Comparison of two techniques for transpharyngeal endoscopic auditory tube diverticulotomy in the horse

Abstract

Auditory tube diverticula, also known as guttural pouches, are naturally occurring dilations of the auditory tube in horses that communicate with the nasopharynx through a small ostium. Infection and select other conditions can result in inflammation and narrowing of the nasopharyngeal ostium, which prevents drainage of fluid or egress of air and can lead to persistent infection or guttural pouch tympany. Auditory tube diverticulotomy allows continuous egress from the auditory tube diverticula and is a feature of disease treatment in horses, in which medical treatment alone is not successful. Transpharyngeal endoscopic auditory tube diverticulotomy was performed using a diode laser either at a single dorsal pharyngeal recess location or bilaterally caudal to the nasopharyngeal ostium in 10 horse head specimens. Both methods resulted in clear communication between the nasopharynx and auditory tube diverticula. Diverticulotomy performed in the dorsal pharyngeal recess required less laser energy and activation time and had a shorter surgical duration than diverticulotomy performed caudal to the nasopharyngeal ostium. Further study related to the clinical application of both techniques is warranted.

Clinical outcome of horses with guttural pouch infection following transpharyngeal fenestration

“…6 Techniques using endoscopy-guided transpharyngeal laser energy have been developed to create a fenestration into the guttural pouch, often referred to as salpingopharyngostomy, to facilitate removal and speed drainage of purulent material, relieve increased pressure due to guttural pouch tympany, and modify the guttural pouch's environment for treatment of mycosis, all while avoiding the aforementioned challenges of an open transcutaneous surgical approach. [7][8][9][10][11] A distinct advantage of the transpharyngeal approach is that it can be readily performed with the horse standing, avoiding general anesthesia. Detailed description of this surgical technique applied to clinical cases with chronic guttural pouch infection has not been published.…”

Creation of salpingopharyngeal fistulae for the management of guttural pouch tympany and persistent guttural pouch empyema

“…Comparison of the two different locations for trans‐pharyngeal endoscopic auditory tube diverticulotomy has been described in some detail by Koch et al (2018) who performed both techniques in cadaver heads. Essentially, diverticulotomy performed in the dorsal pharyngeal recess required less laser energy and activation time (because the tissue here is much thinner) than diverticulotomy performed in the floor of the pouch, caudal to the nasopharyngeal ostium.…”

Salpingopharyngeus fistula by means of videosurgery to treat horse bilateral gutural pouch chronic empyema – a case study

“…Minimally invasive surgery for the healing of guttural pouch empyema has several advantages, such as the minimal approach, with the use of light sedation with no need for general anesthesia, reduced risk of iatrogenic injury to the cranial nerve, and easy post-surgery management; as the surgical wound is internal and has no communication with the external environment, it minimizes the possibility of an ascending infection (KOCH et al, 2018). The animal in this report was subjected to sedation only, was discharged on the same day of the procedure and had no post-surgical complications.…”

“…The technique of opening a salpingopharyngeal fistula by video surgery employed in this animal for the treatment of guttural pouch empyema is not described in the literature, being a modification of the technique developed by Koch et al (2018), which used ten corpses of horses, for pharyngeal opening of the guttural pouch with laser. Moreover, after that, employing computed tomography to analyze the diameter and aspect of the formed fistula.…”