Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses

Abstract

Anatomical knowledge of the extent of the vestibulum esophagi reduces the risk of penetrating its lumen or adventitia during suture placement on the muscular process of the arytenoid cartilage.

Management of postoperative dysphagia after prosthetic laryngoplasty or arytenoidectomy

“…Horses with endoscopically confirmed hyperabduction had failure of the contralateral right arytenoid to fully adduct, resulting in an additional deficit at the level of the corniculate process. When esophageal reflux was observed, this was interpreted as a cranial esophageal sphincter problem, either a deficit or an obstructive lesion associated with adhesions of the esophageal isthmus on the muscular process or adhesions from the esophagus to the cricopharyngeus and thyropharyngeus Vocal fold augmentation was used when a structural deficit of the vocal folds was present, leading to incomplete contact of remnants of the vocal folds and failure of the right arytenoid to adduct past midline to compensate. Horses that were unable to fully retrovert their epiglottis, had the remnants of the vocal folds contacting during swallowing, and had subjectively restrictive perilaryngeal fibrosis were treated with laryngeal tie‐forward to elevate the larynx.…”

“…[1][2][3][4][5][6]10 Although tracheal aspiration is the most commonly reported cause of coughing, more recently, traction on the isthmus of the esophagus has been proposed as a cause of coughing. 11 Finally, tracheal aspiration from esophageal reflux from damage to the cranial esophageal sphincter during laryngeal surgery has also been reported. 12 In many species, and, presumably in horses also, protection of the upper airway from feed contamination is accomplished by a coordinated sequence of events.…”

“…Regardless, coughing is the most commonly reported complication of laryngoplasty, with reports describing an incidence of 5% to 57% . Although tracheal aspiration is the most commonly reported cause of coughing, more recently, traction on the isthmus of the esophagus has been proposed as a cause of coughing . Finally, tracheal aspiration from esophageal reflux from damage to the cranial esophageal sphincter during laryngeal surgery has also been reported …”

“…In addition, laryngeal surgery, by restricting laryngeal elevation by postoperative scarring, interferes with proper epiglottic retroversion and, thus, its role in the protection of the rima glottidis. Finally, because of the proximity of motor and sensory nerves responsible for deglutition, sensory and/or motor neuromuscular surgical trauma may interfere with coordination of these aforementioned protection mechanisms to the approach for prosthetic laryngoplasty and reported secondary fibrosis at this site …”

“…Finally, because of the proximity of motor and sensory nerves responsible for deglutition, sensory and/or motor neuromuscular surgical trauma may interfere with coordination of these aforementioned protection mechanisms to the approach for prosthetic laryngoplasty and reported secondary fibrosis at this site. 12,18 Restoring the geometry of the larynx is a well-known strategy to reduce aspiration. It has been reported that removing the laryngoplasty sutures or freeing the esophagus from the muscular process 1,7,11 results in success by reducing the degree of abduction of the fixed arytenoid cartilage.…”