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

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Presentation on theme: "Large Animal Surgery Amy Fayette November 2005 Equine Respiratory Sx Guttural Pouch Diseases."— Presentation transcript:

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

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 Partial

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

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