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Watkins AR, Ford M, van Eps AW, Stefanovski D, Parente EJ. The effect of cyanoacrylate on knot elongation in three sutures used for prosthetic laryngoplasty in the horse. Vet Surg 2023; 52:428-434. [PMID: 36691965 DOI: 10.1111/vsu.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study investigated the elongation following cyclic loading on square knots of 5 USP multifilament long-chain ultra-high molecular weight polyethylene core (UHMWPE), 2 mm woven UHMWPE tape, and 5 USP braided polyester, with and without cyanoacrylate glue. STUDY DESIGN Experimental study. SAMPLE POPULATION n = 4. METHODS Three conditions (suture without knot, suture with knot, suture with knot + cyanoacrylate) were evaluated for each suture material on a mechanical test stand by measuring the increased length of the construct after cycling from 25 to 50N for 1000 repetitions at 20 mm/second. Knot elongation was determined by subtracting the length of the control suture from the suture with knot or suture with knot + cyanoacrylate. The data were analyzed with a linear regression model with robust estimation of variance. Post-hoc analysis determined the model adjusted differences (square knot vs. cyanoacrylate) as a difference from control. t-tests were conducted to identify the significant findings. RESULTS Total elongation of polyester (6.2-7.8 mm) was greater than multifilament UHMWPE (3.4-6.4 mm) and UHMWPE tape (2-3.7 mm) for all conditions. Polyester had the lowest knot elongation (1.6 mm) and the addition of cyanoacrylate decreased knot elongation for polyester by 1 mm. CONCLUSIONS Polyester had the most total construct elongation followed by multifilament UHMWPE and UHMWPE tape. Polyester showed the least knot elongation and cyanoacrylate decreased this knot elongation. CLINICAL SIGNIFICANCE Total construct and knot elongation should be considered as contributing factors to loss of arytenoid abduction following prosthetic laryngoplasty when using polyester, multifilament UHMWPE, or UHMWPE tape. Addition of cyanoacrylate to polyester knots should be explored to limit elongation.
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Affiliation(s)
- Amanda R Watkins
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Matt Ford
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Andrew W van Eps
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Darko Stefanovski
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Eric J Parente
- University of Pennsylvania New Bolton Center, Kennett Square, Pennsylvania, USA
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Byrne CA, Hotchkiss JW, Barakzai SZ. Variations in the application of equine prosthetic laryngoplasty: A survey of 128 equine surgeons. Vet Surg 2023; 52:209-220. [PMID: 36420588 PMCID: PMC10100511 DOI: 10.1111/vsu.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To document variations in the application of equine prosthetic laryngoplasty among equine surgeons. STUDY DESIGN Cross-sectional survey. SAMPLE POPULATION Six hundred and seventy-eight equine surgeons performing prosthetic laryngoplasty. METHODS An online questionnaire was sent to equine surgeons, including diplomates of the American College of Veterinary Surgeons and European College of Veterinary Surgeons. Questions focused on participant profile, surgical technique, antimicrobial therapy, and concurrent procedures. Descriptive statistical analysis was performed on the survey output. RESULTS Complete responses were received from 128/678 individuals, mostly from experienced surgeons. Most participants used 2 prostheses (106/128, 82.8%) and a single loop was the most common method used to anchor the prosthesis in the cricoid (95/128, 74.2%) and arytenoid (125/128, 97.7%) cartilages. Use of general anesthesia was common, although 46/128 (35.9%) participants now performed most laryngoplasty surgery with standing sedation. The material used as a prosthesis varied among surgeons, although participants typically aimed to achieve grade 2 intraoperative arytenoid abduction. Participants most commonly administered perioperative systemic antimicrobial therapy for 1-3 days (57/128, 44.5%) and 48/128 (37.5%) used local antimicrobial therapy. CONCLUSION Most surgeons performed laryngoplasty with 2 prostheses, a single loop construct at the muscular process of the arytenoid cartilage and systemic antimicrobial therapy. There was variation in the preferred method of surgical restraint, prosthesis material selection, and use of local antimicrobial therapy. CLINICAL SIGNIFICANCE Long-established techniques remain popular in clinical practice despite evidence that variations offer advantages, particularly in relation to biomechanics. Other factors are also likely to influence technique selection in a clinical context.
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Broyles AH, Embertson RM, Brett Woodie J, Machado V. The impact of grade of laryngeal function immediately prior to laryngoplasty and ipsilateral ventriculocordectomy on postoperative performance: 623 Thoroughbred racehorses (1998-2013). Equine Vet J 2021; 54:856-864. [PMID: 34626125 DOI: 10.1111/evj.13523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is persistent concern among some trainers, owners and veterinarians regarding the effect of preoperative laryngeal function grade on the outcome of laryngoplasty and ventriculocordectomy (LPVC). OBJECTIVES To determine the effect of laryngeal function grade prior to LPVC on postoperative performance. STUDY DESIGN Retrospective case-series. METHODS Medical and race records of Thoroughbred racehorses diagnosed with recurrent laryngeal neuropathy (RLN) and treated with LPVC between 1998 and 2013 were reviewed. Horses were placed into three groups based on preoperative laryngeal function grade (grade III.1, grades III.2/III.3, and grade IV). The effect of preoperative laryngeal function grade on postoperative performance was determined by multivariable logistic regression, Cox proportional hazard model and multivariable linear regression analysis. RESULTS In a multivariable logistic regression, grade III.2/III.3 horses had 1.88 times higher odds (95% CI = 1.03-3.43) of racing after LPVC than grade IV (P = .04). A multivariable Cox's proportional hazard analysis controlling for race prior to surgery (P < .01) showed that likelihood of racing postoperatively was not different between grade III.1 and grade IV (P = .6), and although not statistically significant, there was a tendency for grades III.2/III.3 to be more likely to race postoperatively than horses with grade IV (P = .07). Kaplan-Meier survival analysis showed that grade IV horses took a longer time to race compared with grade III.1 and grade III.2/III.3. Laryngeal function grade did not influence the mean earnings per start. MAIN LIMITATIONS The small number of horses in the grade III.1 group compared with the III.2/III.3 and IV groups influenced the effect of grade III.1 on outcome. CONCLUSIONS Laryngeal function grade may affect likelihood of racing after LPVC, but not earnings per start. Grade III. 2/III.3 horses were more likely to race postoperatively than grade IV horses, and grade IV horses took a longer time to first race after LPVC.
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Affiliation(s)
- Ali H Broyles
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | | | - J Brett Woodie
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | - Vinicius Machado
- Department of Veterinary Sciences, Texas Tech University, Lubbock, Texas, USA
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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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Caspers MK, Bell CD, Tatarniuk DM. Transendoscopic Ventriculocordectomy Using Monopolar Electrosurgical Instrumentation for Conjunctive Treatment of Laryngeal Hemiplegia in Horses: 24 Cases (2017-2019). Front Vet Sci 2021; 8:628410. [PMID: 33732741 PMCID: PMC7957056 DOI: 10.3389/fvets.2021.628410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study is to evaluate the safety, efficacy, and owner satisfaction following electrosurgical ventriculocordectomy (EVC), in conjunction with prosthetic laryngoplasty, in equine clinical cases affected with left- or right-sided recurrent laryngeal neuropathy. Methods: Retrospective data analysis of clinical signalment, surgery, athletic outcome, intra- and postoperative complications, and postoperative examinations from clinical cases wherein EVC was performed in conjunction with traditional prosthetic laryngoplasty from one practice. Owners were contacted by phone or email for a follow-up questionnaire. Results: Twenty-four horses underwent unilateral EVC, performed transendoscopically under sedated restraint, using monopolar electrosurgical instrumentation successfully. One horse experienced excessive intraoperative hemorrhage. No horses demonstrated postoperative complications. Twenty cases had a history of increased airway noise prior to surgery. In 15 of these cases (15/20, 75%), the airway noise was reported as fully improved post-surgery. Eighteen cases had a history of exercise intolerance prior to surgery. In 15 of these cases (15/18; 83%), the exercise intolerance was reported as resolved. Conclusion: EVC, in conjunction with prosthetic laryngoplasty, can contribute to improvement of RLN symptoms and aid in the effective return to athletic work. Performing transendoscopic ventriculocordectomy with monopolar electrosurgical instrumentation provides comparable clinical outcomes to traditional techniques using a diode laser or direct excision via laryngotomy.
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Affiliation(s)
- McKenna K Caspers
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA, United States
| | - Chris D Bell
- Elders Equine Veterinary Services, Winnipeg, MB, Canada
| | - Dane M Tatarniuk
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA, United States
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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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Boorman S, Richardson DW, Hogan PM, Stefanovski D, Levine DG. Racing performance after surgical repair of medial condylar fracture of the third metacarpal/metatarsal bone in thoroughbred racehorses. Vet Surg 2020; 49:648-658. [PMID: 32133662 DOI: 10.1111/vsu.13403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/18/2020] [Accepted: 02/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report the performance of thoroughbred racehorses after surgical repair of a medial condylar fracture of the third metacarpal/metatarsal bone. STUDY DESIGN Retrospective cohort study. SAMPLE POPULATION Forty-three horses surgically treated for medial condylar fractures, 30 with previous racing experience, 13 without previous racing experience (nonexperienced). METHODS Medical records (2009-2017) were reviewed for signalment, radiographic fracture characteristics, repair technique, and postoperative morbidity and mortality. Each experienced horse was matched with two horses randomly selected from its most recent race to serve as healthy controls. Racing performance parameters (race rating, competitive level, speed rating, performance index) and career racing statistics were compared with multiple regression models between injured experienced horses and controls. The career racing statistics for nonexperienced horses were evaluated. Reasons for nonreturn to racing were obtained. RESULTS The median duration of follow-up was 6 years (minimum 2, maximum 10). Twenty-one of 43 (49%) horses raced again as well as 18 of 30 (60%) experienced horses and three of 13 (23%) nonexperienced horses. Experienced horses were five times more likely than nonexperienced horses to return to racing (95% confidence interval = 0.07-0.58, P = .003). Higher preoperative racing performance parameters were associated with return to racing. Racing performance parameters were lower after the date of fracture in injured horses compared with controls. CONCLUSION Experienced horses were more likely to return to racing after medial condylar fracture repair, although their performance was generally lower than that of comparably uninjured horses. CLINICAL SIGNIFICANCE Owners should be aware that horses with medial condylar fractures likely will race at a lower level than their uninjured peers.
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Affiliation(s)
- Sophie Boorman
- Department of Clinical Science, JT Vaughan Large Animal Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Dean W Richardson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | | | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - David G Levine
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
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Luedke LK, Cheetham J, Mohammed HO, Ducharme NG. Management of postoperative dysphagia after prosthetic laryngoplasty or arytenoidectomy. Vet Surg 2020; 49:529-539. [PMID: 32017140 DOI: 10.1111/vsu.13389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/13/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of various treatments for dysphagia after laryngeal surgery. STUDY DESIGN Retrospective. ANIMALS Horses treated for dysphagia after laryngeal surgery. METHODS Medical records of horses treated for dysphagia after prosthetic laryngoplasty (PLP) or partial arytenoidectomy (PA) were reviewed. Signalment, prior surgery, preoperative videoendoscopic diagnosis, and surgical treatments were recorded. Short- and long-term follow-up were obtained. Chi-square and logistical regression were performed to correlate independent variables and outcomes. RESULTS Forty-four percent of horses with prior PLP and 88% of horses with prior PA had persistent resting dorsal displacement of the soft palate (DDSP). Vocal fold augmentation (VFA) as a single treatment was most commonly performed (n = 22), followed by laryngoplasty removal (LPR; n = 1). Fifteen horses received a combination of treatments: VFA (n = 15), LPR (n = 4), laryngeal tie-forward (LTF; n = 2), and esophageal release (n = 1). Short-term clinical outcomes were reported; 80% of horses treated with VFA (n = 35) had resolution of dysphagia, and 20% were improved. Among the 33 horses available to long-term follow-up, 31 (94%) returned to some level of work, and DDSP during work was reportedly resolved in 23 of 25 horses. CONCLUSION Vocal fold augmentation resulted in resolution of symptoms relating to dysphagia in 81% of horses. Twenty percent of horses treated with LPR had sustained resolution of dysphagia. A combination of LPR, VFA, LTF was performed in 18% of horses. CLINICAL SIGNIFICANCE Treatment options directed at altering laryngeal geometry and/or position of the larynx were successful in resolving 86% of dysphagia in horses previously regarded as very difficult to treat.
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Affiliation(s)
- Lauren K Luedke
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Jonathan Cheetham
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Hussni O Mohammed
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Norm G Ducharme
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
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Miller S, Carstens A. Ultrasonographic findings post laryngoplasty in the horse. Vet Radiol Ultrasound 2019; 60:707-716. [PMID: 31313431 DOI: 10.1111/vru.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Laryngoplasty is commonly used to treat laryngeal hemiplegia in Thoroughbred racehorses. Evaluation of the success of the laryngoplasty is traditionally determined using endoscopy. Laryngeal ultrasonography and normal ultrasonographic appearance have been reported in the standing horse, but post-laryngoplasty and ventriculectomy ultrasonographic evaluation has limited literature coverage. A prospective case series of 10 Thoroughbred racehorses with left laryngeal hemiplegia was examined ultrasonographically and endoscopically prior to 3-10 days, 30-50 days, and 6-12 months after laryngoplasty and ventriculectomy. Anatomical structures and Plica vocalis movements were described and measurements and gradings analyzed by repeated means analysis of variance (P < .05). Postsurgical ultrasonographic visualization of Ventriculus laryngis entrances was possible. The distance between Plica vocalis in exhalation was significantly larger than that during inhalation (P < .05). Pre- and postsurgical caudal Basihyoideum and rostral Cartilago thyroidea depth was significantly different in some instances (P < .05). No significant differences in the Muscularis cricoarytenoideus lateralis measurements were found. Complications in the extra-luminal structures were found in seven horses including soft tissue swelling, seroma, and hematoma. A luminal Plica vocalis abscess and Plica vocalis granuloma were also detected ultrasonographically. Ultrasonography can be used to evaluate the post-laryngoplasty horse for assessing the success of the procedure, monitoring healing, and detecting complications.
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Affiliation(s)
- Sean Miller
- Section Diagnostic Imaging, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Ann Carstens
- Section Diagnostic Imaging, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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Gray SM, Gutierrez-Nibeyro SD, Secor EJ. Partial arytenoidectomy in 14 standing horses (2013-2017). Vet Surg 2019; 48:473-480. [PMID: 30883829 DOI: 10.1111/vsu.13192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/31/2018] [Accepted: 02/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our experience with partial arytenoidectomy in sedated standing horses. STUDY DESIGN Retrospective study. ANIMALS Fourteen client-owned adult horses. METHODS The medical records (2013-2017) of horses treated with unilateral partial arytenoidectomy while standing and sedated were reviewed. Demographics, endoscopic findings, previous treatments, and outcome after surgery were investigated and recorded. RESULTS Thirteen horses had unilateral left-sided recurrent laryngeal neuropathy (RLN) and 1 horse had bilateral RLN. Five horses had a previous failed prosthetic laryngoplasty. Left-sided partial arytenoidectomy without mucosal closure was successfully completed in all horses under sedation and local anesthesia. Report of long-term outcome was obtained via telephone conversations for 12 horses, of which 9 also had an endoscopic reevaluation performed; 3 horses had granulomas at the surgical site, of which 2 eventually required a permanent tracheostomy. Nine horses returned to athletic use without respiratory noise, 2 horses returned to athletic use with noise during exercise that was reduced compared with preoperative levels, and 1 horse continued to be used as a broodmare. CONCLUSION Partial arytenoidectomy in standing horses was achieved with adequate sedation and local anesthesia. CLINICAL SIGNIFICANCE Partial arytenoidectomy on standing sedated horses could be considered as an alternative to eliminate the risks associated with general anesthesia.
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Affiliation(s)
- Sarah M Gray
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Santiago D Gutierrez-Nibeyro
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Erica J Secor
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
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Krueger CR, Lewis RD, McIlwraith CW, Major MD, Brakenhoff JE, Hand DR, Rowland AL, Hess AM, Johnson SW, Hackett ES. A retrospective cohort study of racing performance in Quarter Horses undergoing prosthetic laryngoplasty for treatment of recurrent laryngeal neuropathy. J Am Vet Med Assoc 2019; 254:496-500. [PMID: 30714865 DOI: 10.2460/javma.254.4.496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine effects of prosthetic laryngoplasty on return to racing, performance index, and career longevity in racing Quarter Horses with recurrent laryngeal neuropathy (RLN) and to evaluate performance variables for horses with RLN undergoing prosthetic laryngoplasty, compared with a control horse population. DESIGN Multicenter, retrospective cohort study. ANIMALS 162 racing Quarter Horses with RLN treated with prosthetic laryngoplasty (case horses) and 324 racing Quarter Horse without RLN (control horses). PROCEDURES Medical and race records of case and control horses examined at 5 referral centers between January 2000 and December 2015 were reviewed retrospectively. Two control horses were matched with each case horse. Return to racing, earnings, number of racing starts, performance index, and career longevity were evaluated. RESULTS The odds of returning to racing did not differ significantly between case and control horses but decreased with increasing age. Neither racing starts nor career longevity were affected by prosthetic laryngoplasty or by RLN grade. In fact, horses undergoing laryngoplasty for treatment of RLN and horses with the lowest RLN grade before surgery had higher performance indices after the surgery, compared with indices for control horses. CONCLUSIONS AND CLINICAL RELEVANCE The faster speeds and shorter distances raced with Quarter Horses could alter how RLN impacts respiratory variables and performance in Quarter Horses, compared with other racehorse breeds. Further study is needed to understand the impacts of RLN and surgical treatments for RLN in racing Quarter Horses.
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12
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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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Brandenberger O, Martens A, Robert C, Wiemer P, Pamela H, Vlaminck L, Barankova K, Haspeslagh M, Perkins JD, Ducharme N, Rossignol F. Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses. Vet Surg 2018; 47:942-950. [DOI: 10.1111/vsu.12944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Olivier Brandenberger
- Equine Clinic of Grosbois; Boissy St Leger France
- Hanseklinikfür Pferde; Sittensen Germany
| | - Ann Martens
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Céline Robert
- Université Paris-Est, Ecole Vétérinaire d'Alfort; Departement Anatomie; Maisons-Alfort France
| | - Peter Wiemer
- De Lingehoeve Diergeneeskunde; Lienden The Netherlands
| | - Hugo Pamela
- Equine Clinic of Grosbois; Boissy St Leger France
| | - Lieven Vlaminck
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | | | - Maarten Haspeslagh
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Justin D. Perkins
- Department of Veterinary Clinical Sciences; Royal Veterinary College; North Mymms United Kingdom
| | - Norm Ducharme
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca New York
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Parente EJ. Upper Airway Conditions Affecting the Equine Athlete. Vet Clin North Am Equine Pract 2018; 34:427-441. [DOI: 10.1016/j.cveq.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Secor EJ, Gutierrez-Nibeyro SD, Horn GP. Biomechanical evaluation of modified laryngoplasty by use of a toggle technique for stabilization of arytenoid cartilage in specimens obtained from equine cadavers. Am J Vet Res 2018; 79:226-232. [DOI: 10.2460/ajvr.79.2.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Parente EJ. Fifty years of recurring struggles with recurrent laryngeal neuropathy. Equine Vet J 2017; 50:155-158. [PMID: 28976020 DOI: 10.1111/evj.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
Recurrent laryngeal neuropathy appears to be a simple problem that should have a simple solution, yet the complexity and dynamic nature of laryngeal function is underappreciated. This review highlights the challenges and accomplishments that work towards that greater understanding of what is necessary to find a successful solution.
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Affiliation(s)
- E J Parente
- New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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17
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Wylie CE, Newton JR. A systematic literature search to identify performance measure outcomes used in clinical studies of racehorses. Equine Vet J 2017; 50:304-311. [DOI: 10.1111/evj.12757] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- C. E. Wylie
- Rossdales Equine Hospital; Exning, Newmarket Suffolk, UK
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18
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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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Markwell HJ, Mueller POE. Ex Vivo Mechanical Evaluation of a Sternal ZipFix(®) Implant for Prosthetic Laryngoplasty in Horses. Vet Surg 2016; 45:450-5. [PMID: 27010116 DOI: 10.1111/vsu.12466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the properties of a ZipFix(®) (ZipFix) implant in equine laryngeal cartilages. STUDY DESIGN Ex vivo biomechanical study. SAMPLE POPULATION Equine arytenoid (n=36) and cricoid cartilages (n=18). METHODS Suture bites were placed in arytenoid or cricoid cartilages using a ZipFix(®) implant or a single strand of USP 5 braided polyester (TiCron™), and arytenoid and cricoid cartilages were separately subjected to single load to failure (25 N preload) or cyclic loading for 1,000 cycles, followed by single load to failure. Load, distraction, and stiffness were recorded. RESULTS Four arytenoid-ZipFix cartilages fractured on implant placement. Under single load, arytenoid-ZipFix (n=9) failed at a greater mean load (359.01 ± 57.98 N) than arytenoid-Ticron (159.11 ± 22.98 N; n=12; P<.001). Arytenoid-ZipFix stiffness (31.32 ± 4.26 N/mm) was significantly greater than arytenoid-Ticron (13.18 ± 2.60 N/mm; P<.001). Cricoid-ZipFix stiffness (20.83 ± 3.37 N/mm) was significantly greater than cricoid-Ticron (13.6 ± 3.82 N/mm; n=6; P=.006). Under cyclic load, arytenoid-ZipFix distraction (2.53 ± 0.63 mm; n=5) was significantly less than arytenoid-Ticron (5.06 ± 1.37 mm; n=6, P=.006). After cyclic load, arytenoid-ZipFix failure load (295.16 ± 54.95 N) was significantly greater than arytenoid-Ticron (127.69 ± 32.67 N; P=.002). Arytenoid-ZipFix stiffness (35.59 ± 1.58 N/mm) was significantly greater than arytenoid-Ticron (24.10 ± 6.85 N/mm; P=.019). CONCLUSION In arytenoid cartilages, the sternal ZipFix(®) implant was significantly stronger and stiffer compared to a single strand of Ticron. During placement of the ZipFix(®) implant, frequent arytenoid cartilage failure occurred before testing, suggesting the implant is not suitable for clinical application.
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Affiliation(s)
- Harry J Markwell
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - P O Eric Mueller
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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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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Rossignol F, Vitte A, Boening J, Maher M, Lechartier A, Brandenberger O, Martin-Flores M, Lang H, Walker W, Ducharme NG. Laryngoplasty in standing horses. Vet Surg 2015; 44:341-7. [PMID: 25864499 DOI: 10.1111/vsu.12307] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the clinical experience with standing laryngoplasty in a series of horses mostly nonracing. STUDY DESIGN Case series. ANIMALS Seventy-one client-owned horses. METHODS Medical records (April 2008-February 2014) of horses treated by standing laryngoplasty for abnormal respiratory noise and or poor performance were reviewed. Horses were included if they had a diagnosis of idiopathic right or left recurrent laryngeal neuropathy confirmed by videoendoscopy. All horses underwent a unilateral laryngoplasty with a unilateral or bilateral ventriculectomy or ventriculocordectomy. Follow-up endoscopy was performed in all horses within 24 hours postoperative, in 24 horses at 2-weeks, and in 65 horses at 6 weeks. Late follow-up was obtained from the trainer, owner, or referring veterinarian by telephone. RESULTS Laryngoplasty was performed under endoscopic guidance with the horses sedated, and the surgical site was desensitized with local anesthetic solution. Laryngoplasty was completed in all horses and was well tolerated. No hyperabduction was observed. Two horses developed incisional swelling that resolved with drainage only. Late follow-up reported satisfactory improvement in respiration in all but 3 horses. CONCLUSIONS Laryngoplasty performed with the horse standing avoids risks associated with general anesthesia and recovery and yields comparable results in nonracing horses, to laryngoplasty performed with the horse anesthetized. This technique reduces cost and allows accurate intraoperative adjustment of the degree of arytenoid abduction.
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Affiliation(s)
- Fabrice Rossignol
- Clinique Equine de Grosbois, Domaine de Grosbois, Boissy Saint Léger, France
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22
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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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24
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Senior JM. Mitigating the risk of airway obstruction during recovery from anaesthesia: The way is far from clear. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. M. Senior
- Philip Leverhulme Equine Hospital; University of Liverpool; School of Veterinary Science; Leahurst Campus Neston South Wirral UK
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25
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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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26
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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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27
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Raffetto JA, Wearn JG, Fischer AT. Racing performance following prosthetic laryngoplasty using a polyurethane prosthesis combined with a laser-assisted ventriculocordectomy for treatment of recurrent laryngeal neuropathy in 78 Thoroughbred racehorses. Equine Vet J 2014; 47:60-4. [DOI: 10.1111/evj.12237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. A. Raffetto
- Chino Valley Equine Hospital; Chino Hills California USA
| | - J. G. Wearn
- Gold Coast Equine Hospital; Bundall Queensland Australia
| | - A. T. Fischer
- Chino Valley Equine Hospital; Chino Hills California USA
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28
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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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Affiliation(s)
- T. J. Froydenlund
- The Royal Dick School of Veterinary Studies and The Roslin InstituteThe University of EdinburghEaster Bush Veterinary Centre Scotland EH25 9RG UK
| | - P. M. Dixon
- The Royal Dick School of Veterinary Studies and The Roslin InstituteThe University of EdinburghEaster Bush Veterinary Centre Scotland EH25 9RG UK
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30
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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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Van Erck-Westergren E, Franklin SH, Bayly WM. Respiratory diseases and their effects on respiratory function and exercise capacity. Equine Vet J 2013; 45:376-87. [PMID: 23368813 DOI: 10.1111/evj.12028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 12/02/2012] [Indexed: 12/26/2022]
Abstract
Given that aerobic metabolism is the predominant energy pathway for most sports, the respiratory system can be a rate-limiting factor in the exercise capacity of fit and healthy horses. Consequently, respiratory diseases, even in mild forms, are potentially deleterious to any athletic performance. The functional impairment associated with a respiratory condition depends on the degree of severity of the disease and the equestrian discipline involved. Respiratory abnormalities generally result in an increase in respiratory impedance and work of breathing and a reduced level of ventilation that can be detected objectively by deterioration in breathing mechanics and arterial blood gas tensions and/or lactataemia. The overall prevalence of airway diseases is comparatively high in equine athletes and may affect the upper airways, lower airways or both. Diseases of the airways have been associated with a wide variety of anatomical and/or inflammatory conditions. In some instances, the diagnosis is challenging because conditions can be subclinical in horses at rest and become clinically relevant only during exercise. In such cases, an exercise test may be warranted in the evaluation of the patient. The design of the exercise test is critical to inducing the clinical signs of the problem and establishing an accurate diagnosis. Additional diagnostic techniques, such as airway sampling, can be valuable in the diagnosis of subclinical lower airway problems that have the capacity to impair performance. As all these techniques become more widely used in practice, they should inevitably enhance veterinarians' diagnostic capabilities and improve their assessment of treatment effectiveness and the long-term management of equine athletes.
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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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Ahern BJ, Boston RC, Parente EJ. In VitroMechanical Testing of an Alternate Laryngoplasty System(ALPS) for Horses. Vet Surg 2012. [DOI: 10.1111/j.1532-950x.2012.01061.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Benjamin J. Ahern
- Department of Clinical Studies; School of Veterinary Medicine; University of Pennsylvania; New Bolton Center; Kennett Square; PA
| | - Raymond C. Boston
- Department of Clinical Studies; School of Veterinary Medicine; University of Pennsylvania; New Bolton Center; Kennett Square; PA
| | - Eric J. Parente
- Department of Clinical Studies; School of Veterinary Medicine; University of Pennsylvania; New Bolton Center; Kennett Square; PA
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Compostella F, Tremaine WH, Franklin SH. Retrospective study investigating causes of abnormal respiratory noise in horses following prosthetic laryngoplasty. Equine Vet J 2012:27-30. [DOI: 10.1111/j.2042-3306.2012.00612.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mason BJ, Riggs CM, Cogger N. Cohort study examining long-term respiratory health, career duration and racing performance in racehorses that undergo left-sided prosthetic laryngoplasty and ventriculocordectomy surgery for treatment of left-sided laryngeal hemiplegia. Equine Vet J 2012; 45:229-34. [PMID: 22812572 DOI: 10.1111/j.2042-3306.2012.00601.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
REASONS FOR PERFORMING STUDY The risk of respiratory conditions, such as inflammatory airway disease (IAD) and exercise-induced pulmonary haemorrhage (EIPH), are thought to be higher in racehorses that undergo prosthetic laryngoplasty with ventriculocordectomy (PLVC) surgery to treat left-sided laryngeal hemiplegia (LLH) than in racehorses with normal laryngeal function. However, this has not been investigated formally owing to the difficulty of obtaining reliable follow-up data. OBJECTIVES To determine the incidence of respiratory conditions (IAD and EIPH), duration of racing career, number of starts and number of starts for which stakes money was earned in racehorses that had undergone PLVC surgery to treat LLH, compared with racehorses that did not have LLH or undergo any laryngeal surgery. METHODS A retrospective cohort study design was used, with surgical, clinical and race data of Thoroughbred racehorses obtained from the time of importation until retirement. The surgical cohort consisted of racehorses that had undergone PLVC for LLH and met specific inclusion criteria. Every surgical case was matched, according to trainer, year of import into Hong Kong and pre-import international handicap rating, to 2 unexposed racehorses. RESULTS Respiratory conditions, such as excessive tracheal mucus and epistaxis due to severe EIPH, were significantly increased in the surgical cohort, compared with the matched unexposed cohort (P values <0.001 and <0.004, respectively). Racing career duration in the surgical cohort was significantly shorter than in the unexposed cohort, which was primarily due to retirement because of epistaxis. The number of race starts was fewer in the surgical than in the unexposed cohort after surgery/matching, but the number of starts for which stakes money was earned was not significantly different. CONCLUSIONS AND POTENTIAL RELEVANCE Owners and trainers should be advised that racehorses with LLH that undergo PLVC surgery are at an increased risk of respiratory conditions (IAD and severe EIPH), which is likely to shorten their racing career compared to racehorses with normal laryngeal function. Racing performance in terms of race starts was significantly less in racehorses that had undergone PLVC surgery; however, the number of starts for which stakes money was earned was similar to those racehorses that were unexposed.
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Affiliation(s)
- B J Mason
- Department of Veterinary Clinical Services, Hong Kong Jockey Club, Sha Tin Racecourse, Hong Kong, China.
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36
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Aceto H, Parente EJ. Using Quarterly Earnings to Assess Racing Performance in 70 Thoroughbreds after Modified Laryngoplasty for Treatment of Recurrent Laryngeal Neuropathy. Vet Surg 2012; 41:689-95. [DOI: 10.1111/j.1532-950x.2012.01017.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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DAHLBERG JA, VALDES-MARTINEZ A, BOSTON RC, PARENTE EJ. Analysis of conformational variations of the cricoid cartilages in Thoroughbred horses using computed tomography. Equine Vet J 2011; 43:229-34. [DOI: 10.1111/j.2042-3306.2010.00070.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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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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WITTE SHP, WITTE TH, HARRISS F, KELLY G, POLLOCK P. Association of owner-reported noise with findings during dynamic respiratory endoscopy in Thoroughbred racehorses. Equine Vet J 2010; 43:9-17. [DOI: 10.1111/j.2042-3306.2010.00152.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Cheetham J, Riordan AS, Mohammed HO, McIlwraith CW, Fortier LA. Relationships between race earnings and horse age, sex, gait, track surface and number of race starts for Thoroughbred and Standardbred racehorses in North America. Equine Vet J 2010; 42:346-50. [PMID: 20525054 DOI: 10.1111/j.2042-3306.2010.00032.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
REASONS FOR PERFORMING STUDY There is no consensus on objective outcome measures that can be used to determine if a medical or surgical treatment affects race performance. OBJECTIVE To determine the association between 2 commonly used outcome measures (total starts and total earnings) and age, sex, gait and race surface. METHODS A cross-sectional study was performed using the race performance data for all Thoroughbred horses age 2, 3, 4 and 5 years racing in the United States, and Standardbred horses of the same ages racing in the United States and Canada during the year 2006. Median earnings and starts were determined for each combination of age, sex and track surface (for Thoroughbred) or gait (for Standardbred). The effect these variables had on starts on race earnings ($) was determined using linear regression. RESULTS Race records for 68,649 Thoroughbreds and 25,830 Standardbreds were obtained. All independent variables (age, breed, sex, gait, track surface and total number of starts) had a significant impact on total earnings (P<0.0001). CONCLUSIONS The data show considerable variation across age groups and track surfaces for Thoroughbreds and across age groups for Standardbreds. They also show that the decision to use earnings or starts as outcome measures could have a marked effect on reported success for a particular treatment. POTENTIAL RELEVANCE Both earning and start data should be reported in studies evaluating outcome following surgery or other intervention. Considerations of age, breed, sex, track surface and gait should be included in the design of these studies.
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Affiliation(s)
- J Cheetham
- Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA
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Abstract
REASON FOR PERFORMING STUDY Dynamic pharyngeal collapse (PC) is a condition seen in racehorses that can be career-ending. OBJECTIVES To characterise and grade PC and describe the effects of PC on athletic performance. METHODS Medical records were reviewed for 828 horses, of which 49 (6%) records were identified as horses with a primary diagnosis of PC. Tapes of video-endoscopy of the pharynx during exercise were reviewed. Each video recording was assigned a grade (0-4) reflecting the degree of PC and a classification for severity of upper airway obstruction. Earnings per race prior to diagnosis of PC were compared to earnings per race after diagnosis of PC for all horses, as well as performance index (PI). Available exercising arterial blood gases were reviewed for horses with PC. RESULTS There were 35 (80%) Thoroughbreds (TB), and 9 (20%) Standardbreds (STD). 32 (73%) had a history of making an upper respiratory noise. 4 (9%) grade 1 PC, 8 (18%) grade 2 PC, 26 (59%) grade 3 PC, and 6 (14%) grade 4 PC. Seven (16%) horses were classified as mild PC, 18 (41%) as low-moderate PC, 14 (32%) as high-moderate PC, and 5 (11%) as severe PC. Of 30 horses 11 had abnormally decreased PaO2 and 8 horses had abnormally elevated PaCO2. A significant decrease was found in earnings per race prediagnosis when compared to post diagnosis earnings per race in horses > or =4 years of age (P = 0.003). A significant decrease was also observed for earnings per race prediagnosis when compared to post diagnosis earnings per race in horses with grade 3 PC (P = 0.03) No significant differences were observed in PI before or after diagnosis of PC. CONCLUSIONS There was a trend for PC to be observed in more TB than STD, and more males than females compared to the general hospital population. Horses with PC significant had decreases in arterial oxygenation. Racing records after a diagnosis of PC in all horses > or = 4 years of age suggesting that older horses have a guarded prognosis for continued success. POTENTIAL RELEVANCE This study provides a classification system for dynamic pharyngeal collapse and suggests that older racehorses (> or = 4 years of age) diagnosed with PC and all horses with grade 3 PC have a poor prognosis for return to previous level of performance.
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Affiliation(s)
- A G Boyle
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, 382 W Street Road, Kennett Square, Pennsylvania 19348, USA
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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 SZ, Johnson VS, Baird DH, Bladon B, Lane JG. Assessment of the efficacy of composite surgery for the treatment of dorsal displacement of the soft palate in a group of 53 racing Thoroughbreds (1990-1996). Equine Vet J 2010; 36:175-9. [PMID: 15038442 DOI: 10.2746/0425164044868701] [Citation(s) in RCA: 22] [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
REASONS FOR PERFORMING STUDY There has been no objectively assessed case-control study of the efficacy of surgery to correct dorsal displacement of the soft palate (DDSP) previously reported. HYPOTHESIS Composite surgery has a beneficial result on racing performance in horses affected with DDSP as compared to a matched control population. METHODS Race records were obtained for 53 racing Thoroughbreds which underwent composite staphylectomy, sternothyrohyoideus myectomy and ventriculectomy for correction of idiopathic DDSP at the University of Bristol between 1990 and 1996. Each surgical case was matched for age, sex and training yard with 2 control horses. The racing performance, based on prize money won, of surgical cases and control horses were compared for 3 races run before and after the date of surgery. RESULTS Ninety-two percent of the surgical cases returned to racing after surgery. There was a significant increase in earnings of the surgical group before and after surgery (P = 0.011), but there was no significant difference in earnings of the control group before and after the date of surgery (P = 0335). Sixty percent of the surgical group had higher earnings after surgery than before, compared to 40% of controls. When horses which underwent surgery were ranked relative to their 2 matched controls, surgical cases did not significantly change in rank (P = 033), whereas control horses significantly decreased in rank (P = 0.012). Additionally, horses within the surgical group were more likely (P < 0.01) to start in 3 post operative races than those in the control group. CONCLUSIONS AND POTENTIAL RELEVANCE Composite surgery had a beneficial effect on racing performance of horses afflicted with idiopathic DDSP, and further studies to evaluate objectively the usefulness of other surgical techniques are warranted.
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Affiliation(s)
- S Z Barakzai
- Large Animal Hospital, Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, Easter Bush, Midlothian EH25 9RG, UK
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Woodie JB, Ducharme NG, Kanter P, Hackett RP, Erb HN. Surgical advancement of the larynx (laryngeal tie-forward) as a treatment for dorsal displacement of the soft palate in horses: a prospective study 2001-2004. Equine Vet J 2010; 37:418-23. [PMID: 16163943 DOI: 10.2746/042516405774480076] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Correct placement of sutures ('laryngeal tie-forward') in experimentally created dorsal displacement of the soft palate (DDSP) has been observed to replace the function of the thyrohyoideus muscles and prevent DDSP. HYPOTHESIS The 'laryngeal tie-forward' procedure would prevent or delay the occurrence of DDSP during exercise in horses with naturally occurring DDSP and therefore improve performance. METHODS A clinical population (n = 116), mainly of racehorses was presented for treatment of naturally occurring exercise-induced DDSP. All horses underwent the 'laryngeal tie-forward' procedure. The relative position of the thyroid and cricoid cartilage in relation to the caudal aspect of the basihyoid bone was recorded; follow-up was obtained by telephone communication with trainers, owners and/or referring veterinarians. In addition, a performance index and earnings were determined using race records. RESULTS Preoperatively, the median distance between the caudal aspect of the basihyoid bone and rostral aspect of the thyroid cartilage was 3.5 cm. Post operatively, the thyroid cartilage was moved a median distance of 4 cm rostrally and the larynx was shown to be in a position more rostral and dorsal than in preoperative radiographs. Of 98 horses for which follow-up was available, the performance of 87% was classified as improved, 12% as unchanged and 2% as worse. In 20 horses in which the diagnosis had been confirmed by treadmill videoendoscopy, 80% had a significantly increased performance index and earnings (P = 0.007). For the entire population, there was a significant improvement in performance index and earnings after surgery (82%) (P = 0.0001). CONCLUSIONS Placing the larynx in a more rostral and dorsal position may have improved the performance in 80-82% of the horses affected with naturally-occurring DDSP. POTENTIAL RELEVANCE 'Laryngeal tie-forward' is a surgical technique that has a measurable effect on the position of the larynx and offers an alternative therapy for treating horses affected with DDSP. More experience may be needed with this technique prior to its widespread use in horses with a clinical diagnosis of DDSP.
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Affiliation(s)
- J B Woodie
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA
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