Overground endoscopic findings and respiratory sound analysis in horses with recurrent laryngeal neuropathy after unilateral laser ventriculocordectomy

Background: Unilateral ventriculocordectomy (VeC) is frequently performed, yet objective studies in horses with naturally occurring recurrent laryngeal neuropathy (RLN) are few. Objectives: To evaluate respiratory noise and exercising overground endoscopy in horses with grade B and C laryngeal function, before and after unilateral laser VeC. Study design: Prospective study in clinically affected client‐owned horses. Methods: Exercising endoscopy was performed and concurrent respiratory noise was recorded. A left‐sided laser VeC was performed under standing sedation. Owners were asked to present the horse for re‐examination 6–8 weeks post‐operatively when exercising endoscopy and sound recordings were repeated. Exercising endoscopic findings were recorded, including the degree of arytenoid stability. Quantitative measurement of left‐to‐right quotient angle ratio (LRQ) and rima glottidis area ratio (RGA) were performed pre‐ and post‐operatively. Sound analysis was performed, and measurements of the energy change in F1, F2 and F3 formants between pre‐ and post‐operative recordings were made and statistically analysed. Results: Three grade B and seven grade C horses were included; 6/7grade C horses preoperatively had bilateral vocal fold collapse (VFC) and 5/7 had mild right‐sided medial deviation of the ary‐epiglottic fold (MDAF). Right VFC and MDAF was still present in these horses post‐operatively; grade B horses had no other endoscopic dynamic abnormalities post‐operatively. Sound analysis showed significant reduction in energy in formant F2 (P = 0.05) after surgery. Main limitations: The study sample size was small and multiple dynamic abnormalities made sound analysis challenging. Conclusions: RLN‐affected horses have reduction in sound levels in F2 after unilateral laser VeC. Continuing noise may be caused by other ongoing forms of dynamic obstruction in grade C horses. Unilateral VeC is useful for grade B horses based on endoscopic images. In grade C horses, bilateral VeC, right ary‐epiglottic fold resection ± laryngoplasty might be a better option than unilateral VeC alone

Variations in the application of equine prosthetic laryngoplasty: a survey of 128 equine surgeons

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

Equine cheek tooth repulsion using small diameter repulsion pins: 20 cases

Publication status: PublishedAbstractBackgroundReported complication rates after dental repulsion for equine exodontia are high (up to 80%), but repulsion methods have changed notably in the last 20 years.ObjectivesDescribe the outcome for 20 cases after dental repulsion using small diameter repulsion pins.Study designRetrospective case series.MethodsRecords of horses that underwent cheek tooth repulsion were reviewed (2014–2023). Inclusion criteria included: mandibular or maxillary cheek tooth extraction where oral extraction failed and repulsion was used to complete extraction, and where clinical follow up information was available. Repulsions were carried out under sedation with a regional nerve block or under a short general anaesthetic, using a small diameter repulsion pin (3–5 mm). Intra‐operative radiographs facilitated instrument placement. The alveolus was packed with polymethyl methacrylate post‐extraction. Horses were re‐examined at 4–6 weeks post‐operatively.ResultsTwenty cases were included. Patients had a mean age of 10.3 years old (range 5–16 years). The majority (75%) of teeth had pre‐existing dental fractures. Maxillary (n = 15) and mandibular cheek teeth (n = 5) were all successfully repulsed, with 16 cases performed with the horse standing and 4 with the horse under general anaesthesia. Intra‐operative complications included damage to the mandibular bone (n = 1). Short‐term complications (n = 2) included superficial surgical site infection, and dehiscence of one sinus flap. Long‐term complications included the recurrence of sinusitis (n = 1) and small intra‐alveolar fragments causing persistent bitting problems in another patient.Main limitationsRetrospective study design, small number of cases.ConclusionsWhen oral extraction fails, cheek tooth repulsion using small diameter repulsion pins is an effective extraction technique. The total intra‐ and post‐operative complication rate was 25%, which is comparable to previously published complication rates for repulsion using Steinmann pins and also those encountered after trans‐buccal screw extraction.</jats:sec

Long-term maintenance of arytenoid cartilage abduction and stability during exercise after laryngoplasty in 33 horses

&lt;b&gt;Objectives&lt;/b&gt; To (1) assess long-term maintenance of arytenoid cartilage abduction (ACA) after laryngoplasty (LP); and (2) correlate the residual grade of ACA and postoperative abductory loss with arytenoid cartilage stability (ACS) during exercise.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Study Design&lt;/b&gt; Case series.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Animals&lt;/b&gt; Horses re-examined after laryngoplasty (n = 33).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; Of 89 LP horses (2005–2010), 33 had historic ACA data available and upper airway endoscopy at rest and during over-ground exercise (mean, 33 months; range, 4–71 months) after surgery. ACA grade at 1 and 6 weeks postoperatively were correlated to long-term ACA grade. Effects of long-term ACA grade and magnitude of postoperative abductory loss on ACS during exercise were investigated.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; Median ACA grade at 1 week (n = 33) was 2, reducing to grade 3 by week 6 (n = 16). Grade 3 abduction was maintained in the long-term. Correlation between ACA at 1 week and the long-term was poor (ρ = .43, P = .1), but there was good correlation between week 6 and long-term (ρ = .89, P &lt; .001). Arytenoid cartilage instability was observed during exercise in 7/33 of horses, and not significantly associated with the ACA grade (P = .50), or the number of grades of ACA lost (P = .64).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; Limited abductory loss occurs after 6 weeks postoperatively. Resting ACA grade was not a useful predictor of ACS during exercise.&lt;p&gt;&lt;/p&gt