Traumatic bilateral stylohyoid bone fracture in an Appaloosa

An Appaloosa gelding presented for a traumatic puncture wound of the head ventral to the base of his left ear, bilateral epistaxis and upper respiratory compromise. The horse did not exhibit dysphagia or cranial nerve deficits. The horse suffered bilateral oblique fractures of both stylohyoid bones due to the traumatic incident, diagnosed upon endoscopy of the guttural pouches. Treatment consisted of anti‐inflammatory medication, broad‐spectrum antibiotics, guttural pouch lavage and dietary management with soft feeds. At a one‐month follow‐up examination, endoscopic evaluation revealed a union at both stylohyoid bone fracture sites. Guttural pouch mycosis was diagnosed in the left guttural pouch on the lateral wall at the entrance of the lateral compartment. The guttural pouch mycosis was treated with a nystatin and gentamicin flush, followed by a course of oral fluconazole. At the 3‐month re‐evaluation, the guttural pouch mycosis had completely responded to treatment.     

Laser fenestration of the mesial septum for treatment of guttural pouch chondroids in a pony

OBJECTIVE: To describe removal of guttural pouch chondroids through a laser fenestrated mesial septum in a pony with an obstructed pharyngeal ostium of the left guttural pouch. STUDY DESIGN: Case report. ANIMALS: Pony. METHODS: Transendoscopic laser neodymium:yttrium aluminum garnet (Nd:YAG) fenestration of the mesial guttural pouch septum was made by contact method (bare fiber, 15-25 W, exposure time 4 seconds). Dissected tissue was removed by transendoscopic monopolar electrosurgery (loop electrode, cutting blade) and multiple chondroids of varying size were removed from the left guttural pouch through the fenestration. RESULTS: After removing all chondroids and repeated flushing of the left guttural pouch via the right side, inflammation of the guttural pouch membranes decreased remarkably. The pony was discharged with instructions for transendoscopic lavage once weekly and was reevaluated at 2 months. A permanent septal fenestration was observed and the pony was free of abnormal clinical signs and being used for carriage driving competitions. CONCLUSION: Nd:YAG laser fenestration of the mesial septum is an approach for access to guttural pouch chondroids. CLINICAL RELEVANCE: When guttural pouch empyema and/or chondroids is associated with adhesion of the pharyngeal ostium, laser fenestration of the mesial septum from the opposite guttural pouch should be considered as an alternative approach for access, rather than classic external surgical approaches.     

Guttural pouch empyema secondary to a periocular foreign body

This report describes a 3‐year‐old gelding presenting with signs of injury to its left eye following an accident in which the horse crashed into a hedge. The first treatment attempted to treat infections in the eye and respiratory tract due to secretions identified in the trachea. The horse did not improve and further clinical and radiographic evaluations detected a guttural pouch empyema. Surgical drainage was performed and antimicrobial treatment continued. However, the horse presented with severe epistaxis and euthanasia was elected due to suspected arterial rupture. At necropsy, a round and stiff branch plant was found creating a fistula from the left orbit to the left guttural pouch. Another branch was found inside the pouch, confirming the origin of the persistent infection and severity of the tissue lesion.     

Progression of mycosis of the auditory tube diverticulum (guttural pouch) after arterial occlusion in a horse with contralateral temporohyoid osteoarthropathy

CASE DESCRIPTION: A 6-year-old Appaloosa mare was examined because of inappetance, difficulty eating, and swelling and mucopurulent discharge in the right eye. CLINICAL FINDINGS: Results of a CBC and serum bio-chemical analysis revealed no important findings. Ophthalmologic examination revealed scarring and ulceration of the superficial layers of the cornea. Endoscopic examination of the upper portion of the respiratory tract and auditory tube diverticula (guttural pouches) revealed abnormal thickness of the right stylohyoid bone and a plaque suggestive of mycotic growth on the left internal carotid artery. Radiographic examination revealed right-sided otitis media. Temporohyoid osteoarthropathy in the right guttural pouch and mycosis in the left guttural pouch were diagnosed. TREATMENT AND OUTCOME: Ceratohyoidectomy of the right stylohyoid bone was performed, and the left internal carotid artery was occluded via placement of stainless steel spring embolization coils. The mare regained the ability to eat without difficulty and improved clinically for approximately 4 weeks. However, the mare returned to the medical center 53 days after surgery with left-sided Horner syndrome, atrophy of the right side of the tongue, and a 3-week history of dysphagia and weight loss. Endoscopic evaluation revealed progression of mycotic growth in the left guttural pouch. The mare was euthanatized. CLINICAL RELEVANCE: Although the mycotic lesion in the left guttural pouch was an incidental finding at the time of initial examination, the lesion progressed to cause dysphagia and Horner syndrome after occlusion of the left internal carotid artery, a treatment that is typically associated with resolution of guttural pouch mycosis. Arterial occlusion is not necessarily a reliable method of resolving guttural pouch mycosis.     

Fistula between the guttural pouches and the dorsal pharyngeal recess as a sequela to guttural pouch mycosis in the horse

An unusual case of a two year old gelding with severe unilateral epistaxis due to guttural pouch mycosis is reported. The lesion had spread to involve the dorso-medial aspects of the right guttural pouch and had formed a fistula between the dorsal pharyngeal recess and both the left and right guttural pouches. The diagnosis, surgical treatment and postoperative management are described.     

Treatment of guttural pouch tympany in foals with transnasal Foley catheter placement

This case series describes a technique to treat guttural pouch tympany that may be useful to equine practitioners. The objective of this work is to describe the treatment technique, outcome, possible complications and benefits. Data from a retrospective case series obtained by records review and follow‐up with owners and referring veterinarians were used. Foley catheters were placed into the guttural pouch using endoscopic guidance via the nasal passage, the balloon inflated and the catheter sutured to the external nares under tension. Foals were treated successfully with this method and complications were minor. This treatment method is a viable, low‐cost option for guttural pouch tympany in foals.     

Cystic structures in the guttural pouch (auditory tube diverticulum) of two horses.

Two horses were examined for compression of the pharynx from the dorsal pharyngeal wall. Neither horse had a patent opening of 1 of the guttural pouches. Radiography of the guttural pouch region revealed a retropharyngeal opacity that occluded 1 guttural pouch. Organisms were not isolated on bacteriologic culture of fluid obtained from the affected guttural pouch. Surgical exploration of the guttural pouch revealed the lining to be easily removeable by blunt dissection in 1 horse; however, the lining was more firmly attached and removal was not attempted in the second horse. A fenestration between the normal and affected guttural pouch was created in both horses to allow for drainage. The etiopathogenesis of the cyst in the guttural pouches is unknown.     

Extensive and invasive guttural pouch granuloma in a 2-year-old gelding

This report describes a case of an unusually extensive and invasive fungal granuloma within the right guttural pouch and its surrounding area of a 2-year-old Noriker gelding, causing diverse neurogenic deficits and tissue destruction. The gelding was initially presented with cachexia, unilateral nasal discharge, intermittent fever, swelling of the right side of the head, facial nerve paralysis and dysphagia. The right guttural pouch was not accessible to endoscopic examination initially, but after anti-inflammatory medical management, empyema and an extensive, solid mass appeared within the guttural pouch. Surgical exploration and excision were attempted but were unsuccessful. Histopathological examination identified Aspergillus fumigatus as the causative infective agent of the extensive fungal granuloma, and the consequent invasion and destruction of surrounding bone and soft tissue structures.     

Population genetic analysis of the heritability of gutteral pouch tympany in Arabian purebred foals

The objective of the present study was to analyse the importance of the influences of the sex, inbreeding coefficient and the additive genetic contribution to the occurrence of guttural pouch tympany in Arabian foals. Horses affected by guttural pouch tympany were ascertained in the Clinic for Horses, School of Veterinary Medicine Hannover. The data comprised 27 Arabian purebred foals with guttural pouch tympany. Of these 27 animals 22 were patients of the Clinic for Horses between 1994 and 2001 and 5 Arabian foals were sampled on the studs. Information on the pedigrees of these patients allowed us to sort in the affected foals into four families with a total of 276 animals. Female foals were more often affected by guttural pouch tympany. The difference was 11.9% in favour of female foals. The size of the inbreeding coefficient was not important for the occurrence of guttural pouch tympany. The heritability estimate for the frequency of guttural pouch tympany using a threshold model was 0.49 +/- 0.28. This is the first report that could show a genetic component responsible for guttural pouch tympany in foals.     

Dysphagia caused by focal guttural pouch mycosis: mononeuropathy of the pharyngeal ramus of the vagal nerve in a 20-year-old pony mare

A 20-year-old pony mare was presented to the equine hospital with a ten-day history of dysphagia, regurgitation and coughing. An obstruction of the oesophagus was excluded via endoscopy, but the proximal oesophagus appeared to be distended and circular contractions were missing. A guttural pouch endoscopy revealed a single, black-mottled plaque on the pharyngeal ramus of the vagus nerve in the left guttural pouch, causing a local swelling of this nerve. The pharyngeal ramus seemed to be atrophic distal to the lesion. A biopsy was taken from the lesion and histopathological findings proved the reasonable suspicion of a guttural pouch mycosis with a high degree of purulent-necrotic inflammation and invasion of fungal hyphae. There were no signs of neoplasia, such as melanoma. Daily guttural pouch irrigations with a clotrimazole emulsion (20 g Canesten^® Gyn⁴ solved in 500 ml water), led to a good recovery of the mucosa above the nerve. Periodic endoscopic examination of the left guttural pouch showed that local thickening and distal atrophy of this pharyngeal ramus did not improve, neither did the clinical symptoms. Due to progressive weight loss, acute respiratory distress and aspiration pneumonia, the 20-year-old pony mare unfortunately had to be euthanized three weeks after discharge. This case report emphasizes the enormous importance of a single nerve for the realization of the swallowing process. The one-sided loss of function of the pharyngeal branch of the vagal nerve cannot be compensated neither by the remaining ipsilateral nerves nor by the contralateral normal functioning glossopharyngeal and vagal nerves and thus inevitably leads to severe dysphagia.     

Empyema of the guttural pouch (auditory tube diverticulum) in horses: 91 cases (1977-1997)

OBJECTIVE: To identify features of guttural pouch (auditory tube diverticulum) empyema in horses and compare findings of uncomplicated guttural pouch empyema with guttural pouch empyema complicated by chondroids. DESIGN: Retrospective study. ANIMALS: 91 horses with guttural pouch empyema. PROCEDURE: Medical records of horses with guttural pouch empyema were reviewed. RESULTS: The most common owner complaint and abnormal finding was persistent nasal discharge. Chondroids were detected in 21% (19/91) of affected horses. Streptococcus equi was isolated from the guttural pouch in 14 of 44 horses; for Streptococcus spp, in vitro resistance to sulfadimethoxine and trimethoprim-sulfamethoxazole was detected. Retropharyngeal swelling and pharyngeal narrowing were significantly more prevalent in horses with chondroids, compared with horses with uncomplicated empyema. Ninety-three percent of affected horses were discharged from the hospital; at time of discharge, 66% had complete resolution of disease, 19% had improvement without resolution, and 15% did not have improvement. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with persistent nasal discharge should be examined endoscopically for guttural pouch empyema. Treatment with lavage offers a good prognosis for resolution of uncomplicated guttural pouch empyema. Aggressive treatment with lavage and endoscopic snare removal of chondroids offers a good prognosis and may make surgical intervention unnecessary.     

Cytological and microbiological findings in guttural pouch lavages of clinically normal horses with head restraint

OBJECTIVE: To evaluate the cytological and microbiological contents of guttural pouch washes of ten randomly selected horses restrained so as to prevent them lowering their heads, and to assess the possible effects on the guttural pouch environment in these horses. PROCEDURE: Cytological and microbiological studies were performed on guttural pouch washes of ten clinically normal horses restrained in a standing position so as to prevent them from lowering their heads below normal, as would happen during transportation on long journeys. They were restrained for 12 or 24 h and cytological, bacteriological and mycological findings in guttural pouch washes were recorded. RESULTS: The cytological gradings and neutrophil concentrations of guttural pouch washings were higher in horses that had their heads restrained for a longer period. Washings from these horses were more likely to contain cultivable bacteria and were the only washes yielding potentially pathogenic bacterial species. CONCLUSION: Variation in the cytological differential counts and bacterial cultures of guttural pouch lavages may be found in clinically normal horses which have had their heads restrained in an elevated position for periods from 12 to 24 h. This should be considered when examining this site and care must be taken when interpreting cytology of guttural pouch lavages in samples taken after transportation for more than 12 h. Restriction of head movement could also affect the normal pouch enviroment and predispose it to disease.     

Diverticulum and fistula of the lower cervical esophagus in a horse

Esophageal diverticulum and perforation were diagnosed in a horse. The condition was characterized clinically by dysphagia, polypnea, diffuse swelling of the ventral aspect of neck and cutaneous fistula. Endoscopic examination revealed the presence of food material in the guttural pouch. A barium sulfate esophagram was performed to outline the diverticulum.

Exploratory surgery confirmed esophageal perforation and entrapment of food material between the muscular planes of the cervical region and the horse was euthanized. At necropsy a food-filled periesophageal tract was found extending from the esophageal rupture to the left guttural pouch.

     

Gutteral pouch tympany in German warmblood foals: influence of sex,inbreeding and blood proportions of founding breeds as well as estimation of heritability

The objective of the present study was to analyse the importance of the influences of sex, inbreeding coefficient, proportion of genes of the original breeds and the additive genetic contribution to the occurrence of guttural pouch tympany in foals belonging to German Warmblood breeds. Foals affected by guttural pouch tympany were ascertained in the Clinic of Horses, School of Veterinary Medicine Hannover. This data set comprised 22 German Warmblood foals with guttural pouch tympany, which were patients of the Clinic for Horses between 1994 and 2001. Information on the pedigrees and all available relatives of these patients allowed us to group the affected foals into five families with a total of 289 animals. Female foals were significantly more often affected by guttural pouch tympany. The difference was 16.6% in favour of female foals. The size of the inbreeding coefficient was not important for the occurrence of guttural pouch tympany. The proportion of the genes of the breeds Arabian, Thoroughbred and Trakehner were not significantly different from a randomly selected sample of 10% of foals born in the same birth years and the same region. The heritability estimates for the frequency of guttural pouch tympany using a threshold model was 0.81 +/- 0.16. This is the first report that could show a genetic component responsible for guttural pouch tympany in horses.     

Pituitary gland abscess in a horse subsequent to head trauma

A 5-year-old Thoroughbred gelding with recent history of head trauma presented with multiple facial swellings, bilateral mucopurulent nasal discharge, neck pain, inappetence and depression. On computed tomographic examination, lesions within the pituitary fossa and structures adjacent to the right guttural pouch were identified. Soft tissue swelling was seen in the dorsal aspect of the right guttural pouch surrounding several cranial nerves, with fluid-like material in the dependent portions of the right guttural pouch. A CSF sample revealed mild mixed pleocytosis and increased protein concentration. The horse had concurrent periapical disease of the 209-cheek tooth and mild left sinusitis. The horse's demeanour deteriorated requiring euthanasia. Post-mortem examination revealed a pituitary gland abscess.     

Guttural pouch empyema caused by Corynebacterium pseudotuberculosis in a pregnant mare

During medical management of mild colic in a 12‐year‐old Quarter Horse, mid‐gestation mare, unilateral purulent nasal discharge from the right nostril was noted. Endoscopic examination revealed guttural pouch empyema. Culture was positive for Corynebacterium pseudotuberculosis and negative for Streptococcus equi ssp. equi. A synergistic haemolysis inhibition titre of 1024 was consistent with C. pseudotuberculosis infection. Treatment included serial lavages and local infusion of antibiotics into the guttural pouches along with a 6‐week course of oral trimethoprim–sulfamethoxazole and rifampicin. Overall, no additional sites of infection were identified and the mare responded well to treatment, delivering a healthy, full‐term foal. This case emphasises that C. pseudotuberculosis, although uncommon, should be considered as a differential for guttural pouch empyema.     

Complications of Balloon Catheterization Associated With Aberrant Cerebral Arterial Anatomy in a Horse With Guttural Pouch Mycosis

A 3-year-old Quarter Horse gelding was treated for left guttural pouch mycosis by ligation and balloon catheterization of the left internal carotid artery. Catheter advancement was shorter (10 cm) than the normally reported distance (13–15 cm), but was observed endoscopically during placement as it coursed within the internal carotid artery through the guttural pouch. The horse developed a persistently abnormal respiratory pattern after catheter placement, failed to gain consciousness, developed pulmonary edema, and died 5.5 hours postoperatively. Postmortem examination revelaed an aberrant left internal carotid arterial course with location of the embolectomy catheter at the junction of the basilar and caudal cerebellar arteries. Brainstem neuronal necrosis and alveolar and interstitial pulmonary edema were identified on histological examination. Angiography may be used to identify aberrant branching patterns. Failure to identify and occlude aberrant branches may result in fatal epistaxis and Brainstem lesions.     

Unusual Internal Carotid Artery Branching That Prevented Arterial Occlusion With a Balloon-Tipped Catheter in a Horse

A mare with hemorrhage caused by guttural pouch mycosis was treated by insertion of a balloon-tipped catheter into the left internal carotid artery. During recovery from general anesthesia, the mare had profuse epistaxis, and was anesthetized again to determine the site of hemorrhage. The affected guttural pouch was opened to confirm that hemorrhage was from the left internal carotid artery. The mare was euthanatized, and, at necropsy, the balloon catheter was found in an aberrant branch that arose from the internal carotid artery and joined the basilar artery. The mycotic plaque was on the left internal carotid artery, distal to the origin of the aberrant branch, so that the balloon did not obstruct retrograde flow through the infected segment. Additional dissection of the internal carotid artery before insertion of a balloon catheter is recommended to identify any aberrant branches. Ligation of aberrant branches at their bifurcation with the internal carotid artery is recommended to prevent both inadvertent catheterization and retrograde flow from the cerebral arterial circle.     

Pharyngeal neuromuscular dysfunction associated with bilateral guttural pouch tympany in a foal

A 2-month-old warmblood filly was presented for a 1-week history of a large, nonpainful, fluctuant swelling of the parotid and laryngeal area. Bilateral guttural pouch tympany was diagnosed. Surgical correction resolved the guttural pouch tympany; however, postoperative pharyngeal neuromuscular dysfunction developed.     

Suspected retropharyngeal haemorrhage as a complication of guttural pouch mycosis

An 11-year-old Thoroughbred mare presented for evaluation of severe, acute bilateral epistaxis of several hours’ duration. Endoscopic evaluation revealed active haemorrhage from the right guttural pouch and significant dorsal compression of the nasopharynx. Rapid and severe retropharyngeal swelling developed, prompting placement of a temporary tracheostomy. Guttural pouch mycosis was suspected and transarterial coil embolisation of the right internal carotid, external carotid and maxillary arteries was successfully performed. It was suspected that haemorrhage from the vasculature of the guttural pouch tracked caudally into the retropharyngeal region resulting in significant swelling, pharyngeal collapse and a severely compromised airway. Clinicians should be aware of this rare complication of guttural pouch epistaxis.