Large Animal Surgery

1
Large Animal Surgery
Equine Respiratory Sx Guttural Pouch Diseases

• Amy Fayette
• November 2005

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What are the indications for surgery

• Exercise intolerance
• Poor performance
• Abnormal resp noise
• Mucopurulent nasal discharge
• Serosanguineous nasal discharge
• External distortion of facial region

3
What is the most common respiratory tract
diagnostic technique

• Endoscopy

4
What is your diagnosis for this soft fluctuant
mass

• Epidermal inclusion cyst

5
How can you treat an epidermal inclusion cyst

• Aspiration or surgery

6
What is the problem with using aspiration

• Recurrence

7
What kind of noise is expected with redundant
alar folds

• Expiratory

8
How do you diagnose redundant alar folds

• Place large temporary mattress sutures and see if
  the noise disappears

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What is the treatment for redundant alar folds

• Surgery

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What is the most common complication of surgery
for redundant alar folds

• Highly vascular-gt hemorrhage

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How can you help to decrease the hemorrhage
produced by this procedure

• Large carmalts
• Ice cold saline

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What is your diagnosis

• Wry nose

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What are the clinical signs of diseases of the
nasal septum

• Decreased or complete obstruction
• Stridor
• Discharge
• Facial distortion

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What are the preop considerations before
operating on the nasal septum

• Collect 4-8 L of blood
• Tracheotomy

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What is the aftercare required for surgery of the
nasal septum

• 5-6 days systemic ATBs
• 10 days NSAIDS
• Remove packing 2 days post op
• Remove tracheostomy tube
• Clean and flush with saline

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What is your diagnosis

• Ethmoid hematoma

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What are the CS of progressive ethmoid hematomas

• Epistaxis
• Serosanguinous nasal exudate
• Stridor

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What is the suspected cause of ethmoid hematomas

• Nasal gastric tubing

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What is this instrument

• Funnel screw

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What is this instrument

• Trephine

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What is the main post op complication for
surgical removal of ethmoid hematomas

• Hemorrhage

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What is an ethmoid hematoma made up of on
histopath

• Outer resp epithelium
• Central hemosiderin-filled macrophages

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What is an alternative treatment for ethmoid
hematomas

• Chemical ablation with formalin

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What is the cause of primary sinusitis

• UR tract infection

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What is the causes of secondary sinusitis

• Dental disease
• Facial fx
• Cysts
• Neoplasia

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What are the CS of sinusitis

• Nasal discharge serosanguineous
• Coughing
• Facial deformity

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What is the treatment for sinusitis

• Sinusotomy (trephination)

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What is the aftercare instructions for sinusotomy

• Leave open and flush daily
• ATB and NSAIDS

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What is the prognosis for sinusitis after
sinusotomy

• Good-excellent

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What is this instrument

• Cribbing strap

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What is cribbing

• Grasp object with incisors
• Contract neck muscles
• Pull backward

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What is another name for cribbing

• Windsucker

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What are the causes of cribbing

• Boredom
• Confinement
• Isolation
• Lack of roughage
• Learn from others??
• Genetic??

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What are the consequences of cribbing

• Colic ??
• Abnormal wear of incisors
• Weight loss

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What are some non surgical treatments for cribbing

• Remove fixed objects
• Bitter tasting substances
• Cribbing straps
• Acupuncture
• Shock- aversion
• Naloxon

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What is the possible surgical treatments for
cribbing

• Removal of sternomandibularis, sternothyroideus,
  omohyoideus
• Neurectomy of the ventral branch of accessory
  nerve

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What aftercare should be followed after surgery
for cribbing

• ATB and NSAIDS
• Change the environment

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What dose of NSAIDS should be given

• Should be a bit painful if they try to repeat the
  behavior so low doses

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What is the most common cause of noise

• Recurrent laryngeal hemiplegia

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What is Recurrent laryngeal hemiplegia

• Progresive neurogenic atrophy of the recurrent
  laryngeal nerve

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What is the signalment for Recurrent laryngeal
hemiplegia

• 1-10 years old
• Large breed horses
• Hereditary

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What causes Recurrent laryngeal hemiplegia

• Perivascular injection
• Guttural pouch mycosis
• Trauma
• Strangles
• OP toxicity
• Plant poisoning
• Lead toxicity
• CNS disease

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What is the typical history for Recurrent
laryngeal hemiplegia

• Noise
• Exercise intolerance

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How is Recurrent laryngeal hemiplegia diagnosed

• Palpation
• Slap test
• Endoscopy during treadmill exercise

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What is the slap test

• Slap withers during endoscopy
• Observe adduction of the contralateral arytenoid
  cartilage

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What is the most common surgical treatment for
recurrent laryngeal hemiplegia

• Laryngoplasty (Tie back)

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What are some potential complications with the
tie back procedure

• Seroma
• Cough
• Dysphagia

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What should be done if an animal is coughing
following tieback

• Remove sutures

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How can you decrease dysphagia after tie back

• Feed off the ground

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What other surgical procedures can be performed
for recurrent laryngeal hemiplegia

• Ventriculectomy
• Reinervation of cricoarytenoid muscle
• Arytenoidectomy

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What instrument is this

• Roaring burr

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What are the complications of ventriculectomy

• Granuloma formation
• Mucocele
• Laryngeal web

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How do you know that you excised enough of the
ventricle

• Place on the finger tip---should be as big as
  your distal phalanx

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What is arytenoid chondritis

• Inflammation and thickening of the arytenoid
  cartilage

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What is the treatment for arytenoid chondritis

• Arytenoidectomy

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What is a partial arytenoidectomy

• Arytenoid body and corniculate process removed

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What is a total arytenoidectomy

• Arytenoid body, corniculate and muscular process

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What is the px for a partial arytenoidectomy

• 50 of racehorses return to racing

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Is partial or total arytenoidectomy recommended

• Partial

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What is the colloquial term for DDSP

• Choking up

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What is DDSP

• The soft palate is displaced over the epiglottis

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What are some treatments of DDSP

• Tongue tie
• Staphylectomy
• Myectomy
• Epiglottic augmentation
• Laser cauterization

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What is a staphylectomy

• Cutting part of the soft palate

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Is epiglottic augmentation commonly done

• No because the epiglottis is often normal in size

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What is your diagnosis

• Guttural pouch tympany

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What is guttural pouch tympany

• Air filled guttural pouch

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What are the causes of guttural pouch tympany

• Idiopathic
• Upper airway infection
• Persistent coughing
• Muscle dysfunction

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What are the clinical signs of GP tympany

• Nonpainful
• Dyspnea
• Dysphagia
• Inhalation pneumonia
• Secondary empyema

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What are the treatments for GP tympany

• Needle aspiration
• Indwelling catheter
• Surgery for recurrent problems

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Which approach to the guttural pouch is
illustrated below

• hyovertebrotomy

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What are the problems with the hyovertebrotomy
approach

• No ventral drainage

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Which approach to the guttural pouch is
illustrated below

• Viborgs triangle

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What are the borders of viborgs triangle

• Sternomandibular muscle
• Linguofacial vein
• Caudal border of vertical ramus of the mandible

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Which approach to the guttural pouch is
illustrated below

• Whitehouse

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Which approach to the guttural pouch is
illustrated below

• Modified Whitehouse

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Why might it be a bad idea to use a laser in the
guttural pouch

• Less control than a scalpel and there are a lot
  of vessels and nerves in it

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What are the causes of GP empyema

• Upper resp tract infection
• Abscessation of the retropharyngeal lnn
• Fx of the stylohyoid bone

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Is GP empyema usually uni or bilateral

• Unilateral

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What is the treatment for GP empyema

• Indwelling catheter
• Sx

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What makes treatment of GP empyema difficult

• The presence of chondroids

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What is the most common complication following GP
sx

• Dysphagia

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What is your diagnosis

• GP mycosis

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What are the CS of GP mycosis

• Epistaxis
• Dysphagia

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Which structure in the GP is most commonly
affected by mycosis

• Internal carotid artery

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Why can you not ligate the carotid artery to stop
bleeding

• Blood will still come from the other side via the
  circle of willis

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Can you ligate both carotid arteries

• Hypothetically yes if the animal has a really
  good supply from the basilar artery but often
  will kill the animal

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What are the treatments for GP mycosis

• Arterial ligation
• Flush guttural pouch with antifungals with horse
  under GA