Traumatic stress symptoms are common among parents in the PICU and may persist long after discharge. There is strong support from these data for continued attention to supporting parents both during and after a child's PICU admission.

Objective: To develop an arthroscopic approach to the discomandibular joint (DMJ), the ventral compartment of the temporomandibular joint (TMJ) of the horse. Study design: Experimental study. Sample population: Nine cadaveric equine heads and two live horses. Methods: A 2.5-mm 30 arthroscope was used to explore the DMJ after joint distension. The first portal was created caudally, allowing placement of a rostral portal under visual guidance. Nasotracheal intubation of the live horses allowed mandibular manipulation, which is required for complete visualization of the joint. Results: A novel injection technique allowed consistent arthrocentesis of the DMJ. The joint could be completely explored by using both portals and manipulation of the mandible. Variations in the medial joint capsule were observed between horses along with a cyst of the mandibular condyle in one horse. The only complication consisted of damage to the parotid salivary gland, which occurred in three cadaver heads. No communication was found between the joint compartments of the TMJ. Conclusion: Correct portal placement and intraoperative manipulation of the mandible were critical and allowed complete exploration and debridement of the DMJ. Clinical significance: Determining the independence of the TMJ joint compartments has clinical ramifications for the diagnosis and treatment of clinical disorders. Most TMJ pathology, notwithstanding sepsis, is identified within the DMJ. Arthroscopic exploration of the DMJ is possible and may help manage these conditions.

OBJECTIVE To compare laryngeal impedance, in terms of air flow and pressure, following arytenoid corniculectomy (COR) versus 3 other airway interventions (left-sided laryngoplasty with ipsilateral ventriculocordectomy [LLP], LLP combined with COR [LLPCOR], and partial arytenoidectomy [PA]) performed on cadaveric equine larynges with simulated left recurrent laryngeal neuropathy (RLN) and to determine whether relative laryngeal collapse correlated with the interventions performed. SAMPLE 28 cadaveric equine larynges. PROCEDURES Each larynx in states of simulated left RLN alone and with airway interventions in the order LLP, LLPCOR, COR, and PA was evaluated in a box model construct that replicated upper airway flow mechanics consistent with peak exercise in horses. Results for impedance, calculated from airflow and pressure changes, were compared between states for each larynx. Multivariable mixed-effects analysis controlling for repeated measures within larynx was performed to calculate the predicted mean impedance for each state. RESULTS Results indicated that tracheal adapter diameter, individual larynx properties, airway intervention, and relative laryngeal collapse affected laryngeal impedance. The LLP and LLPCOR interventions had the lowest impedance, whereas the COR and PA interventions did not differ substantially from the simulated left RLN state. Residual intraclass correlation of the model was 27.6 %. CONCLUSIONS AND CLINICAL RELEVANCE Although impedance was higher for the simulated left RLN with the COR intervention state than with the LLP intervention state, given the clinical success of PA for treating RLN in horses and the similar results for the COR and PA intervention states in the present study, the use of COR warrants further investigation. The residual interclass correlation suggested that individual laryngeal variation affected impedance and may have a clinical effect.

Objective: To describe a new technique to repair a sinocutaneous fistula with a masseter muscle transposition flap. Study design: Case report.Animal: One 13-year-old thoroughbred stallion. Methods: One 13-year-old stallion with a 3.5 × 6-cm sinocutaneous fistula over the right caudal maxillary sinus was treated with a transpositional masseter muscle flap. This repair consisted of a commercial wound matrix dressing placed directly over the hole in the maxilla and secured with suture material; a cancellous bone graft collected from the right tuber coxa placed on the dressing; and a portion of the superficial layer of the masseter muscle, with its pedicle at the facial crest, transposed dorsally over the bone graft, followed by a rotational skin flap with skin rostral to the fistula to close the defect.Results: Seroma formation and dehiscence of the skin flap occurred, but the transposed muscle flap survived, and the technique resulted in successful closure of the sinocutaneous fistula with excellent cosmetic and functional outcome. Conclusion: A chronic maxillary sinocutaneous fistula was successfully treated by using a transposition flap of the masseter muscle and a rotational skin flap with minor complications.Clinical impact: Transposition of the superficial layer of the masseter muscle should be considered for a repair of large maxillary sinocutaneous fistulas in horses.

OBJECTIVES To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions. Secondly, to use fluid mechanic principles of flow through a constriction to establish the relationship between measured airflow geometries with impedance for each surgical procedure. SAMPLE 10 cadaveric horse larynges. PROCEDURES While CT scans were performed, inhalation during exercise conditions was replicated for each of the following 5 conditions: laryngeal hemiplegia, left laryngoplasty with ventriculocordectomy, left laryngoplasty with ipsilateral ventriculocordectomy and arytenoid corniculectomy, corniculectomy, and partial arytenoidectomy for each larynx while CT scans were performed. Laryngeal impedance was calculated, and selected cross-sectional areas were measured along each larynx for each test. Measured areas and constriction characteristics were analyzed with respect to impedance using a multilevel, mixed-effects model. RESULTS Incident angle, entrance coefficient, outlet coefficient, friction coefficient, orifice thickness, and surgical procedure were significantly associated with upper airway impedance in the bivariable model. The multivariate model showed a significant influence of incident angle, entrance coefficient, and surgical procedure on impedance; however, the orifice thickness became nonsignificant within the model. CLINICAL RELEVANCE Laryngeal impedance was significantly associated with the entrance configuration for each procedure. This suggested that the equine upper airway, despite having a highly complex geometry, adheres to fluid dynamic principles applying to constrictions within pipe flow. These underlying flow characteristics may explain the clinical outcomes observed in some patients, and lead to areas of improvement in the treatment of obstructive upper airway disease in horses.