Laryngeal fistula formation after laryngoplasty in two Warmblood mares

Abstract

Summary Recurrent laryngeal neuropathy usually results in left‐sided laryngeal hemiparesis or hemiplegia and is one of the most common problems of the upper respiratory tract in equids. There are multiple methods of management, and the laryngoplasty procedure is still the most common surgical treatment. Different nonabsorbable suture materials and techniques are used for laryngoplasty. Post surgical complications are not uncommon. Of these complications, coughing is the most common. The following case report describes diagnosis and treatment of 2 horses with chronic coughing after laryngoplasty due to infection at the surgical site and laryngeal fistula formation. In both horses an elastic material (probably Lycra) had been used as part of the prosthesis implant. This material had deteriorated into multiple small pieces making removal difficult, and therefore use of this material for a laryngoplasty procedure should be avoided.

A review of equine laryngoplasty complications

“…Endoscopy should be performed to identify possible prosthesis penetration of the dorsal laryngeal mucosa (Bienert‐Zeit et al . ) and a prosthesis should always be removed if penetration has occurred. Concurrent secondary arytenoid chondritis is a rare cause of LP wound infection (Ahern and Parente ) and should be treated by long‐term antibiotic therapy or arytenoid resection, depending on endoscopic and ultrasonographic arytenoid findings.…”

“…The irritation from prostheses protruding into the larynx as described by Bienert‐Zeit et al . () in this issue can also cause chronic coughing in horses following laryngoplasty. In one report, LP cases with significant aspiration were administered metronidazole, in addition to routine post operative penicillin and aminoglycoside medication and bacterial pneumonia developed in just 0.5% of cases (Dixon et al .…”

“…Penetration of the dorsocaudal aspect of the laryngeal lumen can occur during suture placement through the cricoid cartilage and this can later cause LP wound infection, with sequelae, including chronic incisional wound drainage and coughing, as described in the article by Bienert-Zeit et al (2014). Laryngeal penetration can be prevented by using a long towel clamp on the caudolateral aspect of the cricoid cartilage to rotate its dorsal aspect dorsorostrally, in addition to rotating it laterally, when the needle is being passed through the cricoid.…”

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

“…Such penetration could have side effects such as deep infection of the sutures and failure of the procedure. Previous reports reported only on penetration of the laryngeal or nasopharyngeal mucosa during equine laryngoplasty. Our study justifies the addition of penetration of the vestibulum esophagi as a possible source of internal contamination.…”

Ultrasonographic findings post laryngoplasty in the horse

“…Equine post‐laryngoplasty ultrasonographic evaluation has limited coverage in the literature. It has mostly been used in horses to identify laryngoplasty prostheses infection and to evaluate extraluminal laryngeal damage …”