Permanent tracheostomy in standing horses: technique and results

Indications for and short- and long-term outcome of permanent tracheostomy performed in standing horses: 82 cases (1995-2005)

OBJECTIVE

To identify indications for and short- and long-term outcome of permanent tracheostomy performed in standing horses.

DESIGN

Retrospective case series.

ANIMALS

82 horses undergoing permanent tracheostomy.

PROCEDURES

Data obtained from medical records included signalment, diagnosis, surgical technique, complications, use of the horse before and after surgery, and owner satisfaction. Follow-up information was obtained through a telephone questionnaire administered to owners.

RESULTS

Indications for permanent tracheostomy included nasopharyngeal cicatrix (n = 59), arytenoid chondropathy (55), and laryngeal hemiplegia (20); 54 horses had multiple indications for tracheostomy. Complications identified prior to discharge included partial dehiscence (n = 8), transient fever (10), and excessive swelling (13). Complications identified after discharge included partial dehiscence (n = 3), inversion of skin (2), and stenosis of the tracheostomy requiring repair (1). Long-term follow-up information was available for 64 horses. Fifty-seven of the 64 (89%) horses returned to their previous use, and owners of 63 (98%) horses reported being very satisfied with the results. The owner of 1 (2%) horse was unsatisfied with the results. The 1-year survival rate was 97% (95% confidence interval, 95% to 100%). Mean estimated truncated survival time (ie, failure-free period) was 9.7 years (95% confidence interval, 9.3 to 10.1 years).

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that permanent tracheostomy can be safely performed in standing horses and was a viable treatment for horses with obstructive disease of the upper respiratory tract that was unresponsive to medical treatment or other surgical treatments.

Placement of a long term tracheal cannula in a Thoroughbred racehorse with bilateral laryngeal dysfunction

A Thoroughbred horse with bilateral laryngeal dysfunction was treated by placement of a long term tracheal cannula in order to restore full athletic function. The horse initially presented with right-sided arytenoid dysfunction that was considered to be due to a congenital malformation of the laryngeal cartilage. This was corrected by a right-sided laryngoplasty and ventriculectomy. The horse re-presented 1 year later with idiopathic left laryngeal hemiplegia. The decision was made to place a long-term tracheal cannula due to the low success rate and high complication rate associated with other surgeries used to correct bilateral arytenoid dysfunction. A three-piece tracheotomy cannula and stopper were positioned under general anaesthesia. The horse rapidly adjusted to the tracheal cannula and no post-surgical complications were encountered. The horse resumed training 4 weeks postoperatively. Due to the rules governing racing in Australia the horse was exported to New Zealand where he continued his racing career. It was concluded that tracheotomy is a straightforward technique associated with minimal complications and can provide an excellent prognosis for return of full airway function in racing horses. It is recognised that many issues need to be considered prior to more general acceptance of this technique, including assessment of animal welfare issues and public perception. In appropriate cases consideration should be given to using long term placement of a tracheotomy cannula as a treatment option to restore maximal airflow in horses with upper airway obstruction.

Management of neck and head injuries

The horse, a flight animal that is used extensively by man, frequently receives injuries to its neck or head that result mostly from its management and handling. Better facilities, training of the horse, and horsemanship skills of the handler could prevent many of these injuries. Because many body systems can be involved, with potentially major consequences regarding health, performance, and appearance, early recognition of trauma and competent treatment are crucial. Progress has been made in the treatment of some tracheal and esophageal injuries. Severe tracheal trauma and rupture of the esophagus still represent major challenges for the attending veterinarian, however. Lacerations of the head generally heal well, likely because of an abundant blood supply. Thorough yet conservative debridement is necessary, as is accurate reconstruction of the tissues to maintain normal function and an acceptable cosmetic appearance. Fractures of the facial bones can result in complications, such as sequestrum formation, sinusitis, nasolacrimal duct injury,facial deformity, and injury to or entrapment of the globe. An awareness of the treatment methods available can help to diminish the complication rate and to restore a normal or acceptable appearance.