, there have been no reports quantifying the degree of retention of arytenoid abduction following LP. Additionally, the complications of LP have been poorly documented. OBJECTIVES To record the degree of arytenoid abduction retention following LP and to accurately document all complications of surgery. METHODS A study (1986-1998) of 200 horses of mixed breed and workload, median age 6 years (prospective 136 cases and retrospective 64 cases) undergoing LP (using 2 stainless steel wires) and combined ventriculocordectomy was undertaken; 198 owners completed questionnaires, a median of 19 months following surgery. The degree of arytenoid abduction achieved was endoscopically, semi-quantitatively evaluated using a 5-grade system, at 1 day, 7 days, and 6 weeks after surgery. RESULTS On the day following LP, 62% of horses had good (median grade 2) arytenoid abduction, 10% had excessive (grade 1), and 5% had minimal (grade 4) abduction (overall-median grade 2). Due to progressive loss of abduction, moderate (median grade 3, range 1-5) abduction was present overall at 1 and 6 weeks after LP. Further surgery was required to re-tighten prostheses in 10% of cases with excessive loss of abduction, or to loosen prostheses in 7% of horses which had continuing high levels of LP abduction and significant post operative dysphagia. LP wound problems (mainly seromas and suture abscesses) were reported to last < 2 weeks in 9% of cases, < 4 weeks in 4% and > 4 weeks in 4%. The (partially sutured) laryngotomy wounds discharged post operatively for < 2 weeks in 22% of cases, < 4 weeks in 7% and for > 4 weeks in 2%. Coughing occurred at some stage post operatively in 43% of cases and its presence correlated significantly with the degree of surgical arytenoid abduction. This coughing occurred during eating in 24% of cases and was not associated with eating (or dysphagia) in the other 19% of cases. Chronic (> 6 months duration) coughing occurred in 14% of cases, but appeared to be due to intercurrent pulmonary disease in half of these horses. CONCLUSIONS Suturing the cricotracheal membrane allows most laryngotomy wounds to heal quickly. Laryngoplasty wound problems were of little long-term consequence when stainless steel wire prostheses were used. POTENTIAL RELEVANCE A significant loss of LP abduction occurs in most horses in the 6 weeks following surgery and efforts should be made to find ways to prevent such loss. However, excessive LP abduction is associated with post operative dysphagia and coughing.
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Affiliation(s)
- R M Dixon
- The Wellcome Trust Centre for Studies in Comparative Respiratory Medicine, The University of Edinburgh, Easter Bush Veterinary Centre, Easter Bush, Midlothian EH26 9RG, UK
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Dixon PM, McGorum BC, Railton DI, Hawe C, Tremaine WH, Dacre K, McCann J. Long-term survey of laryngoplasty and ventriculocordectomy in an older, mixed-breed population of 200 horses. Part 2: Owners' assessment of the value of surgery. Equine Vet J 2003; 35:397-401. [PMID: 12880008 DOI: 10.2746/042516403776014217] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY There is continuing debate on the clinical benefit of laryngoplasty (LP) in the treatment of equine laryngeal paralysis. In particular, there is little information available on the clinical value of this surgery in older horses, in non-Thoroughbreds or in sports or pleasure horses; nor on the relationship between the degree of LP abduction achieved and the clinical value of LP. OBJECTIVES To evaluate the owner's assessment of the value of LP (and combined ventriculocordectomy) in an older, mixed breed and mixed workload population of horses and to also assess the relationship between the degree of LP abduction present and the clinical value of this surgery. METHODS A study (1986-1998) of 200 horses of mixed breed and workload, median age 6 years (prospective 136 cases and retrospective 64 cases) undergoing LP and ventriculocordectomy was undertaken. The degree of laryngoplasty abduction achieved and maintained was semiquantitatively evaluated using a 5-grade system. RESULTS A survey of 198 owners, a median of 19 months after LP surgery, showed that 91% of cases had returned to full work and 3% to reduced work, including 95% of horses with good (Grade 2) laryngoplasty abduction at 6 weeks after surgery, 91% with moderate (Grade 3) abduction, 88% of cases with minsimal (Grade 4) abduction and just 25% of cases with total loss of surgical abduction (Grade 5). Once back in work, 73% of cases were reported to make no abnormal exercise-related noises ('noises') at exercise, with reduced 'noises' reported in some of the 21% of horses that still made 'noises'. In the other 6% of cases, owners were unsure if 'noises' were present. The absence or presence of 'noises' once back at work correlated significantly with the degree of surgical arytenoid abduction present at 6 weeks after LP. Once back in work, 'noises' were less commonly detected in sports and pleasure horses (absent in 76% of cases) than in racehorses (absent in 60%) of cases. Exercise performance following surgery was reported to be markedly increased in 75% of cases, with 10% showing no difference in exercise performance, 3% showing worse performance, and owners unsure of any effect on exercise performance in 13% of cases. Improved work was reported in 70% of sports and pleasure horses and in 67% of racehorses. Overall, 86% of owners believed LP was worthwhile, 7% believed it was not worthwhile and 6% were unsure of its value. Surgery was reported to be of most benefit to sports horses (e.g. reported worthwhile for 100% of show jumpers) and of least benefit to National Hunt (long distance) racehorses where 71% of owners believed it to be worthwhile. CONCLUSIONS AND POTENTIAL RELEVANCE Most horse-owners believe that LP and combined ventriculocordectomy are of clinical value, especially in sports and pleasure horses. Large scale physiological studies on clinical cases, pre- and post operatively, are required to examine more critically the value of such surgery.
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Affiliation(s)
- P M Dixon
- The Wellcome Trust Centre for Studies in Comparative Respiratory Medicine, The University of Edinburgh, Easter Bush Veterinary Centre, Easter Bush, Midlothian EH26 9RG, UK
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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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Kidd JA, Slone DE. Treatment of laryngeal hemiplegia in horses by prosthetic laryngoplasty, ventriculectomy and vocal cordectomy. Vet Rec 2002; 150:481-4. [PMID: 11995680 DOI: 10.1136/vr.150.15.481] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The medical records of 80 horses treated for left laryngeal hemiplegia by prosthetic laryngoplasty, ventriculectomy and vocal cordectomy were examined, first to compare the subjective and objective success rates for groups of horses of different ages and used for different purposes, and secondly, to compare the efficacy of including vocal cordectomy in the surgical protocol with published success rates for laryngoplasty and ventriculectomy alone. Subjectively, 70 per cent of the horses were said to have had a successful surgical outcome. The success rate for thoroughbred racehorses (66 per cent) was lower than for other breeds (90 per cent) on the basis of a subjective assessment by owners and trainers. Thoroughbreds two years old or younger had a success rate of 69 per cent, but older thoroughbreds had a success rate of 61 per cent. Of the 17 horses for which an objective performance index could be calculated, 10 (59 per cent) had an improved performance postoperatively. There was a nearly significant association between the objective and subjective assessments (P=0.078). Six of 69 horses (8.7 per cent) continued to make a respiratory noise after surgery. The subjective assessment of success did not appear to correlate with the objective measure of success used in this study and age had no apparent association with a successful surgical outcome. Inclusion of a vocal cordectomy in the surgical protocol may be more important in the eradication of postoperative respiratory noise than in improving clinical success rates.
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Affiliation(s)
- J A Kidd
- Department of Veterinary Clinical Science, University of Bristol, Langford House
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31
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Goulden BE. The equine larynx. N Z Vet J 2002; 50:117. [DOI: 10.1080/00480169.2002.36286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- BE Goulden
- , 15 Swansea Street, Palmerston North, New Zealand
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Davenport CL, Tulleners EP, Parente EJ. The effect of recurrent laryngeal neurectomy in conjunction with laryngoplasty and unilateral ventriculocordectomy in thoroughbred racehorses. Vet Surg 2001; 30:417-21. [PMID: 11555816 DOI: 10.1053/jvet.2001.25865] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effects of recurrent laryngeal neurectomy (RLN) in combination with laryngoplasty and ventriculocordectomy on the postoperative performance of Thoroughbred racehorses treated for grade III left laryngeal hemiparesis (LLH). STUDY DESIGN Retrospective study. SAMPLE POPULATION Fifty-five Thoroughbred racehorses. METHODS Medical records for Thoroughbred racehorses treated surgically by laryngoplasty and laser ventriculocordectomy with or without RLN between June 1993 and December 1996 were reviewed. Outcome was evaluated subjectively by assessment of performance obtained from telephone interviews with owners and trainers, and objectively by assessment of racing performance for 3 races before and after surgery using a performance index (PI). RESULTS Fifty-five Thoroughbred racehorses with resting endoscopic grade III LLH were treated by laryngoplasty and ventriculocordectomy either with (39 horses) or without (16 horses) RLN. For RLN horses, respondents for 38 horses believed performance was improved in 19 horses, unchanged in 16 horses, and decreased in 3 horses. For horses without RLN, respondents for 9 horses reported that performance was improved in 5 horses, unchanged in 2 horses, and decreased in 2 horses. PI scores were improved in 18 RLN horses and in 6 horses without RLN; there was no statistical difference in outcome. CONCLUSIONS AND CLINICAL RELEVANCE Use of RLN in combination with laryngoplasty and ventriculocordectomy for treatment of grade III LLH may not improve postoperative racing performance.
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Affiliation(s)
- C L Davenport
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
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Jansson N, Ducharme NG, Hackett RP, Mohammed HO. An in vitro comparison of cordopexy, cordopexy and laryngoplasty, and laryngoplasty for treatment of equine laryngeal hemiplegia. Vet Surg 2000; 29:326-34. [PMID: 10917282 DOI: 10.1053/jvet.2000.5599] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the effect of cordopexy, laryngoplasty, and cordopexy combined with a modified laryngoplasty on airway mechanics. STUDY DESIGN Experimental airway mechanics were determined by subjecting equine cadaveric larynges to airflows similar to inspiratory airflow of exercising horses. ANIMALS OR SAMPLE POPULATION Twenty equine larynges. METHODS Using cadaveric larynges, we developed and tested a new technique of arytenoid cartilage abduction. All larynges had the right arytenoid cartilage abducted to mimic the degree of arytenoid abduction that occurs at maximal exertion in live horses. Three surgical techniques were used to stabilize the left arytenoid cartilage of treated larynges; the left arytenoid cartilage was not stabilized in control larynges. Technique 1: Cordopexy--a suture was placed between the vocal ligament and the lamina of the thyroid cartilage. Technique 2: Standard laryngoplasty--a suture was placed between the muscular process of the arytenoid cartilage and the caudomedial aspect of the cricoid cartilage. Technique 3: Cordopexy plus modified laryngoplasty--the cordopexy suture was placed with a second suture between the horizontal ridge rostral to the muscular process of the left arytenoid cartilage and the lamina of the thyroid cartilage. Translaryngeal impedances (TI) were determined for each surgical technique by subjecting the larynges to increasing airflows and measuring the translaryngeal pressure differences. The arytenoid right to left angle quotient (RLQ) and the glottic cross-sectional area (CSA) were also measured. RESULTS At maximal airflow, the adjusted means for the arytenoid RLQ and the TI for the cordopexy plus modified laryngoplasty (1.48 +/- 0.04, 0.69 +/- 0.05 cm H2O/L/s) and the standard laryngoplasty (1.39 +/- 0.04, 0.78 cm H2O/L/s) were different (P < .05) from values obtained after cordopexy alone (2.74 +/- 0.37, 1.76 +/- 0.48 cm H2O/L/s) or in control larynges (3.66 +/- 0.54, 4.16 +/- 0.96 cm H2O/L/s). Overall, a cordopexy plus modified laryngoplasty (9.69 cm2), a standard laryngoplasty (9.34 cm2), and a cordopexy alone (9 cm2) resulted in an increased glottic CSA greater than that for control larynges (6.94 cm2; P = .0001). CONCLUSIONS Cordopexy alone did not improve airflow in a left laryngeal hemiplegic model. Cordopexy plus modified laryngoplasty was as efficacious as the standard laryngoplasty in alleviating the effects of left laryngeal hemiplegia on TI, glottic CSA, and arytenoid RLQ. CLINICAL RELEVANCE Fixation of the vocal cord (cordopexy) in addition to a laryngoplasty procedure may prove useful in the surgical treatment of equine laryngeal hemiplegia.
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Affiliation(s)
- N Jansson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Schumacher J, Wilson AM, Pardoe C, Easter JL. In vitro evaluation of a novel prosthesis for laryngoplasty of horses with recurrent laryngeal neuropathy. Equine Vet J 2000; 32:43-6. [PMID: 10661384 DOI: 10.2746/042516400777611991] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A prosthesis, composed of a steel cable and stress-reducing washers, was developed to prevent failure of laryngoplasty, a common treatment for horses affected by recurrent laryngeal neuropathy. Laryngoplasties were performed on 15 cadaveric larynges using a polyester suture on one side and the cable prosthesis on the other. Each prosthesis was distracted at a displacement rate of 20 mm/s using a servohydraulic materials testing machine until laryngoplasty failed. Distraction force and actuator displacement were recorded and analysed. All 15 laryngoplasties performed with a suture failed at the muscular process at a mean +/- s.d. force of 55.8 +/- 13.1 N. Six laryngoplasties performed with the cable prosthesis failed at the muscular process at mean force 219.6 +/- 125.0 N. In the other 9, the arytenoid cartilage was avulsed from the larynx at mean force 206.4 +/- 75.3 N, and the cable then tore through the muscular process at mean force 357.0 +/- 32.0 N. The difference in force required to cause failure of laryngoplasty was significant (P<0.0001). Although the prosthesis resisted substantially higher forces than did the suture, the effects of the prosthesis in vivo must be evaluated.
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Affiliation(s)
- J Schumacher
- Department of Farm Animal and Equine Medicine and Surgery, The Royal Veterinary College, University of London, Hatfield, Herts
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35
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Hawkins JF, Tulleners EP, Ross MW, Evans LH, Raker CW. Laryngoplasty with or without ventriculectomy for treatment of left laryngeal hemiplegia in 230 racehorses. Vet Surg 1997; 26:484-91. [PMID: 9387213 DOI: 10.1111/j.1532-950x.1997.tb00521.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the influence of laryngoplasty on racing performance and to determine if any of the following variables had a significant effect on outcome: breed (Thoroughbred v Standardbred), endoscopic grade of laryngeal function, ventriculectomy versus no ventriculectomy, type of prosthetic suture used, and number of prostheses placed. STUDY DESIGN Retrospective study of laryngoplasty with or without ventriculectomy for treatment of left laryngeal hemiplegia in racehorses between 1986 and 1993. ANIMALS OR SAMPLE POPULATION 230 horses (174 Thoroughbreds, 56 Standardbreds). METHODS The medical records of racehorses or horses intended for racing were reviewed. Signalment, admitting complaints, physical examination findings, resting endoscopic grade of laryngeal function, type of prosthetic suture material used, number of prosthetic sutures placed, presence or absence of ventriculectomy, and postoperative complications were recorded. RESULTS Upper respiratory tract noise and exercise intolerance were the most common presenting complaints. Two horses had a laryngeal grade of 2, 109 horses a laryngeal grade of 3, and 119 horses a laryngeal grade of 4. Two double-strand braided polyester sutures were used in 147 horses, a single double-strand polyester suture was used in 49 horses, and a single double-strand nylon suture was used in 34 horses. Ventriculectomy was performed on 186 horses. The most common complication recognized during hospitalization was coughing in 50 horses. Telephone follow-up was obtained for 176 horses. For 168 horses, respiratory noise after surgery was decreased in 126 horses, the same in 28, and increased in 14. After hospital discharge, coughing occurred in 43 of 166 horses, and a nasal discharge occurred in 26 horses. Postoperative racing performance for 167 horses was subjectively evaluated by respondents as being improved in 69% of the horses. Overall owner satisfaction with the outcome after surgery was 81%. Of 230 horses, 178 raced at least one time after surgery. Overall, 117 horses raced three or more times before and after surgery, and 65 of these horses had improved performance index scores. None of the variables of surgical interest affected performance index scores. CONCLUSIONS AND CLINICAL RELEVANCE Laryngoplasty with or without ventriculectomy allowed 77% of the horses to race at least one time after surgery, improved racing performance in 56% of the horses that completed three races before and after surgery, and improved subjectively evaluated racing performance in 69% of the horses.
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Affiliation(s)
- J F Hawkins
- Department of Clinical Studies, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, USA
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37
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Valdes-Vazquez M, Aguilera-Tejero E, Mayer-Valor R. Effect of xylazine during endoscopic evaluation of functional upper respiratory disorders in horses. J Equine Vet Sci 1993. [DOI: 10.1016/s0737-0806(06)81087-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rakestraw PC, Hackett RP, Ducharme NG, Nielan GJ, Erb HN. Arytenoid cartilage movement in resting and exercising horses. Vet Surg 1991; 20:122-7. [PMID: 2042281 DOI: 10.1111/j.1532-950x.1991.tb00319.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Endoscopic examinations of the larynx were recorded on 49 horses at rest and while exercising on a 5% inclined high-speed treadmill for 8 minutes at a maximum speed of 8.5 m/sec. Subjective laryngeal function scores at rest and while exercising were based on the degree and synchrony of arytenoid abduction. Arytenoid abduction was expressed as a left:right ratio of rima glottidis measurements. Horses with arytenoid cartilage asynchrony at rest (grade 2) could not be distinguished from normal horses (grade 1) when exercising because full abduction was maintained throughout the exercise period. Five horses with incomplete left arytenoid abduction at rest (grade 3) maintained full abduction during exercise; one grade 3 horse had dynamic collapse of the left side of the larynx. All horses with laryngeal hemiplegia at rest (grade 4) had dynamic collapse of the left side of the larynx during exercise. Forty-two horses with a resting left:right arytenoid abduction ratio greater than or equal to .71 consistently had complete arytenoid abduction at exercise. Seven horses with a left:right ratio less than .71 consistently showed dynamic collapse at exercise. There was no significant difference in the exercising left:right ratio between normal horses (grade 1) and grade 2 or grade 3 horses. These results suggest that horses with arytenoid asynchrony at rest do not suffer progressive collapse of the rima glottidis during exercise, and that incomplete arytenoid abduction at rest is an unreliable predictor of such collapse. Surgical treatment of all grade 2 horses and some grade 3 horses may be inappropriate.
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Affiliation(s)
- P C Rakestraw
- Department of Clinical Sciences, New York State College of Veterinary Medicine, Cornell University, Ithaca 14853
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39
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Affiliation(s)
- J G Lane
- Department of Veterinary Surgery, University of Bristol, Langford
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40
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Affiliation(s)
- V C Speirs
- University of Melbourne, Veterinary Clinical Centre, Werribee, Victoria, Australia
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41
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Speirs VC, Bourke JM, Anderson GA. Assessment of the efficacy of an abductor muscle prosthesis for treatment of laryngeal hemiplegia in horses. Aust Vet J 1983; 60:294-9. [PMID: 6651666 DOI: 10.1111/j.1751-0813.1983.tb02812.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Four variations of abductor muscle prosthesis for treating laryngeal hemiplegia were evaluated in 153 horses by questionnaire, and in the 100 Thoroughbred racehorses in this group survival analysis was used to compare their racing performances and earnings with those of 400 control horses. The questionnaire indicated that the technique which included a ventriculectomy and 2 prostheses was regarded as being the most successful (P less than 0.01) and resulted in the least residual stertor (P less than 0.001). Survival analysis showed that there was no significant difference between the treated group of horses and the control horses (P greater than 0.05).
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