Evaluation of a canine cranial cruciate ligament repair system for use in equine laryngoplasty

OBJECTIVE: To report the use of a nylon suture system (Canine Cranial Cruciate Ligament Repair System; Securos Inc Veterinary Orthopedics) as a prosthesis for equine laryngoplasty. STUDY DESIGN: Experimental and prospective clinical study. ANIMALS: Cadaver specimens (n = 5) and 7 horses with left laryngeal hemiplegia. METHODS: A commercially available monofilament nylon suture system was implanted as a laryngeal prosthesis. Arytenoid cartilage abduction was achieved with a tensioning device applied to the suture prosthesis during transnasal endoscopic observation. Suture fixation was achieved with crimping clamps and a crimping device. RESULTS: The nylon suture system was suitable as a laryngeal prosthesis for arytenoid cartilage abduction. The ratchet mechanism of the tensioning device facilitated abduction of the arytenoid cartilage and suture fixation was achieved by the crimped clamp without any loss of tension. Postoperatively, there was a slight loss of tension in 4 horses and complete loss of tension in 1 horse because of cartilage failure. After convalescence, none of the horses had abnormal respiratory noise, exercise intolerance or cough. CONCLUSIONS: A nylon suture system designed for canine cranial cruciate ligament repair was used successfully as a laryngeal prosthesis and facilitated control of the degree of arytenoid cartilage abduction during laryngoplasty. CLINICAL RELEVANCE: For improved control of the degree of arytenoid cartilage abduction during laryngoplasty, use of a nylon suture system with metal crimps should be considered.     

Maintenance of arytenoid abduction following carbon dioxide laser debridement of the articular cartilage and joint capsule of the cricoarytenoid joint combined with prosthetic laryngoplasty in horses: An in vivo and in vitro study

The objective was to evaluate CO₂ laser debridement of the cricoarytenoid joint (CAJ) combined with prosthetic laryngoplasty to prevent post-operative loss of arytenoid abduction in seven horses. Horses were assigned to either laser debridement of the left CAJ and laryngoplasty (laser treated, n = 5) or control laryngoplasty (sham, n = 2), and were evaluated with endoscopic examinations and measurement of right to left angle quotients (RLQ) to assess maintenance of arytenoid abduction. The animals were euthanased at intervals after surgery and larynges were harvested for post-mortem testing, including determination of translaryngeal flow, pressure, impedance and RLQ. Measurements were obtained under increasing vacuum-generated negative pressure with laryngoplasty sutures intact and with the knot/crimp of the laryngoplasty sutures removed. Following post-mortem testing the cricoarytenoid joints were examined histologically.Post-operative endoscopic examinations revealed no significant differences between RLQ measurements calculated for day 1 following surgery to the termination date of the study for the seven horses. Post-mortem RLQ at airflows of 10 and 60 L/s was significantly higher in sham than in laser treated horses both before and after knot/crimp removal. Translaryngeal impedance at 10 and 60 L/s was not statistically different between groups. Histopathology revealed necrosis and loss of articular cartilage in the laser treated horses. The lymphoid cell infiltration subsided but joint capsule and periarticular fibrosis increased over the course of the study. Post-operative loss of arytenoid abduction after laryngoplasty can be minimized with CO₂ laser debridement of the CAJ joint.     

A modified laryngoplasty approach promoting ankylosis of the cricoarytenoid joint

Objective: To perform a modification to the standard laryngoplasty procedure in vivo that would result in ankylosis of the cricoarytenoid (CA) joint, and determine the stability provided to the abducted arytenoid in vitro. Study Design: Experimental study. Animals: Horses (n=8). Methods: Horses were assigned to either control laryngoplasty (n=3) or modified laryngoplasty (5) procedure. Endoscopic upper airway evaluations were used to measure right:left quotients 1 day and 3 months postoperatively to assess maintenance of abduction. Horses were euthanatized 3 months after surgery and larynges collected for measurement of translaryngeal impedance and histologic evaluation of CA joint ankylosis. Each specimen was exposed to increasing negative pressure with the sutures intact or cut while translaryngeal impedance was recorded. Data were analyzed using ANOVA with significance set at P<.05. Results: Loss of left arytenoid cartilage abduction at 3 months was greater in the control laryngoplasty group. Overall, impedance was significantly lower for the modified laryngoplasty group compared with the control laryngoplasty group and lower with the sutures intact than cut. Histologic evaluation of the joints confirmed fibrous bridging of the left CA joints of the modified laryngoplasty group. Conclusions: A modified laryngoplasty approach promotes ankylosis of the CA joint and decreases the loss of abduction of the arytenoid.     

Equine laryngoplasty sutures undergo increased loading during coughing and swallowing

Objectives: To report (1) the force required on a single laryngoplasty suture to achieve optimal abduction of the left arytenoid cartilage, (2) peak forces experienced by the suture during induced swallowing and coughing, and during 24‐hour resting activity in a stall, and (3) peak forces during induced swallowing and coughing after left recurrent laryngeal nerve blockade. Study Design: Experimental study. Animals: Horses (n=8). Methods: Each laryngoplasty suture was instrumented with an E‐type buckle force transducer to measure the force required for optimal intraoperative left arytenoid cartilage abduction. This was correlated with abduction observed postoperatively. Change in suture force from baseline was measured during induced coughing and swallowing, and during normal stall activity. Results: Optimal intraoperative arytenoid abduction was achieved with a mean (±SD) force of 27.6±7.5 N. During saline‐induced swallowing and coughing mean force on the suture increased by 19.0±5.6 N (n=233 measurements; 7 horses) and 12.1±3.6 N (n=31; 4 horses), respectively. Sutures underwent increased loading a mean of 1152 times in 24 hours. No change in suture force was observed with respiratory rhythm. Conclusion: Swallowing increases laryngoplasty suture force to a greater extent than coughing.     

In vitro effect of ventriculocordectomy before laryngoplasty on abduction of the equine arytenoid cartilage

Objective: To determine whether ventriculocordectomy (VCE) performed before prosthetic laryngoplasty (PL) results in increased rima glottidis size compared with PL alone. Study Design: Experimental study. Animals: Equine cadaver larynges (n=13). Methods: Right arytenoid cartilages were maximally abducted using a standard PL technique. Standard PLs were then performed on the left side and the force required to maximally abduct the left arytenoid cartilage recorded (F_max). Photographs were taken of the rima glottidis at zero force and at five equal levels of force up to F_max. The force applied was released, left VCE performed, and photographs repeated. Arytenoid left:right angle quotients (LRQ) and glottic cross‐sectional area ratios (CSAR) were calculated at each force level in each condition (PL and VCE‐PL). Results: Mean LRQ and CSAR for both PL and VCE‐PL increased with increasing force, initially rapidly before plateauing at ～50% of F_max. LRQ and CSAR were significantly greater for VCE‐PL than for PL (P<.001). When VCE was performed before PL, 12% less force was required to achieve an LRQ of 0.8, and 45% less for a CSAR of 0.8. Conclusions: In vitro, VCE performed before PL enables the arytenoid cartilage to be abducted to a greater degree for a given PL suture force.     

In vitro evaluation of a novel prosthesis for laryngoplasty of horses with recurrent laryngeal neuropathy

A prosthesis, composed of a steel cable and stress-reducing washers, was developed to prevent failure of laryngoplasty, a common treatment for horses affected by recurrent laryngeal neuropathy. Laryngoplasties were performed on 15 cadaveric larynges using a polyester suture on one side and the cable prosthesis on the other. Each prosthesis was distracted at a displacement rate of 20 mm/s using a servohydraulic materials testing machine until laryngoplasty failed. Distraction force and actuator displacement were recorded and analysed. All 15 laryngoplasties performed with a suture failed at the muscular process at a mean +/- s.d. force of 55.8 +/- 13.1 N. Six laryngoplasties performed with the cable prosthesis failed at the muscular process at mean force 219.6 +/- 125.0 N. In the other 9, the arytenoid cartilage was avulsed from the larynx at mean force 206.4 +/- 75.3 N, and the cable then tore through the muscular process at mean force 357.0 +/- 32.0 N. The difference in force required to cause failure of laryngoplasty was significant (P<0.0001). Although the prosthesis resisted substantially higher forces than did the suture, the effects of the prosthesis in vivo must be evaluated.     

Exercising videoendoscopic evaluation of 45 horses with respiratory noise and/or poor performance after laryngoplasty

Objective: To (1) assess upper airway function by videoendoscopy in horses performing poorly after laryngoplasty and (2) establish whether dynamic collapse of the left arytenoid can be predicted by the degree of resting postsurgical abduction. Study Design: Case series. Animals: Horses that had left laryngoplasty (n=45). Methods: Medical records (June 1993–December 2007) of horses evaluated for abnormal respiratory noise and/or poor performance after laryngoplasty were reviewed. Horses with video recordings of resting and exercising upper airway endoscopy were included and postsurgical abduction categorized. Horses with immediate postoperative endoscopy recordings were also evaluated and postsurgical abduction categorized. Relationships between resting postsurgical abduction and historical information with exercising endoscopic findings were examined. Results: Dynamic collapse of the left arytenoid cartilage was probable in horses with no postsurgical abduction and could not be predicted in horses with grade 3 or 4 postsurgical abduction. Respiratory noise was associated with upper airway obstruction but was not specific for arytenoid collapse. Most horses with a left vocal fold had billowing of the fold during exercise. Other forms of dynamic collapse involved the right vocal fold, aryepiglottic folds, corniculate process of left arytenoid cartilage, dorsal displacement of soft palate, and pharyngeal collapse. Complex obstructions were observed in most examinations and in all horses with exercising collapse of the left arytenoid cartilage. Conclusions: There was no relationship between exercising collapse of the left arytenoid cartilage and grade 3 or 4 postsurgical abduction but was likely in horses with no abduction.     

The Effect of Unilateral Arytenoid Lateralization on Rima Glottidis Area in Canine Cadaver Larynges

Five modifications of a cricoarytenoid lateralization and two modifications of a thyroarytenoid lateralization laryngoplasty technique were evaluated for their effect on rima glottidis area. All procedures and evaluations were performed on canine cadaver larynges. Cricoarytenoid lateralization (CAL) techniques provided a greater increase of the size of the glottic opening than did any of the thyroarytenoid lateralization techniques. Cricoarytenoid and interarytenoid disarticulation associated with CAL did not significantly increase glottic size compared with normal. After disarticulation of the cricoarytenoid joint, there was no difference in glottic enlargement whether the suture was placed through the muscular process or through the articular facet of the arytenoid cartilage. Transection of the sesamoid band combined with cricoarytenoid diarticulation distorted the dorsal margin of the rima glottidis.     

Effects of age and prosthesis material on in vitro cartilage retention of laryngoplasty prostheses in horses

Cartilage retention strengths of laryngoplasty prostheses were compared in larynges of 2-, 3-, and 4-year-old horses, using doubled polyester and expanded polytetrafluoroethylene prostheses. Bilateral laryngoplasties were performed on each of 15 (seven 2-year-old, two 3-year-old, and six 4-year-old) larynges, which were collected at an abbatoir. Prostheses were secured to a mechanical testing machine, and tension causing arytenoid cartilage abduction was applied, until total failure of the cartilage or prosthesis resulted. Tension caused cricoid cartilage failure in 1 specimen, and muscular process cartilage failure in the remainder. There was no significant effect of age, prosthetic material, or side of prosthesis placement on cartilage retention of the prostheses. Additionally, frequency of multiple load-displacement peaks, indicating partial muscular process failure, was not affected by age or prosthetic material variables.     

A review of equine laryngoplasty complications

Prosthetic laryngoplasty is a common treatment for equine recurrent laryngeal neuropathy (RLN). Complications of this surgery include immediate post operative problems, such as dysphagia, seroma formation, wound infection and sudden loss of arytenoid abduction. Longer term complications include gradual loss of arytenoid abduction, chronic coughing, arytenoid granulomas and dynamic upper airway collapse unrelated to RLN such as palatal dysfunction, and aryepiglottic fold or vocal fold collapse. However, the benefit of this procedure greatly outweighs these potential post operative complications, especially if appropriate surgical and post operative management practices are employed.     

In Vitro Model for Testing Novel Implants for Equine Laryngoplasty

Objective— To develop an in vitro laryngeal model to mimic airflow and pressures experienced by horses at maximal exercise with which to test laryngoplasty techniques.
Study Design— Randomized complete block.
Sample Population— Cadaveric equine larynges (n=10).
Methods— Equine larynges were collected at necropsy and a bilateral prosthetic laryngoplasty suture was placed with #5 Fiberwire^™ suture to achieve bilateral maximal arytenoid abduction. Each larynx was positioned in a flow chamber and subjected to static flow and dynamic flow cycling at 2 Hz. Tracheal pressure and flow, and pressure within the flow chamber were recorded at a sampling frequency of 500 Hz. Data obtained were compared with the published physiologic values for horses exercising at maximal exercise.
Results— Under static flow conditions, the testing system produced inspiratory tracheal pressures (mean±SEM) of −33.0±0.98 mm Hg at a flow of 54.48±1.8 L/s. Pressure in the flow chamber was −8.1±2.2 mm Hg producing a translaryngeal impedance of 0.56±0.15 mm Hg/L/s. Under dynamic conditions, cycling flow and pressure were reproduced at a frequency of 2 Hz, the peak inspiratory (mean±SEM) pharyngeal and tracheal pressures across all larynges were −8.85±2.5 and −35.54±1.6 mm Hg, respectively. Peak inspiratory flow was 51.65±2.3 L/s and impedance was 0.57±0.06 mm Hg/L/s.
Conclusions— The model produced inspiratory pressures similar to those in horses at maximal exercise when airflows experienced at exercise were used.
Clinical Relevance— This model will allow testing of multiple novel techniques and may facilitate development of improved techniques for prosthetic laryngoplasty.     

Effects of Arytenoid Abduction and Modified Castellated Laryngofissure on the Rima Glottidis in Canine Cadavers

The percentages of change in cross-sectional area and dorsoventral height of the rima glottidis were measured after seven types of laryngoplasty in 30 postmortem canine specimens. The mean increases in area after each procedure were, in decreasing order, bilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of arytenoid abduction sutures 350% +/- 42%, bilateral placement of arytenoid abduction sutures 318% +/- 40%, bilateral cricothyroid disarticulation before placement of arytenoid abduction sutures 255% +/- 51%, modified castellated laryngofissure 244% +/- 30%, unilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of an arytenoid abduction suture 161% +/- 25%, unilateral placement of an arytenoid abduction suture 151% +/- 24% and unilateral cricothyroid disarticulation before placement of an arytenoid abduction suture 108% +/- 25%. Bilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of arytenoid abduction sutures resulted in a significantly greater increase in rima glottidis area than modified castellated laryngofissure and all unilateral arytenoid abduction techniques. Modified castellated laryngofissure resulted in a significantly greater increase than unilateral placement of an arytenoid abduction suture and cricothyroid disarticulation before placement of an arytenoid abduction suture. Bilateral disarticulation of the cricothyroid joint before placement of arytenoid abduction sutures resulted in significant collapse of the dorsoventral height of the rima glottidis.     

Effect of Prosthesis Number and Position on Rima Glottidis Area in Equine Laryngeal Specimens

Objective— To assess the effect of 1 or 2 laryngeal prosthetic sutures on rima glottidis areas in equine laryngeal specimens. Study Design— Experimental, randomized design. Animals— Cadaveric equine larynges (n=16). Methods— Larynges were collected from 10 horses; 2 sutures each were preplaced in the right and left sides of each larynx. A dorsal suture (DS) was placed through the caudal rim of the dorsal midline of the cricoid cartilage, under the cricopharyngeus muscle and through the proximal and rostral aspect of the muscular process. A lateral suture (LS) was placed 1.5 cm lateral to the DS and through the muscular process more distal and caudal to the 1st suture. Larynges were positioned in a customized stand and the rima glottidis photographed after each suture (LS or DS) or suture combination (CS) was tied in random sequence. An additional 6 larynxes were used to determine whether the tension applied to the sutures was repeatable. Sutures were preplaced in both the right and left side of each larynx as described above and each suture and CS was tied and released 3 times in each larynx. Photographs were taken of the rima glottidis after each suture or CS was tied generating 3 replicates for each suture configuration on each side of the 6 larynges. Results— Mean rima glottidis area was not different between DS and LS when tied alone (P=.85); however, mean area after CS (DS+LS) was greater than DS (P<.001) and LS (P<.001) alone. The coefficient of variation for the 6 suture patterns were low (1–7%) and the intraclass correlation coefficient estimates were very high (0.997–0.998) demonstrating excellent repeatability between replicates for each of the 3 suture configurations. Conclusion— Our results suggest that laryngoplasty using 2 prostheses; 1 placed dorsally in the cricoid and through the rostral and proximal muscular process and 1 placed 1.5 cm lateral to the 1st and more caudal and distal in the muscular process results in a greater cross sectional area of the rima glottidis than either suture used alone. Clinical Relevance— Seemingly prosthetic sutures contribute independently to each other in determining the contour of the rima glottidis. Use of 2 prosthetic sutures improves crosssectional area of the rima glottidis compared with each suture alone and may improve surgical outcome in laryngoplasty.     

Management of arytenoid chondropathy and failed laryngoplasty in horses: 75 cases (1979-1985)

By use of endoscopy, 75 horses with respiratory noise and/or exercise intolerance were determined to have structural arytenoid cartilage abnormalities (60 primary, 11 after previous laryngeal surgery), or failed left laryngoplasty (4 horses) for laryngeal hemiplegia in which the arytenoid cartilage still appeared normal. Eighty-eight percent of the horses were either Thoroughbred (54 horses; 72%) or Standardbred (12 horses; 16%) racehorses; only 9 horses (12%) had occupations not related to racing. Seventy-six percent of the racehorses were 2 to 4 years old; all non-racehorses were greater than 4 years old. The male:female ratio was approximately 2:1. Of the horses with cartilage abnormalities, 28 had left-sided involvement, 22 had right-sided involvement, and 21 had bilateral involvement. Sixty-two arytenoidectomies were performed, 58 for cartilage abnormalities (22 left, 19 right, 17 bilateral), and 4 for failed left laryngoplasties. Overall, 45% of the Thoroughbred racehorses that returned to racing after arytenoidectomy raced successfully (50% left, 75% right, 22% bilateral); only 20% of the Standardbreds were able to race. Seventy-five percent of non-racehorses were able to return to their previous use. Many horses were retired intentionally after surgery.     

Ventroaxial luxation of the apex of the corniculate process of the arytenoid cartilage in resting horses during induced swallowing or nasal occlusion

OBJECTIVE: To report ventroaxial luxation of the apex of the left or right corniculate process of the arytenoid cartilage under the contralateral corniculate process during resting endoscopic examination, and morphologic features of the larynx of 1 affected horse. STUDY DESIGN: Retrospective study. ANIMALS: Horses (n=8). METHODS: Horses had endoscopic examination as part of a survey of Clydesdale horses (n=7), or investigation of poor performance in Thoroughbred horses (1). One Clydesdale was euthanatized and the larynx examined; 4 cadaver larynges from normal horses were also examined. RESULTS: Ventroaxial luxation of the apex of the left or right corniculate process of the arytenoid cartilage was not detected during quiet breathing but was induced by swallowing or nasal occlusion. Prevalence in Clydesdales was 5.2% (7/133). A Thoroughbred with identical endoscopic appearance of the larynx at rest had progressive ventroaxial luxation of the apex of the arytenoid cartilage during high-speed treadmill endoscopy, associated with abnormal respiratory noise. Necropsy examination of an affected Clydesdale larynx revealed an excessively wide (10 mm) transverse arytenoid ligament that allowed easy separation of the apices of the corniculate processes. In normal cadaver larynges, the apices could not be separated with abaxial traction. CLINICAL RELEVANCE: The clinical relevance of this laryngeal observation in resting horses is unclear. Ventroaxial luxation of the corniculate process of the arytenoid cartilage during induced swallowing or nasal occlusion in resting horses or during high-speed treadmill exercise may be caused by an abnormally wide transverse arytenoid ligament.     

In vitro comparison of two techniques for suture prosthesis placement in the muscular process of the equine arytenoid cartilage

OBJECTIVE: To compare in vitro the load necessary for a partial and complete rupture of the muscular process arytenoid cartilage when a suture prosthesis is positioned by a bone trocar versus a trocar point needle and to compare failure mode. STUDY DESIGN: Experimental using cadaver specimens. SAMPLE POPULATION: Larynges from 18 Thoroughbred race horses, aged 2-20 years. METHODS: Arytenoid cartilages were separated randomly into 2 groups: group 1-suture prosthesis inserted directly through the muscular process using a curved trocar point needle and group 2-suture passed through a hole predrilled with a 3 mm bone trocar. Distracting force (constant rate, 1 mm/s) was applied to the suture until failure of the muscular process. Partial failure load, maximum load at complete failure, and force-time curve were recorded. Each arytenoid cartilage was examined, radiographed, and classified as having a linear or curved failure plane. RESULTS: No significant differences in mechanical test variables were detected. Failure mode followed the fissures occurring at the beginning of failure and then followed the tension axis. Significantly more linear failures occurred in group 2 (trocar) and more curved failures occurred in group 1 (needle). CONCLUSION: Use of a bone trocar for tunneling through the muscular process may reduce fissure formation. CLINICAL RELEVANCE: Use of bone trocar to create a hole in the muscular process of the arytenoid cartilage for suture passage in laryngoplasty may reduce fissure formation and decrease the risk of cartilage failure from suture pullout.     

Effects of doxapram HCl on laryngeal function of normal dogs and dogs with naturally occurring laryngeal paralysis

OBJECTIVES: To compare the effects of IV doxapram on glottic size and arytenoid motion in normal dogs and in dogs with laryngeal paralysis. STUDY DESIGN: Prospective experimental and clinical trials. ANIMALS: Six healthy dogs weighing 24.5 +/- 3.9 kg and six dogs weighing 27.4 +/- 11.5 kg suspected of having laryngeal paralysis. METHODS: Dogs were pre-medicated with acepromazine and butorphanol, and a light plane of anesthesia was induced with isoflurane by mask. Videoendoscopic examination of laryngeal function was recorded before (baseline) and after IV doxapram administration. Normalized glottal gap area (NGGA) at maximal inspiration and expiration, and percentage change in height, width, area, and NGGA were calculated with measurements from digitized images of the glottal gap. RESULTS: Active arytenoid motion was present in all normal dogs at baseline. After doxapram administration, depth of respiration appeared greater, but arytenoid motion, as measured by percentage change in NGGA, and in area and width, did not significantly increase in normal dogs. No arytenoid motion was detected in dogs with laryngeal paralysis at baseline; however, rima glottidis NGGA of dogs with laryngeal paralysis was greater at inspiration and expiration than normal dogs. After doxapram administration, dogs with laryngeal paralysis developed paradoxical arytenoid motion and significant, negative percentage change in area (-61%) and NGGA (-145%) because of inward collapse of the arytenoids during inspiration. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of doxapram during laryngeal examination is useful for differentiating normal dogs from dogs with laryngeal paralysis. Dogs with laryngeal paralysis may suffer extreme glottic constriction with vigorous respirations, and may require intubation during examination.     

Biomechanical Comparison of Six Suture Configurations Using a Large Diameter Polyester Prosthesis in the Muscular Process of the Equine Arytenoid Cartilage

Objective— To compare biomechanical properties of 6 suture configurations using a large diameter polyester prosthesis in the muscular process (MP) of the arytenoid cartilage and to determine failure mode.
Study Design— Experimental study.
Sample Population— Cadaveric equine larynges (n=121).
Methods— Suture configurations (4 single, 2 double) were inserted, and then constructs were tested in a single-cycle to failure at a 100 mm/min distraction. Load deformation curves were generated to assess the biomechanical properties of each construct. A 1-way ANOVA was used to compare the mean differences in construct failure force, cricoarytenoid joint (CAJ) disarticulation force, and energy stored at failure. A 2-sample t-test was used to compare single versus double suture patterns and a Fisher's exact test was used to compare failure mode.
Results— Both construct and CAJ failure force were significantly greater ( P <.05) for double suture patterns compared with single suture patterns; however, there were no significant differences in energy stored at construct failure. Failure at the MP accounted for ≥50% of construct failures for 3 of the single suture patterns and 1 of the double suture patterns tested. The remaining 2 patterns had an increased frequency of clamp failures as well as failure of the cricoid cartilage.
Conclusions— Sutures that sufficiently engage the spine of the MP alone or in conjunction with a second suture were found to be biomechanically superior.
Clinical Relevance— Engaging the spine of the MP appears to result in the most biomechanically sound laryngeal construct.     

Use of successive dynamic videoendoscopic evaluations to identify progression of recurrent laryngeal neuropathy in three horses

CASE DESCRIPTION: 3 racehorses were evaluated because of poor performance or abnormal noise originating from the upper portion of the respiratory tract. CLINICAL FINDINGS: During maximal exercise, initial dynamic videoendoscopy of the upper respiratory tract revealed complete arytenoid cartilage abduction in 2 horses and incomplete but adequate abduction of the left arytenoid cartilage in 1 horse. Subsequent exercising endoscopic evaluation revealed severe dynamic collapse of the left arytenoid cartilage and vocal fold in all 3 horses. TREATMENT AND OUTCOME: 2 horses were treated with prosthetic left laryngoplasty and raced successfully. One horse was retired from racing. CLINICAL RELEVANCE: Idiopathic laryngeal hemiplegia can be a progressive disease. Successive dynamic videoendoscopic upper airway evaluations were used to confirm progression of left laryngeal hemiplegia in these 3 horses. Videoendoscopy of the upper respiratory tract during exercise should be considered as part of the clinical evaluation of horses with signs of upper respiratory tract dysfunction.     

Neuroanatomy of the equine dorsal cricoarytenoid muscle: surgical implications

Reason for performing study: Studies are required to define more accurately and completely the neuroanatomy of the equine dorsal cricoarytenoid muscle as a prerequisite for developing a neuroprosthesis for recurrent laryngeal neuropathy. Objective: To describe the anatomy, innervation, fibre types and function of the equine dorsal cricoarytenoid muscle. Methods: Thirty‐one larynges were collected at necropsy from horses with no history of upper airway disease and 25 subjected to gross dissection. Thereafter, the following preparations were made on a subset of larynges: histochemical staining (n = 5), Sihler's and acetylcholinesterase staining for motor endplates (n = 2). An additional 6 larynges were collected and used for a muscle stimulation study. Results: Two neuromuscular compartments (NMC), each innervated by a primary nerve branch of the recurrent laryngeal nerve, were identified in all larynges. Stimulation of the lateral NMC produced more lateral displacement of the arytenoid cartilage than the medial NMC (P<0.05). The medial NMC tended to rotate the arytenoid cartilage dorsally. Motor endplates were identified at the junction of the middle and caudal thirds of each NMC. If fibre type grouping was present it was always present in both NMCs. Conclusions: The equine dorsal cricoarytenoid muscle has 2 distinct muscle NMCs with discrete innervation and lines of action. The lateral NMC appears to have a larger role in increasing cross‐sectional area of the rima glottidis. Potential relevance: This information should assist in planning surgical reinnervation procedures and development of a neuroprosthesis for recurrent laryngeal neuropathy.