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Summary

Fifty-seven Standardbred and 44 Thoroughbred racehorses and 1 Thoroughbred polo mare with primary clinical signs of exercise intolerance or respiratory tract noise or combined exercise intolerance and respiratory tract noise were referred for laser correction of epiglottic entrapment. Significantly (P < 0.001) more Standardbred than Thoroughbred racehorses were affected, compared with the observed hospital population during the same period. At referral, 14 horses did not have evident epiglottic entrapment and were returned to exercise without development of entrapment after treatment, which consisted of 1 week of rest and administration of anti-inflammatory medication.

In 88 standing horses under sedation and topical anesthesia, epiglottic entrapment was corrected transendoscopically by use of a contact neodymium:yttrium aluminum garnet laser. In these 88 horses, 98% of entrapments were persistent, 92% were thick, 97% were wide, and 45% were ulcerated. Thirty-one percent of the horses had endoscopic evidence of epiglottic hypoplasia, and 8% had deviated epiglottic axis.

Complete correction was achieved in 97% of the horses, Persistent dorsal displacement of the soft palate in 1 horse and severe epiglottic hypoplasia with thick, chronic entrapping membranes in 2 horses precluded successful transendoscopic correction with the horses in standing position. Most horses were treated onan outpatient basis, and all were able to be returned to exercise after 7 to 14 days of rest and treatment with anti-inflammatory medication.

Entrapment recurred in 4 horses (5%), 3 of which had hypoplastic epiglottis. Dorsal displacement of the soft palate developed after surgery in 9 horses (10%) and continued in 4 horses (5%) that had displaced soft palate before surgery. All these horses had epiglottic hypoplasia.

Laser correction of epiglottic entrapment in standing horses was safe, well tolerated, and effective. Laser surgery was an alternative to conventional surgery, and eliminated the need for general anesthesia and laryngotomy. It also reduced convalescence and postoperative complications.

Free access
in Journal of the American Veterinary Medical Association

Summary

Epiglottic entrapment in 35 Thoroughbred and 44 Standardbred horses was corrected transendoscopically by use of a neodymium:yttrium aluminum garnet laser. Before surgery, the entrapped epiglottis was classified as hypoplastic or normal in each horse on the basis of endoscopic appearance alone. Using a digitizer, thyroepiglottic length was determined from lateral-view laryngeal radiographs. For 78 racehorses, earnings (<$5,000 or >$5,000) were compared before and after surgery. Earnings category and racing performance after surgery were tested for association with endoscopically determined epiglottic hypoplasia and radiographically determined thyroepiglottic length.

Endoscopy and radiography were useful methods of evaluating the epiglottis in horses with epiglottic entrapment. Mean (±sd) thyroepiglottic length for both breeds of horses with epiglottic entrapment was significantly (P = 0.0001) smaller (Thoroughbreds, 7.28 ± 0.67 cm; Standardbreds, 7.21 ± 0.62 cm), compared with thyroepiglottic length measured from control groups composed of clinically normal Thoroughbred (8.56 ± 0.29 cm) and Standardbred (8.74 ± 0.38 cm) racehorses. Both breeds of horses with epiglottic entrapment that had endoscopically apparent hypoplastic epiglottis had significantly (P < 0.0001) smaller thyroepiglottic length (Thoroughbreds, 6.64 ± 0.60 cm; Standardbred, 6.93 ± 0.72 cm) than did horses with epiglottic entrapment that had endoscopically normal epiglottis (Thoroughbreds, 7.57 ± 0.47 cm, Standardbreds, 7.36 ± 0.50 cm). Significant difference was not detected in endoscopic appearance of the epiglottis among age, gender, or breed distributions.

For either breed, earnings and performance were not significantly associated with endoscopically determined epiglottic hypoplasia or radiographically determined thyroepiglottic length. Prognosis for racing performance after laser correction of epiglottic entrapment should be based on assessment of the endoscopic and radiographic appearances of the epiglottis, pharynx, and larynx, determination of thyroepiglottic length, and a knowledge of the horse's earnings and racing performance prior to surgery.

Free access
in Journal of the American Veterinary Medical Association

Summary

Three basic techniques (and one modified technique) were developed, allowing successful excision of subepiglottic cysts in 10 horses (5 Standardbreds, 4 Thoroughbreds, and 1 Quarter Horse; mean age, 3.5 years) via peroral approach. This approach eliminated the need for laryngotomy or pharyngotomy and reduced postoperative care. None of the cysts redeveloped. Clinical signs of disease before surgery included respiratory noise, exercise intolerance, coughing, and dysphagia and were eliminated in all horses except one that raced successfully, but in which some respiratory noise was detected.

Peroral subepiglottic cyst excision was performed on anesthetized horses that were positioned in lateral recumbency and intubated via the nares and trachea. General anesthesia allowed careful intraoral palpation and endoscopic visualization of the oropharynx on a television monitor. Custom-designed instruments, including a guide tube, cyst snare, and long grasping forceps, facilitated either laser or snare, or laser and snare cyst excision. Hemorrhage was negligible in all horses. Initial attempts to develop a technique to submucosally excise subepiglottic cysts through a transnasal transendoscopic approach in conscious horses, using a contact neodymium:yttrium aluminum garnet laser, were unsuccessful. In each of 3 horses, the cyst was inadvertently penetrated before it could be excised, causing it to collapse and disappear beneath the soft palate.

Postoperative complications were excessive subepiglottic swelling after laser excision (n = 1 horse), which resolved completely in response to anti-inflammatory treatment, and subepiglottic cicatrix formation after snare excision (n= 1 horse), which required surgical excision of the cicatrix.

Free access
in Journal of the American Veterinary Medical Association

Objective

To describe a technique of contact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser-assisted excision of progressive ethmoid hematoma (PEH) in horses, to determine the recurrence rate of clinical signs of PEH in horses with follow-up time of a minimum of 12 months, and to compare this result with reported results achieved by using conventional techniques.

Design

Retrospective study.

Animals

21 horses with 26 PEH.

Procedure

Medical records of all horses with PEH treated by Nd:YAG laser excision from December 1986 through August 1996 were analyzed. Twenty-one horses underwent unilateral (18 surgeries) or bilateral (4) frontonasal bone flap with excision of the mass, using an Nd:YAG laser. One horse with bilateral PEH underwent a unilateral bone flap twice, 1 year apart.

Results

1 horse died. Four of 20 horses with follow-up times of 12 months or longer had recurrence of PEH. The PEH recurrence rate was 20% (5/25 PEH). Three of 6 horses with bilateral lesions had recurrence of PEH. Recurrence rate for horses that had bilateral PEH (3/6 horses) was greater than for horses with unilateral PEH (1/14 horses).

Clinical Implications

Treatment of PEH by Nd:YAG laser excision through a frontonasal bone flap results in a recurrence rate comparable with that reported for conventional techniques. Horses with bilateral lesions are more likely to have a recurrence of PEH. (J Am Vet Med Assoc 1999;214:1037–1041)

Free access
in Journal of the American Veterinary Medical Association

Summary

Epiglottitis was diagnosed and treated in 20 horses (13 Thoroughbreds and 7 Standardbreds) over a 5-year period. Eighteen horses were used for racing, and 2 Standardbreds were broodmares. Primary clinical signs were exercise intolerance, respiratory noise, and coughing. The most common endoscopic diagnosis made by referring veterinarians was epiglottic entrapment (11 horses).

In 19 horses, endoscopic evaluation at admission revealed mucosal ulceration and thickening of the lingual surface of the epiglottis. Other endoscopic findings included dorsal displacement of the soft palate (14 horses), and dorsal deviation of the epiglottic axis (11 horses). Only 1 horse had epiglottic entrapment. Treatment consisting of stall confinement for 7 to 14 days, topical administration of a solution of furacin, dimethyl sulfoxide, glycerin, and prednisolone, and systemic administration of nonsteroidal anti-inflammatory drugs and corticosteroids was effective in controlling epiglottic edema and inflammation. Antimicrobials were administered to 6 horses.

Racing performance of the 18 racehorses was evaluated by examination of racing records. One horse was still convalescing at the time of the study, and 1 horse had been euthanatized 1 week after treatment for epiglottitis because of colic. The remaining 16 horses all started at least 1 race (mean time between initial examination and start of first race, 74 days; range, 8 to 265 days). Thirteen horses started at least 4 races following treatment for epiglottitis; racing performance after treatment was the same in 8 and decreased in 5. Long-term sequelae of epiglottitis included epiglottic deformity (5 horses), intermittent or persistent dorsal displacement of the soft palate (4 horses), and epiglottic entrapment (1 horse).

Free access
in Journal of the American Veterinary Medical Association

Objective

To evaluate laryngeal function by means of videoendoscopy during high-speed treadmill exercise in racehorses with grade-III left laryngeal hemiparesis at rest and to determine outcome of treatment.

Design

Retrospective study.

Animals

26 racehorses.

Procedure

Videoendoscopy of the larynx was performed while horses were at rest and exercising on a treadmill. Horses were classified as having grade-III A, -IIIB, or -IIIC laryngeal hemiparesis on the basis of the degree of arytenoid cartilage abduction maintained during exercise. Postoperative racing performance was determined by evaluating race records and conducting telephone surveys.

Results

20 (77%) horses had grade-IIIC laryngeal hemiparesis (ie, severe dynamic laryngeal collapse during exercise). Eighteen underwent surgery, and racing performance was improved in 9. Five (19%) horses had grade-IIIB laryngeal hemiparesis (ie, left arytenoid cartilage and vocal fold were maintained in an incompletely abducted position during exercise). Four underwent surgery, and racing performance was improved in 1. One (4%) horse had grade-IIIA laryngeal hemiparesis (ie, full abduction of arytenoid cartilage during exercise); surgery was not performed.

Clinical Implications

Videoendoscopy is useful in determining dynamic laryngeal function in racehorses with grade-III laryngeal hemiparesis at rest. (J Am Vet Med Assoc 1998; 212:399-403)

Free access
in Journal of the American Veterinary Medical Association

Objective

To determine whether epiglottic augmentation, in conjunction with more traditional surgical methods, would be useful in the treatment of dorsal displacement of the soft palate in racehorses.

Design

Retrospective study.

Animals

40 Thoroughbred and 19 Standardbred racehorses.

Procedure

Polytetrafluoroethylene paste was injected submucosally on the lingual epiglottic surface of each horse. In addition, sternothyrohyoideus myectomy or sternothyroideus tenectomy and staphylectomy were performed in most horses.

Results

Racing performance was improved after surgery in 29 of 40 (73%) Thoroughbreds and 10 of 19 (53%) Standardbreds. Twenty-nine (49%) horses won ≥ 1 race after surgery.

Clinical Implications

Results suggest that epiglottic augmentation, in conjunction with other surgical methods, may be an effective method of treating horses with poor racing performance attributable to dorsal displacement of the soft palate. (J Am Vet Med Assoc 1997;211:1022–1028)

Free access
in Journal of the American Veterinary Medical Association

Summary

Between 1979 and 1992, the alar folds were resected bilaterally in 22 horses and unilaterally in 2 horses. Abnormal respiratory tract noise and exercise intolerance were the primary complaints prior to surgery. Significantly (P = 0.01) more Standardbreds underwent resection of the alar folds, compared with the number of Standardbreds in the hospital population during the same period. The alar folds palpated abnormally thick in 13 horses and normal in 11 horses. Temporary dilatation of the nares with mattress sutures or clips lessened the respiratory tract noise and improved exercise tolerance in all 8 horses in which the diagnostic test was performed. Manual elevation of the alar folds reduced respiratory noise in the 11 horses evaluated.

Long-term follow-up evaluation by telephone was available for 14 horses. All surgical incisions had healed cosmetically. Respiratory tract noise was decreased, and exercise tolerance improved in 10 of 14 (71%) horses. Complete charted racing information was obtained for 16 horses. Fourteen horses started their first race a mean of 118 days (range, 13 to 321 days) after surgery. The mean number of starts after surgery was 51, with 14 of 16 (88%) horses starting more than 6 times after surgery. Of the 16 horses, 8 horses raced at least 3 times before and after surgery; 4 had improved racing performance, 2 had similar performance, and 2 had decreased performance. Five Standardbreds never raced, and 1 Standardbred raced once before surgery. All 6 Standardbreds were able to complete at least 6 starts after surgery (range, 6 to 140 race starts). Eight horses, subjectively, had narrow nasal passages as determined by physical and endoscopic examination. Of these, 4 did not race after surgery, 3 raced successfully to owners' satisfaction, and 1 raced but continued to experience respiratory impairment. Surgical resection of the alar folds was an effective and cosmetic surgical technique for relief of airway obstruction associated with the alar folds.

Free access
in Journal of the American Veterinary Medical Association

Summary

Medical records of 32 cattle treated for umbilical abnormalities that had undergone ultrasonographic examination of the umbilicus followed by umbilical resection or postmortem examination were reviewed. Thirty of the cattle were between 6 and 240 days old (mean, 73 days); the remaining 2 cattle were a 3-year-old bull and a 5-year-old cow. Thirty (94%) animals had external evidence of infection associated with the umbilicus. Two calves did not have external signs of infection; 1 had an abscess of the urachus and the other was found to be normal.

Two-dimensional real-time ultrasonography was used to identify abnormal umbilical cord remnants. Ultrasonographic results were most reliable for the urachus, and the urachus was the most commonly affected internal umbilical cord remnant. Statistical agreement between ultrasonographic and physical (surgical or postmortem) findings was good to excellent for all umbilical structures. Intra-abdominal adhesions were found at surgery in 47% of animals with umbilical abnormalities; however, adhesions were not detected ultrasonographically.

Free access
in Journal of the American Veterinary Medical Association