Long-term study of partial arytenoidectomy with primary mucosal closure in 76 Thoroughbred racehorses (1992-2006)

REASON FOR PERFORMING STUDY: The effectiveness and best method to perform a partial arytenoidectomy in racehorses is unclear. This study was performed to evaluate the success of and complications that can occur after a unilateral partial arytenoidectomy with primary mucosal closure in Thoroughbred racehorses. HYPOTHESIS: Partial arytenoidectomy is an effective surgical procedure to return Thoroughbred racehorses, afflicted by arytenoid chondropathy or a failed laryngoplasty, to preoperative levels of performance. METHODS: Seventy-six Thoroughbred racehorses admitted to the New Bolton Centre between 1992 and 2006 were assessed. Information was obtained from the medical records about the horse, laryngeal abnormalities, surgery and other findings during hospitalisation. Racing information was evaluated relative to those independent variables by an analysis of variance with a level of significance of P<0.05. RESULTS: Arytenoid chondropathy was the presenting complaint in 54 horses and failed laryngoplasty in 22 horses. Thirteen horses (17%) underwent a second surgery for laser excision of intralaryngeal granulation tissue at the arytenoidectomy site. Seventy-three horses were discharged from the hospital and racing outcome was evaluated. Sixty horses (82%) raced after surgery and 46 horses (63%) raced 5 or more times after surgery. The median time from surgery to the first start was 6 months. The average earnings/start was not significantly different before and after surgery. There was no association between earnings after surgery and age, gender, location of lesion, type of lesion, duration of tracheal intubation or undergoing a second surgery. CONCLUSIONS AND POTENTIAL RELEVANCE: A Thoroughbred racehorse is likely to race after a unilateral partial arytenoidectomy with primary mucosal closure and return to a preoperative level of performance.     

Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 Thoroughbred racehorses competing at less than 2400 m (1997–2007)

Reasons for performing study: The success of combined prosthetic laryngoplasty with ipsilateral ventriculocordectomy (LPVC) has not been compared to that of partial arytenoidectomy (PA) in a clinical population. Hypotheses: In Thoroughbred (TB) racehorses: 1) earnings after LPVC are unaffected by the severity of recurrent laryngeal neuropathy (RLN) (laryngeal grade III vs. grade IV); 2) LPVC and PA yield similar results in the treatment of grade III RLN; 3) performance outcome following PA is independent of diagnosis (RLN vs. unilateral arytenoid chondritis [UAC]); and 4) neither LPVC nor PA returns horses to the level of performance of controls. Methods: Medical and racing records of 135 TB racehorses undergoing LPVC or PA for the treatment of grade III or IV RLN or UAC were reviewed. Racing records of age and sex matched controls were also reviewed. Results: After LPVC, horses with grade III RLN performed better compared to those with grade IV RLN. Furthermore, horses treated for grade III RLN by LPVC showed post operative earnings comparable to controls. Rate of return to racing were similar for PA and LPVC, although LPVC resulted in higher post operative earnings. Performance after PA was similar regardless of diagnosis (UAC or RLN). Finally, neither LPVC when performed for grade IV RLN, nor PA performed for either diagnosis restored post operative earnings to control levels. Conclusions: Thoroughbred racehorses treated by LPVC for grade III RLN show significantly better post operative earnings compared to horses treated for grade IV disease. In grade III RLN, LPVC returns earning potential to control levels. PA and LPVC lead to similar success in terms of rate of return to racing, but PA leads to inferior earnings after surgery. Potential relevance: Laryngoplasty should be recommended for all TB racehorses with grade III RLN to maximise return to racing at a high level. This contradicts the common approach of waiting for complete paralysis.     

Performance after partial arytenoidectomy without mucosal closure in 27 Thoroughbred racehorses

OBJECTIVE: To examine the effect of partial arytenoidectomy without mucosal closure on postoperative racing performance and long-term complications in Thoroughbred racehorses treated for laryngeal hemiplegia, arytenoid chondropathy, or failed laryngoplasty. STUDY DESIGN: Retrospective study. ANIMALS: Twenty-seven Thoroughbred racehorses. METHODS: Medical records of Thoroughbred racehorses that had partial arytenoidectomy without mucosal closure between 1992 and 2002 were reviewed. Horses were divided into groups: horses that had not raced (Group 1) and those that had raced (Group 2) before surgery. Lifetime race records were compared between groups. A standard starts index (SSI) and performance index (PI) were used for Groups 1 and 2, respectively, to objectively evaluate each horse's postoperative performance. Telephone interviews of owners and trainers were used for subjective performance evaluation and to determine prevalence of long-term complications. RESULTS: Eleven (61%) Group 1 and 7 (78%) Group 2 horses raced and earned money after surgery. All Group 1 horses that raced performed at a level lower than the national average. Only 1 Group 2 horse had an improved PI score postoperatively. CONCLUSIONS: Thoroughbred racehorses have a fair prognosis for racing successfully after partial arytenoidectomy without mucosal closure. CLINICAL RELEVANCE: This technique may be a practical alternative to primary mucosal closure, would decrease surgical time, and avoid some problems reported with primary mucosal closure.     

Evaluation of partial arytenoidectomy as a treatment for equine laryngeal hemiplegia

The efficacy of partial arytenoidectomy was assessed in 6 Standardbred horses, with surgically induced laryngeal hemiplegia, at rest (Period A) and during exercise at speeds corresponding to maximum heart rate (Period C) and 75% of maximum heart rate (Period B). Peak expiratory and inspiratory airflow rate (PEF and PIF), and expiratory and inspiratory transupper airway pressure (P_UE and P_UI) were measured and expiratory and inspiratory impedance (Z_E and Z_I) were calculated. Simultaneously, tidal breathing flow-volume loops (TBFVL) were acquired using a respiratory function computer. Indices derived from TBFVL included airflow rates at 50 and 25% of tidal volume (EF₅₀, IF₅₀, EF₂₅. and IF₂₅) and the ratios of expiratory to inspiratory flows. Measurements were made before left recurrent laryngeal neurectomy (baseline), 2 weeks after left recurrent laryngeal neurectomy (LRLN) and 16 weeks after left partial arytenoidectomy coupled with bilateral ventriculectomy (ARYT). After LRLN, during exercise Periods B and C, Z₁ and the ratio of EF₅₀/IF₅₀ significantly increased and PIF, IF₅₀ and IF₂₅ significantly decreased from baseline values. At 16 weeks after ARYT, Z₁ returned to baseline values during Periods B and C. Although PIF, IF₅₀, IF₂₅, PEF/PIF, and EF₅₀/IF₅₀ returned to baseline values during Period B, these indices remained significantly different from baseline measurements during Period C. After ARYT, TBFVL shapes from horses during Period C approached that seen at the baseline evaluation. Partial arytenoidectomy improved upper airway function in exercising horses with surgically induced left laryngeal hemiplegia, although qualitative and quantitative evaluation of TBFVLs suggested that some flow limitation remains at near maximal airflow rates. These results indicate that, although the procedure does not completely restore the upper airway to normal, partial arytenoidectomy is a viable treatment option for failed laryngoplasty and arytenoid chondropathy in the horse.     

Exercising videoendoscopic evaluation of 7 horses with abnormal respiratory noise and poor performance following partial arytenoidectomy

Exercising upper airway endoscopic evaluation was performed in 7 horses with a history of poor performance after partial arytenoidectomy. Treadmill endoscopy revealed axial deviation of the ipsilateral aryepiglottic fold in all horses. Dynamic collapse of one or more additional upper airway structures was also observed. In 4 horses, laser resection of soft tissue structures that obstructed the upper airway was performed. After laser surgery, 3 horses raced and one performed adequately as a riding horse. Of the remaining 3 horses, 2 raced at a lower class and one performed adequately as a riding horse. In this population of horses, dynamic endoscopy of the upper airway was critical for case management. Based on our observations, horses post arytenoidectomy can have dynamic collapse of the ipsilateral aryepiglottic fold and laser resection of the fold may help resolve the performance problem.     

Fourth branchial arch defects in full‐siblings treated with a partial arytenoidectomy

Fourth branchial arch defects (4‐BAD) is a syndrome that consists of aplasia, or varying degrees of hypoplasia, of one or more of the cartilaginous or muscular structures derived from the fourth branchial arch, unilaterally or bilaterally. This case report describes the cases of 2 directly related siblings admitted with a complaint of abnormal respiratory noise at rest and complete exercise intolerance. Laryngeal palpation, resting upper airway (UA) endoscopy, lateral radiography of the larynx and cervical trachea, and laryngeal ultrasonography revealed multiple laryngeal and pharyngeal abnormalities. The clinical findings were compatible with the diagnosis of fourth branchial arch defects. A left partial arytenoidectomy and a unilateral ventriculocordectomy were performed in both cases. The follow‐up endoscopies revealed a functional airway aperture. The surgery enabled the horses to be used for riding. Considering the direct family relationship between the horses, these cases would support a genetic component of 4‐BAD.