Evaluation of the effects of transendoscopic diode laser palatoplasty on clinical, histologic, magnetic resonance imaging, and biomechanical findings in horses

Alkabes, Kira C; Hawkins, Jan F.; Miller, Margaret A.; Nauman, Eric A.; Widmer, William R.; Dunco, Doug; Kras, Jeffery; Couëtil, Laurent L.; Lescun, Timothy B.; Gautam, Raju

doi:10.2460/ajvr.71.5.575

Cited by 15 publications

(5 citation statements)

References 8 publications

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“…It is also a consideration that the overstretching of the tissue and subsequent healing response may have contributed to the overall success of the treatment in the DDSP horses. However, laser palatoplasty induced inflammation and fibrosis that was observed in a study by Alkabes et al [38] resulted in a significant decrease in soft palate elastic modulus. This finding may suggest that the fibrosis and inflammation resulting from the tissue stretching (at the time of injection) in the current study may have reduced the palatal stiffening effects seen in the efficacy phase horses.…”

Section: Resultsmentioning

confidence: 98%

“…The histological analyses were conducted on the safety phase horses exclusively at 7 days after treatment. This constitutes a limitation of the present study considering that other similar soft palate treatment studies evaluated changes to the treated tissues from 2 to 45 days [38] and from 2 weeks to 6 months [39] after treatment. In particular, it would be valuable to have audio and dynamic endoscopic data from efficacy phase horses at later time-points corresponding to histological data from sacrificed horses.…”

Section: Resultsmentioning

confidence: 99%

“…In particular, it would be valuable to have audio and dynamic endoscopic data from efficacy phase horses at later time-points corresponding to histological data from sacrificed horses. Alkabes et al [38] found that edema and inflammation decreased from day 2 to day 45. Therefore having later time-points in subsequent studies may make it possible to deduce the relative contribution of tissue stretching induced inflammation and fibrosis to the increased palatal stiffness and reduced palate displacements observed in this first study.…”

Section: Resultsmentioning

confidence: 99%

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Soft Palate Modification Using a Collagen Crosslinking Reagent for Equine Dorsal Displacement of the Soft Palate and Other Upper Airway Breathing Disorders

Hunt

Kuo²,

Aristizábal

et al. 2019

International Journal of Biomaterials

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The mechanical properties of the soft palate can be associated with breathing abnormalities. Dorsal displacement of the soft palate (DDSP) is a naturally occurring equine soft palate disorder caused by displacement of the caudal edge of the soft palate. Snoring and a more serious, sometimes life-threatening, condition called obstructive sleep apnea (OSA) are forms of sleep-related breathing disorders in humans which may involve the soft palate. The goal of this study was to investigate the effect of injecting the protein crosslinker genipin into the soft palate to modify its mechanical properties for the treatment of equine DDSP with potential implications for the treatment of snoring and OSA in humans. Ex vivo experiments consisted of mechanical testing and a wind tunnel study to examine the effect of genipin on the mechanical properties, displacement, and vibration of equine soft palates. A pilot in vivo study was completed using DDSP and control horses to test the safety and effectiveness of injecting a genipin reagent into the soft palate. The wind tunnel testing demonstrated a greater than 50% decrease in transient deformation and a greater than 33% decrease in steady-state vibrations for all doses of genipin tested. Ultimate tensile stress, yield stress, and Young’s modulus were higher in the genipin-treated distal soft palate specimens by 52%, 53%, and 63%, respectively. The pilot in vivo study showed a reduction of snoring loudness in all DDSP horses and elimination of DDSP in at least one of three horses. The difficulty of using a 1-meter-long endoscopic injection needle contributed to a consistent overinjection of the equine soft palates, causing excessive stretching (pillowing) and related degradation of the tissue. These ex vivo and in vivo results demonstrated reduced vibration amplitude and flaccidity and increased strength of genipin-treated soft palates, suggesting that genipin crosslinking could become an effective and safe treatment for soft palate related breathing abnormalities.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Soft Palate Modification Using a Collagen Crosslinking Reagent for Equine Dorsal Displacement of the Soft Palate and Other Upper Airway Breathing Disorders

Hunt

Kuo²,

Aristizábal

et al. 2019

International Journal of Biomaterials

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“…Additionally, there has been new information that continues to build a body of evidence against use of staphylectomy and various forms of palatoplasty for most horses with this condition. 5,[31][32][33] There is increasing support implicating laryngohyoid positioning as a factor associated with DDSP. 5,6,9,20,21,24,34 As such currently the most widely accepted surgical intervention, following failed conservative therapy, is laryngeal tie-forward with or without myectomy of the sternohyoideus and sternothyrohyoideus.…”

Section: Update On Diseases and Treatment Of The Pharynxmentioning

confidence: 98%

Update on Diseases and Treatment of the Pharynx

Chesen¹,

Whitfield-Cargile

2015

Veterinary Clinics of North America: Equine Practice

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“…Staphylectomy can cause persistent dysphagia or aspiration of food material (Ahern & Parente, 2008). Laser palatoplasty can cause full thickness injury of skeletal muscle with atrophy of muscle fibres (Alkabes et al, 2010). Thermocautery injury has resulted in oropharyngeal fistula formation (Ahern & Parente, 2008).…”

Section: Introductionmentioning

confidence: 99%

Genipin treatment of equine palatal dysfunction: A preliminary study of safety and efficacy

Dillon

O'Brien

Feeney

2022

Equine Veterinary Education

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Summary Background Palatal dysfunction is a common cause of poor performance in racehorses. Although conservative management resolves just over 60% of cases, there is a requirement for further intervention in the residual 40% of cases that do not respond. It is proposed that a palatal stiffening technique that is simple to perform, safe, minimally invasive and enables a rapid return to exercise would be an acceptable first intervention. Genipin is a self‐polymerising molecule that bonds to collagen matrices increasing tissue strength, stiffness and resilience. A previous study demonstrated that implanted genipin increased palatal strength and its resistance to deformation and potentially was effective in decreasing likelihood of palatal dysfunction in horses. Objectives The objective of the study was to appraise the safety and feasibility of implanting genipin oligomers into the equine soft palate and to report on racehorse trainers' subjective assessment of its usefulness in management of palatal dysfunction. Study design Prospective, non‐randomised, pilot study. Methods Fifty Thoroughbred racehorses diagnosed with palatal dysfunction were implanted transendoscopically with genipin. The horses were monitored for adverse reactions during hospitalisation. A standard questionnaire provided to the horses' trainers was used to record additional adverse reactions and satisfaction with the animals' subsequent performance. Post‐treatment dynamic endoscopy was performed in a subgroup of animals. Results One horse developed adverse clinical signs of pyrexia and reduced appetite, which responded to treatment. Post‐procedural endoscopic examination revealed mild palatal abnormalities in 6 of 50 horses that showed no clinical signs. One horse had mild generalised oedema, four with mild focal swelling and one with a superficial mucosal ulceration at a single site of implantation of the soft palate. Following treatment, 76% of horses were reported to show clinical improvement by their trainers with 24% reported not to show improvement. Main limitations The study was not controlled, and outcome measures were mainly subjective. Conclusions The procedure was well tolerated, safe, minimally invasive and enabled a rapid return to exercise. Trainer reported improvement was comparable to previously reported palatoplasty procedures.

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Evaluation of the effects of transendoscopic diode laser palatoplasty on clinical, histologic, magnetic resonance imaging, and biomechanical findings in horses

Abstract: Laser palatoplasty resulted in soft palate fibrosis and skeletal muscle loss; however, the fibrosis did not result in an increase in soft palate elastic modulus.

Cited by 15 publications

References 8 publications

Soft Palate Modification Using a Collagen Crosslinking Reagent for Equine Dorsal Displacement of the Soft Palate and Other Upper Airway Breathing Disorders

Soft Palate Modification Using a Collagen Crosslinking Reagent for Equine Dorsal Displacement of the Soft Palate and Other Upper Airway Breathing Disorders

Update on Diseases and Treatment of the Pharynx

Genipin treatment of equine palatal dysfunction: A preliminary study of safety and efficacy

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