1. Large Animal Surgery Equine Respiratory Sx Guttural Pouch Diseases
Amy Fayette
November 2005

2. 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

9. What is the treatment for redundant alar folds
Surgery

10. What is the most common complication of surgery for redundant alar folds
Highly vascular-> hemorrhage

11. How can you help to decrease the hemorrhage produced by this procedure
Large carmalts
Ice cold saline

12. What is your diagnosis
Wry nose

13. What are the clinical signs of diseases of the nasal septum
Decreased or complete obstruction
Stridor
Discharge
Facial distortion

14. What are the preop considerations before operating on the nasal septum
Collect 4-8 L of blood
Tracheotomy

15. 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

16. What is your diagnosis
Ethmoid hematoma

17. What are the CS of progressive ethmoid hematomas
Epistaxis
Serosanguinous nasal exudate
Stridor

18. What is the suspected cause of ethmoid hematomas
Nasal gastric tubing

19. What is this instrument
Funnel screw

20. What is this instrument
Trephine

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

22. What is an ethmoid hematoma made up of on histopath
Outer: resp epithelium
Central: hemosiderin-filled macrophages

23. What is an alternative treatment for ethmoid hematomas
Chemical ablation with formalin

24. What is the cause of primary sinusitis
UR tract infection

25. What is the causes of secondary sinusitis
Dental disease
Facial fx
Cysts
Neoplasia

26. What are the CS of sinusitis
Nasal discharge: serosanguineous
Coughing
Facial deformity

27. What is the treatment for sinusitis
Sinusotomy (trephination)

28. What is the aftercare instructions for sinusotomy
Leave open and flush daily
ATB and NSAIDS

29. What is the prognosis for sinusitis after sinusotomy
Good-excellent

30. What is this instrument
Cribbing strap

31. What is cribbing Grasp object with incisors Contract neck muscles
Pull backward

32. What is another name for cribbing
Windsucker

33. What are the causes of cribbing
Boredom
Confinement
Isolation
Lack of roughage
Learn from others??
Genetic??

34. What are the consequences of cribbing
Colic ??
Abnormal wear of incisors
Weight loss

35. What are some non surgical treatments for cribbing
Remove fixed objects
Bitter tasting substances
Cribbing straps
Acupuncture
Shock- aversion
Naloxon

36. What is the possible surgical treatments for cribbing
Removal of sternomandibularis, sternothyroideus, omohyoideus
Neurectomy of the ventral branch of accessory nerve

37. What aftercare should be followed after surgery for cribbing
ATB and NSAIDS
Change the environment

38. What dose of NSAIDS should be given
Should be a bit painful if they try to repeat the behavior so low doses

39. What is the most common cause of noise
Recurrent laryngeal hemiplegia

40. What is Recurrent laryngeal hemiplegia
Progresive neurogenic atrophy of the recurrent laryngeal nerve

41. What is the signalment for Recurrent laryngeal hemiplegia
1-10 years old
Large breed horses
Hereditary

42. What causes Recurrent laryngeal hemiplegia
Perivascular injection
Guttural pouch mycosis
Trauma
Strangles
OP toxicity
Plant poisoning
Lead toxicity
CNS disease

43. What is the typical history for Recurrent laryngeal hemiplegia
Noise
Exercise intolerance

44. How is Recurrent laryngeal hemiplegia diagnosed
Palpation
Slap test
Endoscopy during treadmill exercise

45. What is the slap test Slap withers during endoscopy
Observe adduction of the contralateral arytenoid cartilage

46. What is the most common surgical treatment for recurrent laryngeal hemiplegia
Laryngoplasty (Tie back)

47. What are some potential complications with the tie back procedure
Seroma
Cough
Dysphagia

48. What should be done if an animal is coughing following tieback
Remove sutures

49. How can you decrease dysphagia after tie back
Feed off the ground

50. What other surgical procedures can be performed for recurrent laryngeal hemiplegia
Ventriculectomy
Reinervation of cricoarytenoid muscle
Arytenoidectomy

51. What instrument is this
Roaring burr

52. What are the complications of ventriculectomy
Granuloma formation
Mucocele
Laryngeal web

53. How do you know that you excised enough of the ventricle
Place on the finger tip---should be as big as your distal phalanx

54. What is arytenoid chondritis
Inflammation and thickening of the arytenoid cartilage

55. What is the treatment for arytenoid chondritis
Arytenoidectomy

56. What is a partial arytenoidectomy
Arytenoid body and corniculate process removed

57. What is a total arytenoidectomy
Arytenoid body, corniculate and muscular process

58. What is the px for a partial arytenoidectomy
50% of racehorses return to racing

59. Is partial or total arytenoidectomy recommended

60. What is the colloquial term for DDSP
Choking up

61. What is DDSP
The soft palate is displaced over the epiglottis

62. What are some treatments of DDSP
Tongue tie
Staphylectomy
Myectomy
Epiglottic augmentation
Laser cauterization

63. What is a staphylectomy
Cutting part of the soft palate

64. Is epiglottic augmentation commonly done
No because the epiglottis is often normal in size

65. What is your diagnosis
Guttural pouch tympany

66. What is guttural pouch tympany
Air filled guttural pouch

67. What are the causes of guttural pouch tympany
Idiopathic
Upper airway infection
Persistent coughing
Muscle dysfunction

68. What are the clinical signs of GP tympany
Nonpainful
Dyspnea
Dysphagia
Inhalation pneumonia
Secondary empyema

69. What are the treatments for GP tympany
Needle aspiration
Indwelling catheter
Surgery for recurrent problems

70. Which approach to the guttural pouch is illustrated below
hyovertebrotomy

71. What are the problems with the hyovertebrotomy approach
No ventral drainage

72. Which approach to the guttural pouch is illustrated below
Viborgs triangle

73. What are the borders of viborgs triangle
Sternomandibular muscle
Linguofacial vein
Caudal border of vertical ramus of the mandible

74. Which approach to the guttural pouch is illustrated below
Whitehouse

75. Which approach to the guttural pouch is illustrated below
Modified Whitehouse

76. 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

77. What are the causes of GP empyema
Upper resp tract infection
Abscessation of the retropharyngeal lnn
Fx of the stylohyoid bone

78. Is GP empyema usually uni or bilateral
Unilateral

79. What is the treatment for GP empyema
Indwelling catheter Sx

80. What makes treatment of GP empyema difficult
The presence of chondroids

81. What is the most common complication following GP sx
Dysphagia

82. What is your diagnosis
GP mycosis

83. What are the CS of GP mycosis
Epistaxis
Dysphagia

84. Which structure in the GP is most commonly affected by mycosis
Internal carotid artery

85. Why can you not ligate the carotid artery to stop bleeding
Blood will still come from the other side via the circle of willis

86. 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

87. What are the treatments for GP mycosis
Arterial ligation
Flush guttural pouch with antifungals with horse under GA