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Large Animal Surgery. Equine Respiratory Sx Guttural Pouch Diseases. Amy Fayette November 2005. What are the indications for surgery. Exercise intolerance Poor performance Abnormal resp noise Mucopurulent nasal discharge Serosanguineous nasal discharge

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Large Animal Surgery


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large animal surgery

Large Animal Surgery

Equine Respiratory Sx

Guttural Pouch Diseases

Amy Fayette

November 2005

what are the indications for surgery
What are the indications for surgery
  • Exercise intolerance
  • Poor performance
  • Abnormal resp noise
  • Mucopurulent nasal discharge
  • Serosanguineous nasal discharge
  • External distortion of facial region
how do you diagnose redundant alar folds
How do you diagnose redundant alar folds
  • Place large temporary mattress sutures and see if the noise disappears
what is the most common complication of surgery for redundant alar folds
What is the most common complication of surgery for redundant alar folds
  • Highly vascular-> hemorrhage
what are the clinical signs of diseases of the nasal septum
What are the clinical signs of diseases of the nasal septum
  • Decreased or complete obstruction
  • Stridor
  • Discharge
  • Facial distortion
what are the preop considerations before operating on the nasal septum
What are the preop considerations before operating on the nasal septum
  • Collect 4-8 L of blood
  • Tracheotomy
what is the aftercare required for surgery of the nasal septum
What is the aftercare required for surgery of the nasal septum
  • 5-6 days systemic ATBs
  • 10 days NSAIDS
  • Remove packing 2 days post op
  • Remove tracheostomy tube
  • Clean and flush with saline
what is your diagnosis16
What is your diagnosis
  • Ethmoid hematoma
what are the cs of progressive ethmoid hematomas
What are the CS of progressive ethmoid hematomas
  • Epistaxis
  • Serosanguinous nasal exudate
  • Stridor
what is an ethmoid hematoma made up of on histopath
What is an ethmoid hematoma made up of on histopath
  • Outer: resp epithelium
  • Central: hemosiderin-filled macrophages
what is the causes of secondary sinusitis
What is the causes of secondary sinusitis
  • Dental disease
  • Facial fx
  • Cysts
  • Neoplasia
what are the cs of sinusitis
What are the CS of sinusitis
  • Nasal discharge: serosanguineous
  • Coughing
  • Facial deformity
what is the treatment for sinusitis
What is the treatment for sinusitis
  • Sinusotomy (trephination)
what is the aftercare instructions for sinusotomy
What is the aftercare instructions for sinusotomy
  • Leave open and flush daily
  • ATB and NSAIDS
what is cribbing
What is cribbing
  • Grasp object with incisors
  • Contract neck muscles
  • Pull backward
what are the causes of cribbing
What are the causes of cribbing
  • Boredom
  • Confinement
  • Isolation
  • Lack of roughage
  • Learn from others??
  • Genetic??
what are the consequences of cribbing
What are the consequences of cribbing
  • Colic ??
  • Abnormal wear of incisors
  • Weight loss
what are some non surgical treatments for cribbing
What are some non surgical treatments for cribbing
  • Remove fixed objects
  • Bitter tasting substances
  • Cribbing straps
  • Acupuncture
  • Shock- aversion
  • Naloxon
what is the possible surgical treatments for cribbing
What is the possible surgical treatments for cribbing
  • Removal of sternomandibularis, sternothyroideus, omohyoideus
  • Neurectomy of the ventral branch of accessory nerve
what dose of nsaids should be given
What dose of NSAIDS should be given
  • Should be a bit painful if they try to repeat the behavior so low doses
what is the most common cause of noise
What is the most common cause of noise
  • Recurrent laryngeal hemiplegia
what is recurrent laryngeal hemiplegia
What is Recurrent laryngeal hemiplegia
  • Progresive neurogenic atrophy of the recurrent laryngeal nerve
what is the signalment for recurrent laryngeal hemiplegia
What is the signalment for Recurrent laryngeal hemiplegia
  • 1-10 years old
  • Large breed horses
  • Hereditary
what causes recurrent laryngeal hemiplegia
What causes Recurrent laryngeal hemiplegia
  • Perivascular injection
  • Guttural pouch mycosis
  • Trauma
  • Strangles
  • OP toxicity
  • Plant poisoning
  • Lead toxicity
  • CNS disease
what is the typical history for recurrent laryngeal hemiplegia
What is the typical history for Recurrent laryngeal hemiplegia
  • Noise
  • Exercise intolerance
how is recurrent laryngeal hemiplegia diagnosed
How is Recurrent laryngeal hemiplegia diagnosed
  • Palpation
  • Slap test
  • Endoscopy during treadmill exercise
what is the slap test
What is the slap test
  • Slap withers during endoscopy
  • Observe adduction of the contralateral arytenoid cartilage
what is the most common surgical treatment for recurrent laryngeal hemiplegia
What is the most common surgical treatment for recurrent laryngeal hemiplegia
  • Laryngoplasty (Tie back)
what other surgical procedures can be performed for recurrent laryngeal hemiplegia
What other surgical procedures can be performed for recurrent laryngeal hemiplegia
  • Ventriculectomy
  • Reinervation of cricoarytenoid muscle
  • Arytenoidectomy
what are the complications of ventriculectomy
What are the complications of ventriculectomy
  • Granuloma formation
  • Mucocele
  • Laryngeal web
how do you know that you excised enough of the ventricle
How do you know that you excised enough of the ventricle
  • Place on the finger tip---should be as big as your distal phalanx
what is arytenoid chondritis
What is arytenoid chondritis
  • Inflammation and thickening of the arytenoid cartilage
what is a partial arytenoidectomy
What is a partial arytenoidectomy
  • Arytenoid body and corniculate process removed
what is a total arytenoidectomy
What is a total arytenoidectomy
  • Arytenoid body, corniculate and muscular process
what is the px for a partial arytenoidectomy
What is the px for a partial arytenoidectomy
  • 50% of racehorses return to racing
what is ddsp
What is DDSP
  • The soft palate is displaced over the epiglottis
what are some treatments of ddsp
What are some treatments of DDSP
  • Tongue tie
  • Staphylectomy
  • Myectomy
  • Epiglottic augmentation
  • Laser cauterization
what is a staphylectomy
What is a staphylectomy
  • Cutting part of the soft palate
is epiglottic augmentation commonly done
Is epiglottic augmentation commonly done
  • No because the epiglottis is often normal in size
what is your diagnosis65
What is your diagnosis
  • Guttural pouch tympany
what is guttural pouch tympany
What is guttural pouch tympany
  • Air filled guttural pouch
what are the causes of guttural pouch tympany
What are the causes of guttural pouch tympany
  • Idiopathic
  • Upper airway infection
  • Persistent coughing
  • Muscle dysfunction
what are the clinical signs of gp tympany
What are the clinical signs of GP tympany
  • Nonpainful
  • Dyspnea
  • Dysphagia
  • Inhalation pneumonia
  • Secondary empyema
what are the treatments for gp tympany
What are the treatments for GP tympany
  • Needle aspiration
  • Indwelling catheter
  • Surgery for recurrent problems
what are the borders of viborgs triangle
What are the borders of viborgs triangle
  • Sternomandibular muscle
  • Linguofacial vein
  • Caudal border of vertical ramus of the mandible
why might it be a bad idea to use a laser in the guttural pouch
Why might it be a bad idea to use a laser in the guttural pouch
  • Less control than a scalpel and there are a lot of vessels and nerves in it
what are the causes of gp empyema
What are the causes of GP empyema
  • Upper resp tract infection
  • Abscessation of the retropharyngeal lnn
  • Fx of the stylohyoid bone
why can you not ligate the carotid artery to stop bleeding
Why can you not ligate the carotid artery to stop bleeding
  • Blood will still come from the other side via the circle of willis
can you ligate both carotid arteries
Can you ligate both carotid arteries
  • Hypothetically yes if the animal has a really good supply from the basilar artery but often will kill the animal
what are the treatments for gp mycosis
What are the treatments for GP mycosis
  • Arterial ligation
  • Flush guttural pouch with antifungals with horse under GA