Ex vivo evaluation of arytenoid corniculectomy, compared with three other airway interventions, performed on cadaveric equine larynges with simulated recurrent laryngeal neuropathy

Tucker, Michelle L.; Sumner, D.; Reinink, Shawn K.; Wilson, David G.; Carmalt, James L.

doi:10.2460/ajvr.80.12.1136

Cited by 4 publications

(6 citation statements)

References 25 publications

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“…The LP constructs were assessed by subjecting specimens to negative pressure and airflow using the model described by Cheetham 20 and used by others 18,19,21–23 . In our study, the modified toggle LP constructs had similar peak translaryngeal impedance before and after cyclic testing, whereas the standard LP constructs had a slight increase in peak translaryngeal impedance after cyclic testing.…”

Section: Discussionmentioning

confidence: 63%

“…This experimental model can be used to determine the translaryngeal impedance of different LP techniques under conditions of high airflow rates 19–22 . Moreover, this experimental model exposes LP constructs to intermittent airflow in a controlled fashion, thus reducing experimental variability 19,21–23 . The objective of this study was to evaluate the airway mechanics of modified toggle LP constructs in an airflow chamber model and compare these to the airway mechanics of standard LP constructs.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the airway mechanics of modified toggle laryngoplasty constructs using a vacuum chamber airflow model

et al. 2021

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Objective To evaluate the airway mechanics of modified toggle LP constructs in an airflow chamber model and compare these to the airway mechanics of standard LP constructs. Study design Ex‐vivo experimental study. Sample population Fifty‐one equine cadaveric larynges. Methods Bilateral LP constructs were performed using a modified toggle (n = 23) or a standard (n = 21) LP technique. Constructs were tested in an airflow model before and after cyclic loading which was designed to mimic postoperative swallowing. The cross‐sectional area (CSA), peak translaryngeal airflow (L/s), and impedance (cmH20/L/s) were determined and compared between LP constructs before and after cycling. Results The mean CSA of the rima glottidis of the modified toggle LP constructs was 15.2 ± 2.6 cm2 before and 14.7 ± 2.6 cm2 after cyclic loading, and the mean CSA of the rima glottidis of the standard LP constructs was 16.4 ± 2.9 cm2 before and 15.7 ± 2.8 cm2 after cyclic loading. The modified toggle LP constructs had similar peak translaryngeal impedance before and after cyclic loading (p = .13); however, the standard LP constructs had higher peak translaryngeal impedance after cyclic loading (p = .02). Conclusion The modified toggle and standard LP constructs had comparable airway mechanics in an ex‐vivo model. Clinical significance Further investigation is warranted to determine the extent to which the modified toggle LP technique restores normal airway function in horses with RLN.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Evaluation of the airway mechanics of modified toggle laryngoplasty constructs using a vacuum chamber airflow model

et al. 2021

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“…Ten larynges were collected from equine cadavers with no reported history of upper airway disease as previously described ( 8 ). Ages of subjects ranged from 4 to 29 years, with six Quarter Horses, one Thoroughbred, one Canadian Warmblood, one American Paint and one horse of unknown breed included.…”

Section: Methodsmentioning

confidence: 99%

“…(LabView, National Instruments, Austin, TX). Pressure within the trachea and box were recorded, along with flow rate, as previously described (8). Placement of the pressure tranducers measuring the "pharyngeal" pressure and tracheal pressure can be seen in Figure 1.…”

Section: Figurementioning

confidence: 99%

“…In particular, the equine “laryngeal box” flow system has explored the influence of various surgeries on overall airflow through the larynx. It allows for a controlled environment in which the effect of laryngoplasty ( 4 – 8 ), cricoarytenoid joint stabilization ( 9 ), vocal cordopexy ( 5 ), vocal cordectomy ( 10 ), partial arytenoidectomy ( 8 ), and the arytenoid corniculectomy ( 8 ) surgeries have been studied. This system was used to prove that the translaryngeal impedance was related to prosthesis shortening and arytenoid abduction ( 7 ) and demonstrated the mechanical advantage of cricoarytenoid joint stabilization ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

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Computational fluid dynamic analysis of upper airway procedures in equine larynges

et al. 2023

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IntroductionComputational fluid dynamics (CFD) has proven useful in the planning of upper airway surgery in humans, where it is used to anticipate the influence of the surgical procedures on post-operative airflow. This technology has only been reported twice in an equine model, with a limited scope of airflow mechanics situations examined. The reported study sought to widen this application to the variety of procedures used to treat equine recurrent laryngeal neuropathy (RLN). The first objective of this study was to generate a CFD model of an ex-vivo box model of ten different equine larynges replicating RLN and four therapeutic surgeries to compare the calculated impedance between these procedures for each larynx. The second objective was to determine the accuracy between a CFD model and measured airflow characteristics in equine larynges. The last objective was to explore the anatomic distribution of changes in pressure, velocity, and turbulent kinetic energy associated with the disease (RLN) and each surgical procedure performed.MethodsTen equine cadaveric larynges underwent inhalation airflow testing in an instrumented box while undergoing a concurrent computed tomographic (CT) exam. The pressure upstream and downstream (outlet) were measured simultaneously. CT image segmentation was performed to generate stereolithography files, which underwent CFD analysis using the experimentally measured outlet pressure. The ranked procedural order and calculated laryngeal impedance were compared to the experimentally obtained values.Results and discussionThe CFD model agreed with the measured results in predicting the procedure resulting in the lowest post-operative impedance in 9/10 larynges. Numerically, the CFD calculated laryngeal impedance was approximately 0.7 times that of the measured calculation. Low pressure and high velocity were observed around regions of tissue protrusion within the lumen of the larynx. RLN, the corniculectomy and partial arytenoidectomy surgical procedures exhibited low pressure troughs and high velocity peaks compared to the laryngoplasty and combined laryngoplasty/corniculectomy procedures. CFD modeling of the equine larynx reliably calculated the lowest impedance of the different surgical procedures. Future development of the CFD technique to this application may improve numerical accuracy and is recommended prior to consideration for use in patients.

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Computed tomographic geometrical analysis of surgical treatments for equine recurrent laryngeal neuropathy

Tucker

Wilson

Reinink

et al. 2022

ajvr

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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.

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Ex vivo evaluation of arytenoid corniculectomy, compared with three other airway interventions, performed on cadaveric equine larynges with simulated recurrent laryngeal neuropathy

Cited by 4 publications

References 25 publications

Evaluation of the airway mechanics of modified toggle laryngoplasty constructs using a vacuum chamber airflow model

Evaluation of the airway mechanics of modified toggle laryngoplasty constructs using a vacuum chamber airflow model

Computational fluid dynamic analysis of upper airway procedures in equine larynges

Computed tomographic geometrical analysis of surgical treatments for equine recurrent laryngeal neuropathy

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