Laryngeal tie‐forward in standing sedated horses

Abstract

To investigate the feasibility and describe the clinical experience of performing laryngeal tie-forward (LTF) in standing horses unaffected (experimental) and affected (clinical) by intermittent dorsal displacement of the soft palate (iDDSP). Study design: Experimental study and case series. Animals: Five normal experimental controls and five client owned horses affected by iDDSP. Methods: Standing LTF was performed and evaluated in five experimental horses and five clinical cases diagnosed with iDDSP. Standing LTF was performed under endoscopic guidance with horses sedated and the surgical site desensitized with local anesthetic solution. Short term outcome was assessed using radiography, resting and (in clinical cases) dynamic upper respiratory tract (URT) endoscopy.Results: Standing LTF was well tolerated and completed in all horses. Radiographic assessment demonstrated that compared to preoperatively, the basihyoid bone and thyrohyoid-thyroid articulation were positioned dorsally (9.6 mm, p = .006 and 20.4 mm, p = .007, respectively) at 2 days postoperatively. During repeat dynamic URT endoscopy at 48 hours postoperatively, 3/5 horses showed resolution of iDDSP and 2/5 marked improvement. One horse experienced brief iDDSP associated with neck flexion which corrected after swallowing. The second achieved a greater speed and total distance prior to iDDSP. Conclusions: Standing LTF did not incur any major peri-or postoperative complications. The laryngohyoid apparatus was repositioned dorsally and in a small case series had a similar surgical effect on laryngeal position.Clinical significance: Standing LTF is feasible, mitigates the risk of general anesthesia related complications and reduces cost.

Standing laryngeal tie‐forward as a successful treatment of cleft palate in a 3‐month‐old foal

“…Namely, failure of the construct (prosthesis or cartilage), failure to create an effective seal between the oro-and nasopharynx, seroma/haematoma formation, infection or persistent upper-airway inflammation resulting in DDSP or vocal fold collapse. 3,7,[22][23][24] At the discretion of the owner, neither resting nor dynamic endoscopy were performed at the follow-up evaluation. This however would have provided important information when evaluating…”

“…Possible complications of LTF in the foal are similar to those reported in adult horses. Namely, failure of the construct (prosthesis or cartilage), failure to create an effective seal between the oro‐ and nasopharynx, seroma/haematoma formation, infection or persistent upper‐airway inflammation resulting in DDSP or vocal fold collapse 3,7,22–24 . At the discretion of the owner, neither resting nor dynamic endoscopy were performed at the follow‐up evaluation.…”

“…3,19,22,23 This is likely due to the fact that it does not require access to the soft palate itself and thus is less invasive and has better surgical access. Recently, LTF has also been evaluated in the standing horse, 24 eliminating the need for general anaesthesia (GA). The objective of this case report was to describe the technique and outcome of standing LTF used to treat cleft palate in a 3-month-old foal with clinical signs of dysphagia and secondary chronic aspiration pneumonia.…”