Preferential denervation of the adductor muscles of the equine larynx. I: Muscle pathology

The laryngeal muscles of 18 horses were examined histologically. The neurogenic changes found in each muscle were scored by four reviewers and the results evaluated statistically. Fifteen of these horses had endoscopic evidence of abnormal laryngeal function, three of which were defined as having adductor paralysis. Measurement of muscle fibre area in two horses with idiopathic laryngeal hemiplegia (ILH) was performed. In the quantitative study of neurogenic change, the adductor muscles were more significantly affected than the abductor muscle. This was also true in the clinical cases of ILH where measurement of muscle fibre area demonstrated that the lateral cricoarytenoid (adductor) muscles showed a wider range of pathological changes than the dorsal cricoarytenoid muscle (abductor). Those horses with the most severe muscle pathology also had the most abnormal endoscopic findings. The propensity for denervation of the adductor muscles should provide clues as to the pathogenesis and natural history of horses with sub-clinical laryngeal disease and ILH.     

Morphometric study of the recurrent laryngeal nerve in young ‘normal’ horses

Quantitative measurements were made on cross-sectional preparations of the distal part of the recurrent laryngeal nerve (RLN) from nine young mixed-breed horses to establish reference values for the total number of myelinated fibres, mean fibre diameter and percentage of thickest fibres (over 9·5 gm) and to delineate diameter distribution curves. The total number of myelinated fibres, mean fibre diameter and percentage of thickest fibres for the left RLN were significantly lower than those of the right RLN (P<0–005). The distribution of fibres was unimodal. The fibre diameter ranged from 1 μm to 17 μm. Approximately, 95 per cent of fibres had a diameter larger than 5 μm.     

Examination of the laryngeal musculature and recurrent laryngeal nerves of zebra (Equus burchelli) for evidence of idiopathic laryngeal hemiplegia

AIMS: This study was undertaken in order to determine whether wild Burchell's Zebra (Equus burchelli) are affected by Idiopathic Laryngeal Hemiplegia (ILH). ILH has a high prevalence in the domestic horse and a negative control population has not been identified. METHODS: The work was conducted in two phases on two large farms in central Kenya during routine culls. The larynges of 42 zebra were removed and the left and right intrinsic laryngeal adductor and abductor muscles and recurrent laryngeal nerves were isolated. The muscles were weighed and biopsy samples of left and right recurrent laryngeal nerve and cricoarytenoideus lateralis muscles from 16 animals were taken for histological examination. RESULTS: Left adductor muscles were observed to be significantly lighter than right adductor muscles (p = 0.001). There was no significant difference between the weights of left and right laryngeal abductors (p = 0.260). There was no light microscopic evidence of pathological changes consistent with ILH in any of the muscle or nerve samples. CONCLUSIONS: Zebra do not appear to suffer from ILH and equids unaffected by ILH can have significantly lighter muscles on the left of the larynx. CLINICAL RELEVANCE: Mild asymmetries of the larynx on palpation may not be a reliable indicator of ILH. Zebra may be a potentially useful negative control animal for observational ILH studies.     

Experimental crush of the equine recurrent laryngeal nerve: a study of normal and aberrant reinnervation

Experimental reinnervation of the equine larynx in healthy ponies was studied after the recurrent laryngeal nerve was crushed, using endoscopic, electromyographic, and microscopic techniques. In 12 ponies, the recurrent laryngeal nerve was crushed unilaterally in the midcervical area. All showed postoperative paralysis of the larynx on the operated side. In 8 ponies, recovery of movement of the vocal folds occurred at different times (2.5 to 8 months) after surgical operation was done. These movements, which were often abnormal, included trembling and asynchronism. In 2 of these ponies, complete return of normal vocal fold function occurred. Return of function was due to reinnervation, as determined by electromyographic examination of the laryngeal muscles and microscopic evaluation of these muscles and the recurrent laryngeal nerves. In the muscles, there was evidence of fiber-type grouping, and the nerves showed regenerative activity. In 3 ponies, there was evidence of aberrant reinnervation, with adductor or abductor muscles discharging during an inappropriate phase of the respiratory cycle. Further evidence that reinnervation occurred in the larynges of these ponies was determined in microscopic sections of the recurrent laryngeal nerves and muscles, which showed regenerative activity and muscle fiber-type grouping, respectively. The endoscopic abnormalities in these ponies were compared with those seen in horses with spontaneous subclinical laryngeal paralysis. However, the possibility that the abnormal endoscopic findings in this latter group of horses are due to aberrant reinnervation is thought to be unlikely.     

Attempts to restore abduction of the paralyzed equine arytenoid cartilage. III. Nerve anastomosis.

The purpose of this project was to attempt restoration of abduction of a recently denervated left dorsal cricoarytenoid muscle in the horse by anastomosing the first cervical nerve to the abductor branch of the left recurrent laryngeal nerve. Ten horses were used in the study. In six horses the left recurrent laryngeal nerve was transected and ligated while the ventral branch of the left first cervical nerve was anastomosed to the abductor branch of the left recurrent laryngeal nerve. The remaining four horses also had the left recurrent laryngeal nerve transected and ligated but had no nerve anastomosis performed. Each horse was evaluated preoperatively, and at one week, three and six months after surgery, by endoscopy and determination of upper airway resistance. The endoscopy was performed with the horses breathing room air and while breathing 10% carbon dioxide. All ten horses showed endoscopic signs of complete laryngeal hemiplegia immediately postoperatively. Starting at three months postoperatively clonic movements of the left arytenoid cartilage were observed in four of the six reinnervated horses but not in the sham operated horses. At the sixth postoperative month five reinnervated horses had clonic movements of the left arytenoid cartilage. The comparison of upper airway resistance measurements before surgery and at one week, three and six months after surgery showed no significant differences in either control or experimental horses. Following euthanasia at six months postoperatively, the left and right dorsal crioarytenoid muscles were compared for evidence of reinnervation. No significant difference in weight was noted in the reinnervated horses but the left dorsal cricoarytenoid muscle weighed less than the control horses.     

A study of an electrodiagnostic technique for the evaluation of equine recurrent laryngeal neuropathy

The electrodiagnostic measurement of the thoracolaryngeal reflex (TLR) ('slap test') latency was compared to 5 other diagnostic techniques used for evaluation of laryngeal function, namely laryngeal muscle palpation, resting and immediately postexercise endoscopic examinations, and palpable and endoscopic responses to the TLR. Compared to resting endoscopy, the electrodiagnostic measurement of TLR latency was not found to be an accurate test for the evaluation of recurrent laryngeal neuropathy (RLN), nor was laryngeal muscle palpation or the endoscopic response to the TLR. Twenty-five (71%) of 35 Clydesdale horses examined were affected by RLN; 16 (46%) had mild, 5 (14%) moderate, 3 (9%) severe hemiparesis and 1 (3%) had total laryngeal paralysis. Within these 35 horses, physical traits such as height or neck length did not correlate with the incidence or severity of RLN. Ten control ponies showed no evidence of abnormal laryngeal function.     

Pathological aspects of Australian Stringhalt.

Nine horses with clinical signs of Australian Stringhalt were killed and tissues collected for a detailed pathological study. Lesions were limited to peripheral nerves and muscles. The most severely affected nerves were the superficial and deep peroneal, distal tibial, plantar digital, volar and recurrent laryngeal nerve with changes characterised by a selective loss of large diameter myelinated fibres with various degrees of demyelination, fibrosis, Schwann cell proliferation and onion-bulb formation. A routine evaluation of the brain and spinal cord by light microscopy failed to reveal any consistent abnormalities. Morphometric analysis of deep peroneal and recurrent laryngeal nerves confirmed the reduced number of large diameter myelinated axons. Teased fibre preparations of these nerves did not show any abnormalities in internodal distance. The most severe muscle lesions were in the long and lateral digital extensors, cranial tibial, dorsal cricoarytenoid, gracilis and lateral deep digital flexor with extensive atrophy of fibres and diffuse fibrosis. Histochemical evaluation of the long digital extensor from 3 affected horses showed an abnormally wide distribution in fibre size and a reduction in type II fibres compared with controls. These lesions are consistent with a distal axonopathy leading to neurogenic muscle atrophy. The distribution of neuromuscular lesions in Australian Stringhalt may be explained by the susceptibility of longer, larger myelinated nerve fibres to injury, but the cause for this distal axonopathy remains unknown.     

Equine laryngeal hemiplegia. Part II. An electron microscopic study of peripheral nerves

The recurrent laryngeal nerves were examined by electron microscopy in five control, four subclinical and four clinical laryngeal hemiplegic horses. In addition, the peroneal nerve was examined in two horses in the latter group. The distally distributed loss of large myelinated fibres in the left recurrent laryngeal nerve seen by light microscopy was confirmed. In addition, active axonal pathology was found to be more evident than indicated by light microscopic investigations. The onion bulb formations observed indicated the repetitive nature of the damaging influence to nerve fibres. Although the pathological changes were most obvious in the distal left recurrent laryngeal nerve, alterations similar in type and distribution were present in other areas of the left and right nerves, and in the distal hindlimb nerves. The observation of fibres with inappropriately thick myelin sheaths relative to their axonal calibre, was confirmed statistically by determining the regressions of axis cylinder perimeter against the number of myelin lamellae. In conclusion, the peripheral nerve pathology of equine laryngeal hemiplegia was demonstrated to be a distally distributed loss of myelinated fibres, with considerable active axonal damage, in conjunction with axonal atrophy. These features suggest that this disease may be classified as a distal axonopathy.     

Correlation of the Havemeyer endoscopic laryngeal grading system with histopathological changes in equine Cricoarytenoideus dorsalismuscles

The establishment of a single validated endoscopic laryngeal grading system for assessing recurrent laryngeal neuropathy (RLN) is desirable to facilitate direct comparisons between the findings of different clinical and research groups worldwide. The objective of this study was to assess the relationship between the Havemeyer endoscopic laryngeal grading system and histopathological changes consistent with RLN in the left cricoarytenoideus dorsalis (CAD) muscle of horses of different breeds with a full range of clinical severities of RLN, i.e., from normal endoscopic laryngeal function to complete laryngeal hemiplegia. Endoscopic grading of laryngeal function of 22 horses was performed using the Havemeyer endoscopic laryngeal grading system. A biopsy sample of the left CAD muscle was obtained from each horse, either at post mortem examination (n = 16), or during routine laryngoplasty surgery (n = 6). A semi-quantitative histopathological scoring system was used to grade the severity of histopathological lesions consistent with RLN in the left CAD muscle of each horse. A significant positive correlation (rs = 0.705, p < 0.001) was found between the Havemeyer grades and sub-grades of laryngeal function and the semi-quantitative assessment of histopathological lesions consistent with RLN in the left CAD muscle. However, a wide spread of muscle histopathological scores was obtained, particularly from horses with Havemeyer sub-grades II.1, III.1 and III.2. In conclusion, the Havemeyer endoscopic laryngeal grading system was found to broadly correlate with histopathological changes consistent with RLN in equine cricoarytenoideus dorsalis muscle.     

Equine laryngeal hemiplegia. Part IV. Muscle pathology

This study confirmed that neurogenic muscle pathology exists in intrinsic laryngeal muscles supplied by the recurrent laryngeal nerves in horses subclinically and clinically affected with laryngeal hemiplegia. An important additional observation was the occurrence in three out of four laryngeal hemiplegic horses of neurogenic muscle changes in a hindlimb muscle, the extensor digitorum longus, a muscle supplied by another long peripheral nerve. This finding suggests that a polynenropathy exists in laryngeal hemiplegic horses, and supports the classification of this disease as a distal axonopathy. Comparison of the degree of pathology in the intrinsic laryngeal muscles and that of the recurrent laryngeal nerves innervating them, demonstrated a strong correlation between the extent of damage in the distal left recurrent laryngeal nerve and the overall degree of muscle pathology. The muscle damage in clinically affected horses is a reflection of the nerve damage present in the most distal portion of the recurrent laryngeal nerve. The more variable pathological changes found in proximal levels of the left and right recurrent laryngeal nerves probably reflects the ongoing nature of the pathological process affecting nerve fibres. The existence of a subclinically affected group of horses, the earliest involvement of an adductor, the left cricoarytenoideus lateralis muscle, and the presence of changes in the right intrinsic laryngeal muscles all confirmed the findings of previous workers.     

Considerations for pacing of the cricoarytenoid dorsalis muscle by neuroprosthesis in horses

Reasons for performing study: The success rate of prosthetic laryngoplasty is limited and may be associated with significant sequelae. Nerve muscle pedicle transplantation has been attempted but requires a year before function is restored. Objective: To determine the optimal parameters for functional electrical stimulation of the recurrent laryngeal nerve in horses. Methods: An experimental in vivo study was performed on 7 mature horses (2–21 years). A nerve cuff was placed on the distal end of the common trunk of the recurrent laryngeal nerve (RLN). In 6 horses the ipsilateral adductor branch of RLN was also transected. The electrodes were connected to programmable internal stimulator. Stimulation was performed using cathodic phase and then biphasic pulses at 24 Hz with a 0.427 ms pulse duration. Stimulation‐response experiments were performed at monthly intervals, from one week following implantation. The study continued until unit failure or the end of project (12 months). Two of the horses were stimulated continuously for 60 min to assess onset of fatigue. Results: Excellent arytenoid cartilage abduction (mean arytenoid angle of 52.7°, range 48.5–56.2°) was obtained in 6 horses (laryngeal grades I or II (n = 3) and III (n = 2). Poor abduction was obtained in grade IV horses (n = 2). Arytenoid abduction was maintained for up to a year in one horse. Technical implant failure resulted in loss of abduction in 6 horses at one week to 11 months post operatively. Mean tissue impedance was 1.06 kOhm (range 0.64–1.67 kOhm) at one week, twice this value at 2 months (mean 2.32, range 1.11–3.75 kOhm) and was stable thereafter. Maximal abduction was achieved at a stimulation range of 0.65–7.2 mA. No electrical leakage was observed. Constant stimulation of the recurrent laryngeal nerve for 60 min led to full abduction without evidence of muscle fatigue. Conclusions: Functional electrical stimulation of the recurrent laryngeal nerve leading to full arytenoid abduction can be achieved. The minimal stimulation amplitude for maximal abduction angle is slightly higher than those for man and dogs. Clinical relevance: This treatment modality could eventually be applicable to horses with recurrent laryngeal neuropathy.     

Equine laryngeal hemiplegia. Part I. A light microscopic study of peripheral nerves

This light microscopic investigation of 15 Thoroughbred horses provided substantial evidence for the classification of equine laryngeal hemiplegia as a distal axonopathy. Morphologic and morphometric examinations were performed on resin embedded recurrent laryngeal nerves from control, subclinical and clinical laryngeal hemiplegic animals. In the latter group of animals some distal hindlimb nerves were also examined. A distally graded loss of myelinated fibres selectively affecting those of large diameter was demonstrated in both left and right recurrent laryngeal nerves. Morphologic evidence of similar pathological changes in long hindlimb nerves was also present. An explanation for the early involvement of the cricoarytenoideus lateralis muscle in the course of laryngeal hemiplegia, was offered by the demonstration of more large diameter fibres in the branch of the recurrent laryngeal nerve innervating it, thus making it more susceptible to the disease process.     

DIAGNOSTIC SENSITIVITY OF SUBJECTIVE AND QUANTITATIVE LARYNGEAL ULTRASONOGRAPHY FOR RECURRENT LARYNGEAL NEUROPATHY IN HORSES

Recurrent laryngeal neuropathy (RLN) is the most common cause of laryngeal hemiplegia in horses and causes neurogenic atrophy of the intrinsic laryngeal muscles, including the cricoarytenoideus lateralis muscle. Recurrent laryngeal neuropathy results in paresis to paralysis of the vocal fold and arytenoid cartilage, which limits performance through respiratory compromise. Ultrasound has previously been reported to be a useful diagnostic technique in horses with RLN. In this report, the diagnostic sensitivity of subjective and quantitative laryngeal ultrasonography was evaluated in 154 horses presented for poor performance due to suspected upper airway disease. Ultrasonographic parameters recorded were: cricoarytenoideus lateralis echogenicity (subjective and quantitative), cricoarytenoideus lateralis thickness, vocal fold movement, and arytenoid cartilage movement. Ultrasonographic parameters were then compared with laryngeal grades based on resting and exercising upper airway endoscopy. Subjectively increased left cricoarytenoideus lateralis echogenicity yielded a sensitivity of 94.59% and specificity of 94.54% for detecting RLN, based on the reference standard of exercising laryngeal endoscopy. Quantitative left cricoarytenoideus lateralis echogenicity values differed among resting laryngeal grades I–IV. Findings from this study support previously published findings and the utility of subjective and quantitative laryngeal ultrasound as diagnostic tools for horses with poor performance.     

Bilateral laryngeal paralysis in the horse

Four two-year-old Thoroughbreds suffered an acute gastrointestinal illness shortly after dosing with mineral oil which was thought to have been contaminated with an organophosphate compound. Three weeks later all four were noted to be dyspnoeic and endoscopic examination showed that they had developed bilateral laryngeal paralysis. Two of the horses died during severe bouts of dyspnoea six and eight months later and the third was killed shortly thereafter. Examination of the left and right recurrent laryngeal nerves from these horses showed a severe loss of myelinated fibres distally, especially in the left nerve. A similar but less severe lesion was seen in other long peripheral nerves, including the phrenic and digital nerves of the third horse. The spinal cord in two horses showed evidence of mild axonal degeneration which was not related to a particular tract or location. The fourth horse had bilateral laryngeal paralysis two years later. The acute clinical signs and delayed neurological sequelae seen in these horses were strongly suggestive of accidental organophosphate toxicity.     

Attempts to restore abduction of the paralyzed equine arytenoid cartilage. I. Nerve-muscle pedicle transplants.

The purpose of this project was to adapt a surgical technique from humans and dogs to horses in which a portion of an accessory muscle of respiration and its nerve supply is transplanted to a denervated dorsal cricoarytenoid muscle. Anatomical dissections in seven horses revealed two possible donor nerve-pedicle grafts: the omohyoid and the sternothyrohyoid, both innervated by a branch of the first and second cervical nerves. Histochemical evaluations in two ponies of the dorsal cricoarytenoid, omohyoid and sternothyrohyoid muscles revealed similar proportions of fiber types 1 and 2 in all three muscles. Electromyographic studies in these two ponies revealed that the omohyoid and sternothyrohyoid muscles contract synchronously with respirations during forced inspiration under general anesthesia. Based on surgical ease of access, a 1 cm2 portion of the omohyoid muscle at the point of penetration of the second cervical nerve was used as a nerve-muscle pedicle graft in an attempt to reinnervate the left dorsal cricoarytenoid muscle in four ponies. These four ponies (as well as three others which served as controls) had previously undergone left recurrent laryngeal nerve transection. All seven ponies endoscopically showed signs of complete left laryngeal hemiplegia immediately postoperatively. Animals were monitored endoscopically for 30 weeks after surgery. The three control ponies showed no abduction of the arytenoid cartilage. In addition, in these three ponies, histological and histochemical expected changes of muscle fiber atrophy and fibrosis were present in the dorsal cricoarytenoid muscle.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laryngeal paralysis: a study of 375 cases in a mixed-breed population of horses

Referred cases (n = 375) of laryngeal paralysis (1985-1998) from a mixed-breed equine population included 351 (94%) cases of recurrent laryngeal neuropathy (RLN) (idiopathic laryngeal hemiplegia) and 24 cases (6%) of laryngeal paralysis from causes other than RLN. Laryngeal movements were classified endoscopically into one of 6 grades, in contrast to the usual 4 grades. The RLN cases had a median grade 4 laryngeal paralysis, of which 96% were left-sided, 2% right-sided and 2% bilaterally affected. RLN cases included 204 (58%) Thoroughbred, 96 (27%) Thoroughbred-cross, 23 (7%) draught, 16 (5%) Warmbloods and 10 (3%) other breeds, including only 4 (1%) ponies. The median age of RLN cases at referral was 6 years (range 2-12) and their median height was 170.2 cm. The work of RLN horses included National Hunt racing (42%), flat racing (1%), hunting (19%), eventing (16%) and miscellaneous work (22%). Reported presenting signs in RLN-affected horses included abnormal exercise-related respiratory sounds in 90% and reduced exercise tolerance in only 64%. However, many horses were referred before their exercise tolerance could be fully assessed. Forty percent of the RLN cases had intercurrent disorders, including 10% with additional upper respiratory and 7% with lower respiratory tract diseases. The 24 nonidiopathic RLN cases included 12 with bilateral laryngeal paralysis, 11 (92%) of which were ponies. Bilateral laryngeal paralysis occurred with hepatic encephalopathy in 7 cases and following general anaesthesia in 2 cases. The 12 cases of acquired unilateral laryngeal paralysis included 7 caused by guttural pouch mycosis.     

Attempts to restore abduction of the paralyzed equine arytenoid cartilage. II. Nerve implantation (pilot study).

The purpose of this project was to attempt restoration of abduction of a recently experimentally denervated left dorsal cricoarytenoid muscle by implanting a transected nerve-end into the paralyzed muscle. In six ponies the cut end of the second cervical nerve was implanted into a slit made in the left dorsal cricoarytenoid muscle. The nerve end was secured in place with one 5-0 polypropylene suture connecting the epineurium to the epimysium. The left recurrent laryngeal nerve was transected during this procedure. All six ponies showed signs of complete left laryngeal hemiplegia immediately after surgery. Postoperatively all ponies were evaluated qualitatively on a monthly basis by subjective examination for evidence of abduction of the arytenoid cartilages on endoscopy and quantitatively by measurement of the cross sectional area of the left and right half of the rima glottidis. Subjective endoscopic evidence of partial abduction was seen in four of the six ponies six months postoperatively. Measurement of the cross sectional area of the rima glottidis revealed a total loss of 38% of the area immediately postoperatively. There were no significant changes in cross sectional areas of the rima glottidis between the immediate postoperative evaluation to the six months postoperative evaluation. Gross postmortem examination revealed partial dorsal cricoarytenoid muscle atrophy as evidenced by a 24-55% decrease in muscle mass compared to the right dorsal cricoarytenoid muscle. Histopathological studies revealed regions with clusters of large muscle fibers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Upper airway dysfunction associated with collapse of the apex of the corniculate process of the left arytenoid cartilage during exercise in 15 horses

OBJECTIVE: To report dynamic collapse of the apex of the left corniculate process under the right corniculate process into the airway at the dorsal apposition of the paired arytenoid cartilages during exercise as a cause of upper airway dysfunction in horses. DESIGN: Retrospective study. ANIMALS: Fifteen horses with a history of poor performance and/or upper respiratory tract noise during exercise. METHODS: Video recordings of all horses referred for upper airway evaluation using high-speed treadmill videoendoscopy (HSTV) between January 1998 and December 2003 were reviewed. Records of horses that developed dynamic collapse of the apex of the left corniculate process into the airway were included. Clinical history, age, gender, breed, and use of the horse were retrieved. RESULTS: Of 309 horses referred for examination for poor performance and/or upper respiratory tract noise during exercise, 15 (4.9%) had collapse of the apex of the left corniculate process under the right and into the airway at the dorsal apposition between the paired arytenoid cartilages during HSTV. There were 3 females and 13 males, aged from 2 to 5 years. Five horses had previous surgery for left recurrent laryngeal neuropathy (RLN): 2 had nerve muscle pedicle graft and 3 had laryngeal prosthesis. During HSTV, all 15 horses had progressive collapse of the apex of the left corniculate process under the right at the dorsal apposition of the 2 arytenoid cartilages, and into the dorsal aspect of the rima glottidis. Review of video recordings revealed that collapse of the apex of the corniculate process was followed by progressive collapse of the left aryepiglottic fold and left vocal fold. The ventral aspect of the left corniculate cartilage maintained abduction in all horses. Two horses also had progressive collapse of the right vocal fold, 1 had rostral displacement of the palatopharyngeal arch, and another had dorsal displacement of the soft palate. CONCLUSIONS: Dynamic collapse of the apex of the left corniculate process of the arytenoid cartilage under the right is an uncommon cause of upper airway dysfunction in horses and the pathogenesis is unclear. We speculate that the left arytenoideus transversus muscle is unable to support the dorsal apposition between the arytenoid cartilages. This loss of support allows the elastic cartilage of the left corniculate process to collapse under the right and into the airway, as inspiratory pressure increases during exercise. This condition may be associated with an unusually advanced neuropathy of the adductor components of the left recurrent laryngeal nerve and may be an unusual manifestation of RLN; however, this is speculative and further investigation is required to determine its cause. CLINICAL RELEVANCE: Dynamic collapse of the apex of the left corniculate process and into the airway at the dorsal apposition between the paired arytenoid cartilages can only be diagnosed during HSTV. It is an uncommon cause of upper airway dysfunction but may affect the athletic potential of racing Thoroughbreds and Standardbreds.     

Histological and ultrastructural evidence that recurrent laryngeal neuropathy is a bilateral mononeuropathy limited to recurrent laryngeal nerves

Reasons for performing study: Recurrent laryngeal neuropathy (RLN) is a common and debilitating peripheral nerve disease of horses, but it remains unclear if this disease is a mono‐ or polyneuropathy. An understanding of the distribution of the neuropathological lesions in RLN affected horses is fundamental to studying the aetiology of this very significant disease of tall horses. Objective: To determine whether RLN should be classified as a mono‐ or polyneuropathy. Methods: Multiple long peripheral nerves and their innervated muscles were examined systematically in 3 clinically affected RLN horses Results: Severe lesions were evident in the left as well as right recurrent laryngeal nerves in all horses, both distally and, in one case, also proximally. No primary axonal lesions were evident in other nerves nor were changes found in their innervated muscles. Conclusions: RLN is not a polyneuropathy but should be classified as a bilateral mononeuropathy. Potential relevance: Genetic and local factors specifically affecting the recurrent laryngeal nerves in RLN‐affected horses should now be investigated further.