Arytenoid Cartilage Movement in Resting and Exercising Horses

Endoscopic examinations of the larynx were recorded on 49 horses at rest and while exercising on a 5% inclined high-speed treadmill for 8 minutes at a maximum speed of 8.5 m/sec. Subjective laryngeal function scores at rest and while exercising were based on the degree and synchrony of arytenoid abduction. Arytenoid abduction was expressed as a left:right ratio of rima glottidis measurements. Horses with arytenoid cartilage asynchrony at rest (grade 2) could not be distinguished from normal horses (grade 1) when exercising because full abduction was maintained throughout the exercise period. Five horses with incomplete left arytenoid abduction at rest (grade 3) maintained full abduction during exercise; one grade 3 horse had dynamic collapse of the left side of the larynx. All horses with laryngeal hemiplegia at rest (grade 4) had dynamic collapse of the left side of the larynx during exercise. Forty-two horses with a resting left:right arytenoid abduction ratio greater than or equal to .71 consistently had complete arytenoid abduction at exercise. Seven horses with a left:right ratio less than .71 consistently showed dynamic collapse at exercise. There was no significant difference in the exercising left:right ratio between normal horses (grade 1) and grade 2 or grade 3 horses. These results suggest that horses with arytenoid asynchrony at rest do not suffer progressive collapse of the rima glottidis during exercise, and that incomplete arytenoid abduction at rest is an unreliable predictor of such collapse. Surgical treatment of all grade 2 horses and some grade 3 horses may be inappropriate.     

The effect of two modifications of unilateral arytenoid lateralization on rima glottidis area in dogs

OBJECTIVES: To evaluate the clinical outcome and percentage increase in rima glottidis area achieved using a combined technique of cricoarytenoid and thyroarytenoid cartilage lateralization compared with cricoarytenoid cartilage lateralization alone in live anesthetized dogs clinically affected with bilateral laryngeal paralysis. STUDY DESIGN: Randomized prospective clinical study. ANIMALS: Twenty dogs with bilateral laryngeal paralysis. Methods-Bilateral laryngeal paralysis was diagnosed by direct laryngoscopy. Each dog was allocated randomly to 1 of 2 surgical groups: CAL (cricoarytenoid lateralization) and CTAL (cricoarytenoid and thyroarytenoid lateralization). Photographs were taken of each larynx before and after surgery, the images were digitized, and the preoperative and postoperative areas of each rima glottidis were measured. The percentage increase in rima glottidis area produced by each of the arytenoid lateralization procedures was compared. Follow-up was obtained by telephone survey of owners and referring veterinarians. RESULTS: There was no significant difference in mean (+/- SD) percentage increase in rima glottidis area for the CAL group (241.5 +/- 42.9%) or the CTAL group (236.4 +/- 44.5%). Clinical follow-up (median, 18 months postoperatively) indicated 60% of the dogs were still alive and only 1 dog had died as a result of complications related to surgery. CONCLUSIONS: CTAL for the treatment of canine laryngeal paralysis does not significantly increase rima glottidis area compared with CAL alone. The mean percentage increase in rima glottidis area obtained with both procedures was comparable to previously reported mean increases with CAL in live anesthetized dogs. Both procedures resulted in good long-term clinical outcome. CLINICAL RELEVANCE: CTAL is as effective as CAL in providing an increased rima glottidis for the treatment of bilateral laryngeal paralysis in dogs.     

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.     

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)     

A Comparison of the Effects of Unilateral Thyroarytenoid Lateralization Versus Cricoarytenoid Laryngoplasty on the Area of the Rima Glottidis and Clinical Outcome in Dogs with Laryngeal Paralysis

OBJECTIVE: To compare the clinical effects of unilateral thyroarytenoid lateralization versus unilateral cricoarytenoid laryngoplasty for the treatment of canine laryngeal paralysis. Study Design-A prospective, clinical trial. ANIMALS: Twenty client-owned dogs admitted to Glasgow University Veterinary Hospital (GUVH) between 1997 and 1999 with a diagnosis of laryngeal paralysis. METHODS: A thorough evaluation of each dog was undertaken that included history, physical and neurologic examinations, complete blood count, serum biochemistry profile, serum thyroxine (T4) level, and thyroid-stimulating hormone (TSH) assay. The exercise tolerance of each dog was investigated by assessing respiratory rate and arterial blood gas analysis at rest and after 5 minutes of mild exercise. Animals were included in the study on the basis of a definitive diagnosis of laryngeal paralysis made by endoscopic observation of the larynx in the lightly anesthetized patient. The animals were randomly assigned to 1 of 2 treatment groups: unilateral thyroarytenoid lateralization or unilateral cricoarytenoid laryngoplasty, with all procedures being performed by the same surgeon. Video images of the rima glottidis were recorded pre- and postoperatively using video endoscopy. Video images were digitized and the area of the rima glottidis measured using image-analysis software. An increase in the area of the rima glottidis was expressed as a percentage of the preoperative area. All animals were reassessed 6 weeks' postoperatively, and exercise tolerance tests were repeated. RESULTS: The mean increase in the area of the rima glottidis postoperatively when compared with the preoperative area was 140% for those animals undergoing unilateral thyroarytenoid lateralization (range, 120%-158%) and 207% for those animals undergoing unilateral cricoarytenoid laryngoplasty (range, 183%-228%). This difference was statistically significant (P < .0001). At the 6-week postoperative examination, there was no significant difference in improvement between the 2 groups when compared on either a clinical basis or exercise tolerance tests. The mean surgical time in the 2 groups was 25 minutes for thyroarytenoid lateralization and 43 minutes for cricoarytenoid laryngoplasty. This was a statistically significant difference (P = .002). CONCLUSION: Although increase in area of the rima glottidis was significantly greater after unilateral cricoarytenoid laryngoplasty compared with unilateral thyroarytenoid lateralization, no difference in clinical outcome could be detected. However, the cricoarytenoid laryngoplasty procedure required significantly more surgical time. CLINICAL RELEVANCE: Both unilateral cricoarytenoid laryngoplasty and unilateral thyroarytenoid lateralization are successful methods for the treatment of laryngeal paralysis; however, thyroarytenoid lateralization requires less surgical time to perform.     

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.     

Cross-sectional area of the aditus laryngis and rima glottidis before and after transection of the left recurrent laryngeal nerve in the horse

The ventral-to-dorsal height of the rima glottidis was measured from lateral pharyngeal radiographs after correction for magnification. The rima glottidis height was used to enlarge accurately endoscopic photographs of 5 horses taken before and after transection of the left recurrent laryngeal nerve. Areas of the rima glottidis and aditus laryngis were measured, using a computerized digitizer. Mean area of the aditus laryngis was 1,908 mm2 before neurectomy and 1,346 mm2 after neurectomy (P = 0.025). Mean area of the rima glottidis was 1,198 mm2 before neurectomy and 805 mm2 after neurectomy (P = 0.025). Mean width of the rima glottidis was 31 mm before neurectomy and 20 mm after neurectomy (P = 0.001). Significant differences were not found between the pre- and postneurectomy heights of the rima glottidis.     

Surgical management of laryngeal collapse associated with brachycephalic airway obstruction syndrome in dogs

Objective: To describe the use of cricoarytenoid lateralisation combined with thyroarytenoid caudo- lateralisation (arytenoid laryngoplasty) for the management of stage II and III laryngeal collapse in dogs. Methods: A retrospective study of a consecutive series of 12 dogs suffering from life-threatening stage II or III laryngeal collapse associated with brachycephalic airway obstruction syndrome. Results: Pre-operatively, either stage II collapse (2/12) or stage III collapse (10/12) was confirmed on visual examination. In all cases, a left-sided arytenoid laryngoplasty was performed. Two dogs were euthanased postoperatively as a result of persistent life-threatening respiratory compromise. The procedure resulted in subjective enlargement of the rima glottidis and an associated improvement in respiratory function in the remaining 10 dogs. Follow-up, long-term outcome (median, 3·5 years) in these dogs indicated that all owners considered that the surgery had resulted in marked improvements in their dog's respiratory function, tolerance to exercise, and quality of life. Clinical Significance: Combined cricoarytenoid and thyroarytenoid caudo-lateralisation may be a useful procedure for treatment of stage II and III laryngeal collapse in the dog.     

Video-Assisted Left Partial Arytenoidectomy by Diode Laser Photoablation for Treatment of Canine Laryngeal Paralysis

Objectives— To evaluate the clinical outcome of left partial arytenoidectomy by video-assisted laser diode photoablation as a surgical treatment for canine laryngeal paralysis (LP).
Study Design— Case series.
Animals— Dogs with bilateral LP (n=20).
Methods— After endoscopic diagnosis of bilateral LP, left partial arytenoidectomy was performed by photoablation of arytenoid cartilage tissue using a diode laser (600 μm diameter, 15 W power, 980 nm wave length) to increase the width of the rima glottidis. Outcome was evaluated endoscopically (1 and 6 months) and clinically (1, 6, and 12 months).
Results— No substantial complications occurred during photoablation or in the immediate postoperative period. Postoperative width of the rima glottidis ranged from 6 to 10 mm at its widest aspect. At 1 month, respiratory function after walking and short running appeared good. Clinical and endoscopic examination revealed good outcome at 1 and 6 months. At 6 months, there was no evidence of hypertrophic scar, hypertrophic granulation tissue, or stricture of the laryngeal glottis in any dog. Two dogs developed aspiration pneumonia after 12 months.
Conclusions— Partial arytenoidectomy using video-assisted diode laser photoablation appears to be an effective technique for treating LP.
Clinical Relevance— Partial arytenoidectomy by diode laser photoablation should be considered as an alternative technique for treatment of canine LP.     

The Reliability of Endoscopic Examination in Assessment of Arytenoid Cartilage Movement in Horses Part II. Influence of Side of Examination, Reexamination, and Sedation

Twenty Thoroughbred and Standardbred horses underwent endoscopic evaluation of arytenoid cartilage movement twice within 1 week. Each time, a flexible endoscope was passed without sedation through the right nostril and the left nostril, and through the right nostril 5 minutes after administration of xylazine hydrochloride (0.55 mg/kg or 1.1 mg/kg intravenously). Laryngeal cartilage movement was videorecorded. All videotaped images were reviewed by three veterinarians and subjectively placed in one of four grades. The intraobserver agreement rate varied from 52.6% for examination under sedation with 1.1 mg/kg of xylazine to 89.5% for unsedated reexamination through the left nostril. The effect of the various observations on median laryngeal grade was calculated. Examination under xylazine hydrochloride at either dosage yielded a change in median laryngeal grade from the unsedated examination in 45% of the evaluations. Reevaluation through the right or left nostril resulted in a different median laryngeal grade in 21% and 5% of the examinations, respectively. Objective measurements of the rima glottidis obtained by computer-assisted morphometric analysis of the recorded laryngeal images allowed laryngeal images to be dichotomized regardless of the condition of endoscopic examination. Endoscopic evaluation of laryngeal cartilage movement is subjective and is influenced by sedation with xylazine, evaluation through the alternate nostril, and different day of examination. The most consistent evaluation was obtained during repeated examination through the left nostril.     

An experimental evaluation of castellated laryngofissure and bilateral arytenoid literalisation for the relief of laryngeal paralysis in dogs

The aim of this study was to compare the efficacy of 2 surgical procedures for providing an adequate laryngeal airway in dogs after surgically induced laryngeal paralysis. The laryngeal function of 10 healthy, adult experimental dogs was assessed by clinical examination, laryngoscopy, arterial blood gas measurement and analysis of tidal breathing flow-volume loops before, and after, bilateral recurrent laryngeal neurectomy. A castellated laryngofissure with vocal fold resection was done on 5 dogs and bilateral arytenoid cartilage lateralisation performed on the remaining 5 dogs. Six weeks later, the laryngeal function of the 10 dogs was reassessed, before the dogs were killed and a necropsy performed. The visible changes in laryngeal structure were recorded. Both surgical procedures alleviated some of the airway obstruction caused by the bilateral recurrent laryngeal neurectomy, but bilateral arytenoid cartilage lateralisation produced more consistent clinical improvement, a wider rima glottidis, increased inspiratory air flow and a significant increase in post-operative arterial oxygen tension.     

Arytenoid Lateralization for Treatment of Laryngeal Paralysis in 10 Cats

Objective— To describe the signalment, history, clinical signs, surgical technique, and outcome for cats with laryngeal paralysis that had arytenoid lateralization.
Study Design— Case series.
Animals— Cats with laryngeal paralysis (n=10).
Methods— Medical records (1996–2002) for cats with laryngeal paralysis that had arytenoid lateralization were reviewed for signalment, history, clinical signs, degree of paralysis, cause, concurrent medical conditions, surgical technique, and outcome. Follow-up information was obtained from owners or referring veterinarians.
Results— Of 10 cats, 9 had bilateral and 1 had unilateral laryngeal paralysis. Arytenoid lateralization were unilateral (n=7), bilateral (1), and staged bilateral procedures (2), 10 days and 3 years apart, respectively. Postoperatively, 1 cat had persistent inspiratory noise because of minimal enlargement of the rima glottidis and 2 cats required a temporary tracheostomy for management of laryngeal swelling. Three cats developed aspiration pneumonia and died 4, 7, and 150 days after surgery; all 3 had bilateral (simultaneous or staged) procedures. Of the 7 remaining cats, 4 were alive at follow-up and 3 had died of causes unrelated to arytenoid lateralization. The calculated mean survival time for all 10 cats was 406 days (median, 150 days; range, 4–1825 days).
Conclusions— Arytenoid lateralization was effective at enlarging the rima glottidis and reducing signs of airway obstruction in most cats.
Clinical Relevance— Unilateral arytenoid lateralization is a feasible option for the surgical management of cats with marked clinical signs; however, bilateral procedures should be avoided or at least performed with considerable caution because of the apparent risk for aspiration pneumonia.     

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.     

Laryngeal function in normal dogs administered isoflurane following partial clearance of alfaxalone or propofol

ObjectiveTo assess laryngeal function in normal dogs administered isoflurane following partial clearance of alfaxalone or propofol.Study designRandomized experimental crossover study.AnimalsA group of 12 purpose-bred, male Beagle dogs.MethodsDogs were randomly assigned to one of two treatments: alfaxalone–isoflurane (ALF-ISO) or propofol–isoflurane (PRO-ISO) and anesthetized for three video laryngoscopy examinations. The alternate treatment occurred after ≥ 14 days interval. Examinations were performed after induction of anesthesia (LS-A), after 20 minutes of breathing isoflurane via a facemask (LS-B) and after a further 20 minutes of isoflurane (LS-C). Parameters of objective laryngeal function included inspiratory rima glottidis surface area (RGSA-I), expiratory rima glottidis surface area (RGSA-E) and % RGSA increase, calculated from three consecutive respiratory cycles in the final 15 seconds of each video laryngoscopy examination. The % RGSA increase was calculated using [(RGSA-I – RGSA-E)/RGSA-E] × 100. Subjective laryngeal function was evaluated independently by two experienced surgeons blinded to treatment.ResultsThe % RGSA increase within each treatment was greater for LS-B and LS-C than for LS-A (ALF-ISO: p = 0.03, PRO-ISO: p = < 0.001). There was no difference within each treatment from LS-B compared with LS-C. RGSA-I increased within each treatment from LS-A to both LS-B and LS-C (ALF-ISO: p = 0.002) and to LS-C (PRO-ISO: p = 0.006). Subjective laryngeal function scores improved from LS-A to LS-C.Conclusions and clinical relevanceLaryngeal function improved from postinduction examination following either 20 or 40 minutes of anesthesia with isoflurane via facemask. This study demonstrates that isoflurane may have a lesser effect on arytenoid abduction activity compared with more commonly used intravenous induction anesthetics (alfaxalone and propofol).     

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.     

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.     

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.     

Development of equine upper airway fluid mechanics model for Thoroughbred racehorses

REASON FOR PERFORMING STUDY: Computational fluid dynamics (CFD) models provide the means to evaluate airflow in the upper airways without requiring in vivo experiments. HYPOTHESIS: The physiological conditions of a Thoroughbred racehorse's upper airway during exercise could be simulated. Methods: Computed tomography scanned images of a 3-year-old intact male Thoroughbred racehorse cadaver were used to simulate in vivo geometry. Airway pressure traces from a live Thoroughbred horse, during exercise was used to set the boundary condition. Fluid-flow equations were solved for turbulent flow in the airway during inspiratory and expiratory phases. The wall pressure turbulent kinetic energy and velocity distributions were studied at different cross-sections along the airway. This provided insight into the general flow pattern and helped identify regions susceptible to dynamic collapse. RESULTS: The airflow velocity and static tracheal pressure were comparable to data of horses exercising on a high-speed treadmill reported in recent literature. The cross-sectional area of the fully dilated rima glottidis was 7% greater than the trachea. During inspiration, the area of highest turbulence (i.e. kinetic energy) was in the larynx, the rostral aspect of the nasopharynx was subjected to the most negative wall pressure and the highest airflow velocity is more caudal on the ventral aspect of the nasopharynx (i.e. the soft palate). During exhalation, the area of highest turbulence was in the rostral and mid-nasopharynx, the maximum positive pressure was observed at the caudal aspect of the soft palate and the highest airflow velocity at the front of the nasopharynx. CONCLUSIONS AND CLINICAL RELEVANCE: In the equine upper airway collapsible area, the floor of the rostral aspect of the nasopharynx is subjected to the most significant collapsing pressure with high average turbulent kinetic during inhalation, which may lead to palatal instability and explain the high prevalence of dorsal displacement of the soft palate (DDSP) in racehorses. Maximal abduction of the arytenoid cartilage may not be needed for optimal performance, since the trachea cross-sectional area is 7% smaller than the rima glottidis.     

Sedation with detomidine and acepromazine influences the endoscopic evaluation of laryngeal function in horses

REASON FOR PERFORMING STUDY: Endoscopy of the upper airways of horses is used as a diagnostic tool and at purchase examinations. On some occasions it is necessary to use sedation during the procedure and it is often speculated that the result of the examination might be influenced due to the muscle-relaxing properties of the most commonly used sedatives. OBJECTIVES: To evaluate the effect of detomidine (0.01 mg/kg bwt) and acepromazine (0.05 mg/kg bwt) on the appearance of symmetry of rima glottidis, ability to abduct maximally the arytenoid cartilages and the effect on recurrent laryngeal neuropathy (RLN) grade. METHODS: Forty-two apparently normal horses underwent endoscopic examination of the upper airways on 3 different occasions, under the influence of 3 different treatments: no sedation (control), sedation with detomidine and sedation with acepromazine. All examinations were performed with a minimum of one week apart. The study was performed as an observer-blind cross-over study. RESULTS: Sedation with detomidine had a significant effect on the RLN grading (OR = 2.91) and ability maximally to abduct the left arytenoid cartilages (OR = 2.91). Sedation with acepromazine resulted in OR = 2.43 for the RLN grading and OR = 2.22 for the ability to abduct maximally. The ability to abduct maximally the right arytenoid cartilage was not altered. CONCLUSIONS: Sedating apparently healthy horses with detomidine or acepromazine significantly impairs these horses' ability to abduct fully the left but not the right arytenoid cartilage. This resulted in different diagnosis with respect to RLN when comparing sedation to no sedation. POTENTIAL RELEVANCE: Since the ability to abduct the right arytenoid cartilage fully is not altered by sedation, it is speculated that horses changing from normal to abnormal laryngeal function when sedated, might be horses in an early stage of the disease. To confirm or reject these speculations, further studies are needed. Until then sedation during endoscopy should be used with care.     

Effects of bilateral arytenoid cartilage stenting on canine laryngeal resistance ex vivo

Objective: To evaluate the effect of Nitinol stents for bilateral arytenoid lateralization on canine laryngeal resistance. Study Design: Ex vivo experimental study. Animals: Canine cadaver larynges (n=7). Methods: Laryngeal resistance was calculated in all specimens with the epiglottis in open and closed positions. Bilateral arytenoid stenting was performed, rima glottidis width measured, and laryngeal resistance calculated. The effects of stenting on laryngeal resistance were evaluated by repeated measures ANOVA. Results: Calculated laryngeal resistance in the 3 stented groups, 2 cm (0.034±0.059 cmH₂O/L/s), 3 cm (0.034±0.059 cmH₂O/L/s), and 4 cm (0.034±0.059 cm H₂O/L/s), was significantly decreased versus the control (unstented) group (0.947±0.624 cmH₂O/L/s; P=.0098) with an epiglottis in the normal position. Calculated laryngeal resistance in the 3 stented groups, 2 cm (43.407±17.348 cm H₂O/L/s), 3 cm (70.659±34.705 cmH₂O/L/s), and 4 cm (92.637±44.509 cm H₂O/L/s), was significantly increased versus the control (unstented) group (29.561±14.499 cm H₂O/L/s) (P=.0185) with an epiglottis in the closed position. The width of the rima glottidis correlated with the size of the stent (r=0.95, P<.001). Conclusions: Bilateral arytenoid stenting significantly reduced calculated laryngeal resistance with an open epiglottis. Stenting resulted in a significant increase in laryngeal resistance versus the control with a closed epiglottis. Use of bilateral arytenoid stenting in clinical cases of laryngeal paralysis may provide an adequate decrease in open‐epiglottis airway resistance to alleviate clinical signs, while increasing closed‐epiglottis airway resistance. This could potentially lead to a decrease in the risk of postoperative aspiration pneumonia.