Evaluation of a stented laryngoplasty for correction of cranial glottic stenosis in four dogs

After laryngeal surgery, cranial glottic stenosis secondary to laryngeal web formation was diagnosed as the cause of upper airway obstruction in 4 dogs. Initial treatment of 3 dogs by peroral laryngeal web excision resulted in rapid recurrence of clinical signs. Subsequently, these 3 and the fourth dog were treated by scar excision, mucosal flap coverage, and placement of a silicone intraluminal laryngeal stent for 14 days. By 5 months (average) after surgery, on the basis of clinical evaluation of exercise intolerance, respiratory distress, and stridor, all dogs had alleviation of upper airway obstruction.     

Imaging diagnosis--acquired pectus excavatum secondary to laryngeal paralysis in a dog

A 13-year-old neutered female Labrador retriever had inspiratory dyspnea secondary to bilateral laryngeal paralysis. Radiographically, there was pectus excavatum with a mediastinal shift to the right. Arytenoid lateralization was performed, relieving the upper respiratory obstruction, and the sternal deformity also resolved. Chronic upper respiratory obstruction should be considered in dogs with pectus excavatum. Furthermore, correction of upper respiratory obstruction has the potential to result in resolution of pectus excavatum.     

Upper airway obstruction in canine laryngeal paralysis

The type and the severity of airway obstruction in 30 dogs with bilateral laryngeal paralysis was assessed, using tidal breathing flow-volume loop (TBFVL) analysis. The dogs had clinical evidence of mild-to-severe upper airway obstruction (ie, respiratory distress, exercise intolerance, stridor). Seventeen dogs had TBFVL consistent with a nonfixed (inspiratory) obstruction, 10 had TBFVL indicative of a fixed (inspiratory/expiratory) obstruction, and 3 had normal TBFVL. Analysis of TBFVL confirmed that dogs with laryngeal paralysis have upper airway obstruction that differs in type and severity. Use of TBFVL provided a quantitative evaluation of airway obstruction and demonstrated the effects of bilateral laryngeal paralysis on the breathing patterns of dogs.     

Acute Upper Airway Obstruction Due to Inflammatory Laryngeal Disease in 5 Cats

Objective: To describe a clinical syndrome of upper airway obstruction in 5 cats due to inflammatory laryngeal disease.
Series Summary: Medical records of 5 cats with upper airway obstruction and a histopathologic diagnosis of inflammatory laryngeal disease were reviewed. Historical findings included: dyspnea, anorexia, voice change, and gagging/non-productive retching. Thoracic radiographs revealed a bronchial pattern in 2 cats, with consolidation of the right middle lung lobe in one cats. Laryngeal examinations typically revealed severe swelling and erythema which could not be grossly distinguished from neoplasia. Histopathologic examination of laryngeal biopsies revealed neutrophilic (n=5) and lymphoplasmacytic (n=4) inflammation. All of the cats were treated with corticosteroids and 4 cats received antibiotics. Two cats died while hospitalized, one was discharged and lost to follow-up, and 2 are doing well 7 months and 4 years later, respectively.
New information provided: Inflammatory laryngeal disease in cats may present as an acute upper airway obstruction. These cases may respond to corticosteroids and antibiotics, and some cases may have an excellent long-term prognosis.( J Vet Emerg Crit Care 2001; 11(3): 205–211 )     

Evaluation of upper respiratory tract function during strenuous exercise in racehorses

Forty-six racehorses with a history of poor performance underwent endoscopic evaluation of laryngeal and pharyngeal function while exercising on a high-speed treadmill. This evaluation allowed the definitive diagnosis of intermittent or continual upper respiratory tract obstruction as a cause of poor performance, as well as the documentation of the dynamic functional anatomy of the obstruction. Ten of the horses (22%) were determined to have a functional abnormality of the upper respiratory tract. These abnormalities included epiglottic entrapment (1 horse), persistent dorsal displacement of the soft palate during exercise (4 horses), and left laryngeal hemiplegia (5 horses). Thirty-two horses were observed to have signs of left laryngeal hemiparesis (asynchronous arytenoid movement) at rest that did not impair full laryngeal abduction during strenuous exercise.     

Comparison of unilateral arytenoid lateralization and ventral ventriculocordectomy for the treatment of experimentally induced laryngeal paralysis in dogs.

This study evaluated changes in respiratory function in dogs with experimentally induced laryngeal paralysis treated with either unilateral arytenoid lateralization or ventral ventriculocordectomy, and compared the effectiveness of these procedures. Evaluation consisted of clinical assessment and tidal breathing flow volume loop and upper airway resistance measurements. Carbon dioxide and doxapram hydrochloride were used as respiratory stimulants. Initially, all dogs improved clinically after corrective surgery. However, by the end of the study, laryngeal collapse had developed in 2 of 5 dogs corrected by ventral ventriculocordectomy. No statistical differences in upper airway mechanics testing were seen between the surgical procedures. With both groups combined, many measurements of upper airway obstruction improved after surgical correction. Based on this study, these surgical procedures yield comparable results, although additional studies are needed to evaluate both the cause of laryngeal collapse and the role of upper airway mechanics testing in the evaluation of canine laryngeal paralysis.     

Obstructive inflammatory laryngeal disease in three cats

Three cats with upper respiratory tract obstruction due to laryngeal inflammation are presented. Cervical radiography showed the presence of a soft tissue mass in the laryngeal region in all cases, and laryngoscopy allowed direct visualization of a mass associated with the larynx. Laryngeal samples were obtained by a combination of fine needle aspiration, cutting biopsy forceps, by ventral laryngotomy, and at post-mortem. Histopathology of the laryngeal samples showed the presence of a predominantly granulomatous inflammation, with macrophage and lymphocyte infiltration. One case was euthanased due to severe dyspnoea. The remaining two cases underwent combined medical (corticosteroid and antibiotic) and surgical (permanent tracheostomy or excision of laryngeal tissue by ventral laryngotomy) treatment. One case died of an undetermined cause 15 weeks after surgery while the other case remains clinically well 20 months after diagnosis. Recognition of the existence of granulomatous laryngitis is important as clinical signs and radiographic findings are indistinguishable from laryngeal neoplasia.     

Evaluation of a modified castellated laryngofissure for alleviation of upper airway obstruction in dogs with laryngeal paralysis

A modified castellated laryngofissure procedure (castellated laryngofissure, vocal fold resection, and bilateral arytenoid lateralization) was performed on 12 dogs with bilateral laryngeal paralysis. Clinical signs of airway obstruction were assessed and a pulmonary function test (tidal breathing flow volume loop) was used to evaluate the severity of obstruction. The dogs were evaluated before surgery and at various periods from 4 days to 15 months after surgery. One dog died immediately after surgery and 3 dogs died due to nonrelated or unknown causes 1, 9, and 11 months after surgery. Clinical signs of upper airway obstruction disappeared or decreased in severity in the 11 dogs that recovered from surgery. Tidal breathing flow volume loop values were normal in 7 of 10 dogs evaluated within 5 to 189 days after surgery. The modified castellated laryngofissure procedure provided successful long-term relief of upper airway obstruction associated with bilateral laryngeal paralysis.     

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.     

Radiographic and computed tomographic appearance of caseous lymphadenitis in a goat

A 2‐year‐old Boer doe was presented with respiratory distress and severe inspiratory dyspnea. Cervical and thoracic radiographs revealed a marked retropharyngeal soft tissue mass effect, several mineralized pharyngeal and retropharyngeal structures, and a pulmonary mass. Computed tomography (CT) revealed a severely enlarged right medial retropharyngeal lymph node, which caused laryngeal compression, leading to upper airway obstruction. Multiple cervical and thoracic lymph nodes, and the pulmonary mass had an irregular layered/laminated pattern of mineralization. Imaging findings were consistent with caseous lymphadenitis, and further confirmed with culture, necropsy, and histopathology. This is the first report of CT appearance of caseous lymphadenitis in a goat.     

Effect of laryngoplasty on respiratory noise reduction in horses with laryngeal hemiplegia

REASONS FOR PERFORMING STUDY: Laryngoplasty is the technique of choice for treatment of laryngeal hemiplegia, with the aim of improving airway function and/or eliminating respiratory noise. However, there are no quantitative data in the literature describing the effect of laryngoplasty on upper airway noise or its relationship to upper airway mechanics in horses with laryngeal hemiplegia. OBJECTIVES: To determine whether laryngoplasty reduces respiratory noise in exercising horses with laryngeal hemiplegia; and to establish whether the degree of upper airway obstruction can be predicted by upper airway noise, or the degree of arytenoid abduction correlated with airway obstruction and noise production. METHODS: Six Standardbred horses with normal upper airways during maximal exercise were used. Respiratory sounds and inspiratory transupper airway pressure (Pui) were measured in all horses before and after induction of laryngeal hemiplegia and 30, 60 and 90 days after laryngoplasty. Inspiratory sound level (SL) and the sound intensity of the 3 inspiratory formants (F1, F2 and F3, respectively) were measured using a computer-based sound analysis programme. The degree of abduction was graded by endoscopic visualisation 1, 30, 60 and 90 days post operatively. Linear regression analysis was used to determine correlations between Pui, sound indices and grades of arytenoid abduction. RESULTS: In laryngeal hemiplegia-affected horses, Pui, inspiratory SL and the sound intensity of F1, F2 and F3 were significantly increased. At 30 days following laryngoplasty, the sound intensity of F1 and Pui returned to baseline values. The sound intensities of F2, F3 and SL were significantly improved from laryngeal hemiplegia values at 30 days post operatively, but did not return to baseline at any measurement period. Sound level, F2 and F3 were significantly correlated with Pui (P<0.05), but the correlations were weak (r2 = 0.26, 035 and 0.40, respectively). Grade of abduction and F2 were positively and significantly correlated (P<0.006, r2 = 0.76). Grade of arytenoid abduction and Pui were not correlated (P = 0.12). CONCLUSIONS: Laryngoplasty reduced inspiratory noise in laryngeal hemiplegia-affected horses by 30 days following surgery, but did not return it to baseline values. While upper airway noise and Pui were correlated, this relationship was insufficiently strong to predict Pui from noise in individual animals. The degree of arytenoid abduction was not correlated with Pui, but was positively correlated with noise production. POTENTIAL RELEVANCE: Laryngoplasty reduces upper airway noise in horses with laryngeal hemiplegia, but is not as effective as bilateral ventriculocordectomy in this regard, although respiratory noise reduction occurs more rapidly than with bilateral ventriculocordectomy. Residual noise during exercise cannot be used as a predictor of improvement in upper airway function in individual horses following laryngoplasty. The degree of arytenoid abduction obtained following surgery does not affect upper airway flow mechanics. Interestingly, we found that the greater the arytenoid abduction, the louder the respiratory noise.     

Nasopharyngeal cicatrices in horses: 47 cases (1972-1985)

Nasopharyngeal cicatrices were observed endoscopically in 47 horses examined because of abnormal respiratory noises and/or exercise intolerance. A review of these cases revealed a correlation between cicatrization and age, sex, and the presence of other upper airway abnormalities. The age of affected horses ranged from 6 to 21 years, with a mean age of 12.7 +/- 7.8 (+/- 2 SD) years. Females were affected 2.7 times more frequently than males. Abnormalities commonly observed with a nasopharyngeal cicatrix included chondritis of the arytenoid cartilage, epiglottic deformity, and deformity of the guttural pouch openings. The nasopharyngeal cicatrix was responsible for respiratory obstruction in only 3 horses. Treatment for the cicatrix was not performed on any horse in this series. Generalized nasopharyngeal and laryngeal inflammation were postulated as causes of the cicatrices and associated abnormalities.     

Use of continuous positive airway pressure in the acute management of laryngeal paralysis in a cat

Continuous positive airway pressure (CPAP) has been is used widely in humans to manage obstructive sleep apnoea syndrome, but it has not been widely used in animals. A brachycephalic cat, with previously undiagnosed laryngeal paralysis, that developed acute upper respiratory tract obstruction on recovery from anaesthesia, is presented. The condition was managed by CPAP, delivered via a facial mask.     

Surgical relief of severe laryngeal malformation in an English Bulldog

A 22 month old English Bulldog was presented with progressive upper airway obstruction associated with an elongated soft palate, tonsillitis, everted laryngeal saccules and laryngeal malformation. Surgical management of the case consisted of resection of the elongated soft palate and everted laryngeal saccules, unilateral tonsillectomy and correction of the laryngeal stenosis. The latter was achieved by using a castellated incision through the laryngeal cartilages and first tracheal ring. From this case, it is postulated that, at least in some cases, the common upper airway obstruction syndrome in Bulldogs may not be due to laryngeal collapse as previously thought but rather to congenital malformation of the laryngeal cartilages.     

Surgical relief of severe laryngeal malformation in an English Bulldog

A 22 month old English Bulldog was presented with progressive upper airway obstruction associated with an elongated soft palate, tonsillitis, everted laryngeal saccules and laryngeal malformation. Surgical management of the case consisted of resection of the elongated soft palate and everted laryngeal saccules, unilateral tonsillectomy and correction of the laryngeal stenosis. The latter was achieved by using a castellated incision through the laryngeal cartilages and first tracheal ring. From this case, it is postulated that, at least in some cases, the common upper airway obstruction syndrome in Bulldogs may not be due to laryngeal collapse as previously thought but rather to congenital malformation of the laryngeal cartilages.     

Complications and Long-term Results after Partial Laryngectomy for the Treatment of Idiopathic Laryngeal Paralysis in 45 Dogs

Forty-five dogs with severe respiratory signs caused by idiopathic, acquired laryngeal paralysis were treated by partial laryngectomy. The predominant postoperative complications were coughing in 28 dogs and pneumonia in 15 dogs. Eight dogs required a second operation to alleviate persistent or recurrent upper airway obstruction. Results of surgery were considered excellent in 11 dogs (25%), good in 18 dogs (40%), fair in 6 dogs (13%), and poor in 10 dogs (22%). Poorer results were obtained by surgical residents than by more experienced surgeons. Death in the immediate postoperative period was related to pneumonia (8 dogs) and laryngeal collapse (1 dog). Nine dogs died later of respiratory disease. Although partial laryngectomy is effective for the treatment of laryngeal paralysis, it is not recommended because of the high incidence of postoperative complications.     

A Mucosal Flap Technique for Correction of Laryngeal Webbing Results in Four Dogs

Postoperative laryngeal webbing in four dogs was corrected with a mucosal flap technique using mucosa harvested from the lateral wall of the laryngeal ventricle. Airway obstruction caused by the webbing was relieved in all dogs. Follow-up time was 3 months to 5 years. The technique allowed mucosal apposition without undue tension on the suture line.     

Association of owner-reported noise with findings during dynamic respiratory endoscopy in Thoroughbred racehorses

Reasons for performing study: To determine the association between owner‐reported noise and findings during dynamic respiratory endoscopy (DRE) in a large case series. Hypothesis: The sensitivity of owner‐reported noise for dynamic upper respiratory tract obstructions in horses is low, and the specificity is high. Methods: One hundred horses underwent DRE for the investigation of abnormal respiratory noise and/or poor performance. The association of abnormal noise with findings during DRE was evaluated. Results: Eighty‐five horses underwent DRE for the investigation of abnormal respiratory noise. Of these, 82% were found to have one or more obstructive upper respiratory tract abnormalities during DRE. Forty‐eight percent of horses reported to gurgle, rattle or make a rough noise were diagnosed with solitary palatal dysfunction. A further 24% with this history showed palatal dysfunction in combination with an additional abnormality. Twenty‐seven percent of horses with a history of whistling or roaring showed some degree of recurrent laryngeal neuropathy. Seven percent of horses with a history of whistling or roaring had vocal cord collapse as a solitary condition, whereas 40% had vocal cord collapse and another abnormality. The sensitivity of abnormal respiratory noise for any obstruction of the upper portion of the respiratory tract was high (84%), while the specificity was low (25%). Characteristic owner reported noise patterns showed moderate to low sensitivity for specific conditions. Whistling and roaring showed the highest specificity (≥80%) for laryngeal dysfunction. Conclusion: Diagnosis of upper respiratory tract obstructions based solely on owner‐reported noise and performance history may result in incomplete diagnoses. Clinical relevance: DRE should be performed in horses with abnormal respiratory noise to rule out complex conditions of the upper portion of the respiratory tract.     

Branchial remnant cysts of mature and juvenile horses

This clinical report describes 8 cases of branchial remnant cysts (BRC) in the horse. The horses presented with bimodal age distribution, with 5 cases in mature horses (age 8–21 years) and 3 in foals (age 1, 6 and 10 months). Mature cases presented for dysphagia or intermittent oesophageal obstruction (2/5), and retropharyngeal swelling (3/5), whereas respiratory stridor and visible mass were presenting complaints in the foals. Presence of a right‐sided (5/8) or dorsally located (2/8) palpable retropharyngeal mass of 3–35 cm diameter was noted clinically; one left‐sided mass was identified as an incidental finding at necropsy. Ultrasonography typically revealed a thick‐walled cyst containing hypoechoic fluid with dependent hyperechoic masses consistent with blood clots. Radiographs and upper airway endoscopy were also consistent with a retropharyngeal mass. Fluid cytology revealed chronic haemorrhage in 6/8 cases, and squamous epithelial cells in one case. Histopathology in all cases demonstrated an epithelium‐lined cyst with no smooth muscle or thyroid tissue. Two cases was subjected to euthanasia; one due to concurrent laryngeal anomalies and one due to financial constraints. The remaining 5 cases were treated via surgical excision. Post operatively, right laryngeal hemiplegia was observed in 4/5 cases. All previous reports of BRC in the horse have described juvenile individuals. Brachial remnant cyst should be considered a differential diagnosis for mature horses with masses of the throatlatch area and can be definitively diagnosed by the presence of squamous epithelium in aspirated fluid or by histopathology of the excised mass. Right recurrent laryngeal nerve damage is a common complication of surgery.