To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions. Secondly, to use fluid mechanic principles of flow through a constriction to establish the relationship between measured airflow geometries with impedance for each surgical procedure.
10 cadaveric horse larynges.
While CT scans were performed, inhalation during exercise conditions was replicated for each of the following 5 conditions: laryngeal hemiplegia, left laryngoplasty with ventriculocordectomy, left laryngoplasty with ipsilateral ventriculocordectomy and arytenoid corniculectomy, corniculectomy, and partial arytenoidectomy for each larynx while CT scans were performed. Laryngeal impedance was calculated, and selected cross-sectional areas were measured along each larynx for each test. Measured areas and constriction characteristics were analyzed with respect to impedance using a multilevel, mixed-effects model.
Incident angle, entrance coefficient, outlet coefficient, friction coefficient, orifice thickness, and surgical procedure were significantly associated with upper airway impedance in the bivariable model. The multivariate model showed a significant influence of incident angle, entrance coefficient, and surgical procedure on impedance; however, the orifice thickness became nonsignificant within the model.
Laryngeal impedance was significantly associated with the entrance configuration for each procedure. This suggested that the equine upper airway, despite having a highly complex geometry, adheres to fluid dynamic principles applying to constrictions within pipe flow. These underlying flow characteristics may explain the clinical outcomes observed in some patients, and lead to areas of improvement in the treatment of obstructive upper airway disease in horses.
Evaluation of the strength of the novel suture technique by comparison with a 2-interrupted suture technique.
40 equine larynges.
40 larynges were used; 16 laryngoplasties were performed using the currently accepted 2-suture technique and 16 using the novel suture technique. These specimens were subjected to a single cycle to failure. Eight specimens were used to compare the rima glottidis area achieved with 2 different techniques.
The mean force to failure, as well as the rima glottidis area of both constructs, were not significantly different. The cricoid width did not have a significant effect on the force to failure.
Our results suggest that both constructs are equally strong and can achieve a similar cross-sectional area of the rima glottidis. Laryngoplasty (“tie-back”) is currently the treatment of choice for horses with exercise intolerance due to recurrent laryngeal neuropathy. Failure to maintain the expected degree of arytenoid abduction post-surgery occurs in some horses. We believe this novel 2-loop pulley load-sharing suture technique can help achieve and, more importantly, maintain the desired degree of abduction during surgery.
To compare laryngeal impedance, in terms of air flow and pressure, following arytenoid corniculectomy (COR) versus 3 other airway interventions (left-sided laryngoplasty with ipsilateral ventriculocordectomy [LLP], LLP combined with COR [LLPCOR], and partial arytenoidectomy [PA]) performed on cadaveric equine larynges with simulated left recurrent laryngeal neuropathy (RLN) and to determine whether relative laryngeal collapse correlated with the interventions performed.
28 cadaveric equine larynges.
Each larynx in states of simulated left RLN alone and with airway interventions in the order LLP, LLPCOR, COR, and PA was evaluated in a box model construct that replicated upper airway flow mechanics consistent with peak exercise in horses. Results for impedance, calculated from airflow and pressure changes, were compared between states for each larynx. Multivariable mixed-effects analysis controlling for repeated measures within larynx was performed to calculate the predicted mean impedance for each state.
Results indicated that tracheal adapter diameter, individual larynx properties, airway intervention, and relative laryngeal collapse affected laryngeal impedance. The LLP and LLPCOR interventions had the lowest impedance, whereas the COR and PA interventions did not differ substantially from the simulated left RLN state. Residual intraclass correlation of the model was 27.6 %.
CONCLUSIONS AND CLINICAL RELEVANCE
Although impedance was higher for the simulated left RLN with the COR intervention state than with the LLP intervention state, given the clinical success of PA for treating RLN in horses and the similar results for the COR and PA intervention states in the present study, the use of COR warrants further investigation. The residual interclass correlation suggested that individual laryngeal variation affected impedance and may have a clinical effect.