Clinical Features and Outcome of Dogs with Epiglottic Retroversion With or Without Surgical Treatment: 24 Cases

Abstract

BackgroundPublished information describing the clinical features and outcome for dogs with epiglottic retroversion (ER) is limited.Hypothesis/ObjectivesTo describe clinical features, comorbidities, outcome of surgical versus medical treatment and long‐term follow‐up for dogs with ER. We hypothesized that dogs with ER would have upper airway comorbidities and that surgical management (epiglottopexy or subtotal epiglottectomy) would improve long‐term outcome compared to medical management alone.AnimalsTwenty‐four client‐owned dogs.MethodsRetrospective review of medical records to identify dogs with ER that underwent surgical or medical management of ER.ResultsDogs with ER commonly were middle‐aged to older, small breed, spayed females with body condition score (BCS) ≥6/9. Stridor and dyspnea were the most common presenting signs. Concurrent or historical upper airway disorders were documented in 79.1% of cases. At last evaluation, 52.6% of dogs that underwent surgical management, and 60% of dogs that received medical management alone, had decreased severity of presenting clinical signs. In dogs that underwent surgical management for ER, the incidence of respiratory crisis decreased from 62.5% before surgery to 25% after surgical treatment. The overall calculated Kaplan–Meier median survival time was 875 days.Conclusion and clinical importanceOur study indicated that a long‐term survival of at least 2 years can be expected in dogs diagnosed with epiglottic retroversion. The necessity of surgical management cannot be determined based on this data, but dogs with no concurrent upper airway disorders may benefit from a permanent epiglottopexy to alleviate negative inspiratory pressures.

Intraoperative and major postoperative complications and survival of dogs undergoing surgical management of epiglottic retroversion: 50 dogs (2003‐2017)

“…The etiology remains unknown, although several theories have been proposed, including epiglottic fracture or malacia, hypothyroidism‐associated peripheral neuropathy, and hypoglossal/glossopharyngeal nerve degeneration . Epiglottic retroversion is most commonly reported in small‐to‐medium breeds, especially Yorkshire terriers . A condition similar to that recognized as ER in the current literature, epiglottic entrapment, was previously described by Leonard .…”

“…Epiglottic retroversion (ER) is increasingly recognized as a cause of intermittent upper airway obstruction in dogs . This condition was first described in 2 dogs in 2009, followed by 2 case reports and 1 retrospective case series .…”

“…Epiglottic retroversion (ER) is increasingly recognized as a cause of intermittent upper airway obstruction in dogs . This condition was first described in 2 dogs in 2009, followed by 2 case reports and 1 retrospective case series . Epiglottic retroversion is characterized by dynamic or persistent retroflexion/caudal displacement of the epiglottis and obstruction of the rima glottidis .…”

“…Partial epiglottectomy involves excision of an area of the rostral epiglottis to permit airflow through the dorsal aditus laryngis . Subtotal epiglottectomy involves epiglottic excision across its widest base and has been described as a salvage option for recurrent ER . The most effective treatment method for ER remains unknown, with the decision to perform any of these procedures based on surgeon preference.…”

“…Information regarding the incidence and type of intraoperative and postoperative complications in dogs treated surgically for ER is limited to case reports and 1 retrospective case series, describing a total of 23 surgically treated dogs. Within these reports, a high incidence of complications has been reported with both NI‐EP and I‐EP procedures . In a study of 19 surgically treated dogs, 36.8% of index temporary epiglottopexy and 62% of revision permanent epiglottopexy procedures failed, and 31.6% of those 19 dogs developed aspiration pneumonia (AP).…”