Objective—To identify history, clinical signs, endoscopic findings, treatment, and outcome of mature (> 8 years old) nonracehorses with epiglottic abnormalities.
Design—Retrospective case series.
Animals—23 horses with an epiglottic abnormality.
Procedures—Medical records of horses examined between 1990 and 2009 because of an epiglottic abnormality were reviewed to obtain information on signalment, history, clinical signs, clinical examination findings, upper airway endoscopic findings, diagnosis, surgical procedure, clinical management, postoperative care, and outcome.
Results—Mean ± SD age was 16 ± 6 years (range, 9 to 30 years). Sixteen of the 23 (70%) horses had a primary complaint of a chronic cough. Thirteen (57%) horses had epiglottic entrapment, 7 (30%) had a subepiglottic granuloma, and 3 (13%) had a subepiglottic cyst. All 23 horses were treated surgically, with 1 (4%) requiring further surgical treatment. Follow-up examinations and conversations with owners indicated resolution of the primary complaint in 17 of the 23 (74%) horses, with 4 (24%) requiring prolonged medical treatment because of postoperative subepiglottic inflammation. Of the 6 horses without complete resolution, 4 (67%) had signs of recurrent airway obstruction and 2 (33%) developed persistent dorsal displacement of the soft palate following laryngotomy and subepiglottic membrane resection.
Conclusions and Clinical Relevance—Results suggested that coughing is a common complaint in mature nonracehorses with epiglottic abnormalities. Therefore, upper airway endoscopy is recommended in the evaluation of older horses with a cough. Surgical treatment can be beneficial in most horses, with some requiring further postoperative medical treatment.
Case Description—3 racehorses were evaluated because of poor performance or abnormal noise originating from the upper portion of the respiratory tract.
Clinical Findings—During maximal exercise, initial dynamic videoendoscopy of the upper respiratory tract revealed complete arytenoid cartilage abduction in 2 horses and incomplete but adequate abduction of the left arytenoid cartilage in 1 horse. Subsequent exercising endoscopic evaluation revealed severe dynamic collapse of the left arytenoid cartilage and vocal fold in all 3 horses.
Treatment and Outcome—2 horses were treated with prosthetic left laryngoplasty and raced successfully. One horse was retired from racing.
Clinical Relevance—Idiopathic laryngeal hemiplegia can be a progressive disease. Successive dynamic videoendoscopic upper airway evaluations were used to confirm progression of left laryngeal hemiplegia in these 3 horses. Videoendoscopy of the upper respiratory tract during exercise should be considered as part of the clinical evaluation of horses with signs of upper respiratory tract dysfunction.
Case Description—A 1-day-old Standardbred foal with a history of extreme respiratory distress after birth consistent with upper airway obstruction was evaluated. A temporary tracheostomy tube was placed by the referring veterinarian.
Clinical Findings—On initial examination, there was evidence of hypoxic-ischemic syndrome, secondary to perinatal asphyxia. Endoscopy revealed obstruction of both nares at the level of the choanae; a diagnosis of bilateral choanal atresia was made.
Treatment and Outcome—The foal was anesthetized and underwent transendoscopic laser fenestration of the buccopharyngeal membranes. Three weeks after surgery, cicatricial narrowing of the choanae was apparent and further transendoscopic ablation was performed. Recurrent stenosis necessitated revision surgeries involving a combination of laser ablation with topical administration of mitomycin and, subsequently, a combination of radial incisions into the stenotic tissue and repeated bougienage with a cuffed endotracheal tube. The degree of stenosis decreased, and at 1 year of age, the horse was an appropriate size for its age, had choanae that were almost maximally open (> 85%), and had entered training. Mild stenosis was still evident when the horse was reexamined the following year, although there was no evidence of exercise intolerance or respiratory compromise.
Clinical Relevance—Bilateral choanal atresia in a foal can be successfully treated via transendoscopic fenestration of the buccopharyngeal membranes, enabling the horse to subsequently participate in athletic activities. Secondary problems resulting from initial asphyxia and recurrent stenosis at the surgical site can be overcome but may require prolonged and extensive treatment.
Case Description—An 8-year-old multiparous Thoroughbred broodmare was admitted for evaluation of a rectal tear sustained during parturition.
Clinical Findings—On initial evaluation, the mare had mild signs of abdominal discomfort. A full-thickness rectal tear located 30 cm cranial to the anus and extending approximately 15 cm longitudinally along the surface of the small colon between the 4 and 6 o'clock positions, when viewed from behind, was diagnosed on examination per rectum.
Treatment and Outcome—Laparoscopic evaluation of the abdomen was performed to assess the tear and extent of peritoneal contamination. A hand-assisted repair via a flank incision was performed. The tear was closed in a single-layer, simple continuous pattern with size-0 polydioxanone with a handheld needle holder. Subsequently, a ventral midline celiotomy was performed, and intestinal contents were evacuated via a pelvic flexure enterotomy and a typhlotomy. Following surgery, the mare was managed with IV fluid therapy, partial parenteral nutrition, antimicrobials, and NSAIDs for 5 to 7 days before being gradually reintroduced to a complete pelleted feed and alfalfa hay. Prior to discharge, examination per rectum revealed no stricture formation associated with repair. The mare was discharged from the hospital and performed successfully as a broodmare, with the delivery of a live foal 1 year after surgery.
Clinical Relevance—Successful repair with an excellent outcome was achieved in this mare. Hand-assisted laparoscopic repair should be considered as a possible treatment option in horses with grade IV rectal tears.
Objective—To determine results for horses undergoing
a high-speed treadmill examination, including
videoendoscopy of the pharynx and larynx before and
during exercise, echocardiography before and after
exercise, and electrocardiography before, during, and
after exercise, because of poor performance.
Results—A definitive diagnosis was obtained for 256
(73.5%) horses. One hundred forty-eight horses had
dynamic obstruction of the airway during exercise, 33
had clinically important cardiac arrhythmias alone, 22
had a combination of dynamic airway obstruction and
clinically important cardiac arrhythmias, 19 had poor
cardiac fractional shortening immediately after exercise,
10 had exertional rhabdomyolyis, 15 had clinically
apparent lameness, and 9 had other disorders. Thirtynine
of the horses with dynamic obstruction of the airway
during exercise had multiple airway abnormalities.
Fifty-three horses also had subclinical myopathy.
Conclusion and Clinical Relevance—Results suggest
that a complete evaluation, including a highspeed
treadmill examination, should be conducted in
horses with poor performance, regardless or whether
horses do or do not have a history of abnormal respiratory
noises and particularly if the horses have grade-
II or -III left laryngeal hemiplegia. (J Am Vet Med