Surgical advancement of the larynx (laryngeal tie-forward) as a treatment for dorsal displacement of the soft palate in horses: a prospective study 2001-2004

REASONS FOR PERFORMING STUDY: Correct placement of sutures ('laryngeal tie-forward') in experimentally created dorsal displacement of the soft palate (DDSP) has been observed to replace the function of the thyrohyoideus muscles and prevent DDSP. HYPOTHESIS: The 'laryngeal tie-forward' procedure would prevent or delay the occurrence of DDSP during exercise in horses with naturally occurring DDSP and therefore improve performance. METHODS: A clinical population (n = 116), mainly of racehorses was presented for treatment of naturally occurring exercise-induced DDSP. All horses underwent the 'laryngeal tie-forward' procedure. The relative position of the thyroid and cricoid cartilage in relation to the caudal aspect of the basihyoid bone was recorded; follow-up was obtained by telephone communication with trainers, owners and/or referring veterinarians. In addition, a performance index and earnings were determined using race records. RESULTS: Preoperatively, the median distance between the caudal aspect of the basihyoid bone and rostral aspect of the thyroid cartilage was 3.5 cm. Post operatively, the thyroid cartilage was moved a median distance of 4 cm rostrally and the larynx was shown to be in a position more rostral and dorsal than in preoperative radiographs. Of 98 horses for which follow-up was available, the performance of 87% was classified as improved, 12% as unchanged and 2% as worse. In 20 horses in which the diagnosis had been confirmed by treadmill videoendoscopy, 80% had a significantly increased performance index and earnings (P = 0.007). For the entire population, there was a significant improvement in performance index and earnings after surgery (82%) (P = 0.0001). CONCLUSIONS: Placing the larynx in a more rostral and dorsal position may have improved the performance in 80-82% of the horses affected with naturally-occurring DDSP. POTENTIAL RELEVANCE: 'Laryngeal tie-forward' is a surgical technique that has a measurable effect on the position of the larynx and offers an alternative therapy for treating horses affected with DDSP. More experience may be needed with this technique prior to its widespread use in horses with a clinical diagnosis of DDSP.