Management of postoperative dysphagia after prosthetic laryngoplasty or arytenoidectomy.

OBJECTIVE To evaluate the efficacy of various treatments for dysphagia after laryngeal surgery. STUDY DESIGN Retrospective. ANIMALS Horses treated for dysphagia after laryngeal surgery. METHODS Medical records of horses treated for dysphagia after prosthetic laryngoplasty (PLP) or partial arytenoidectomy (PA) were reviewed. Signalment, prior surgery, preoperative videoendoscopic diagnosis, and surgical treatments were recorded. Short- and long-term follow-up were obtained. Chi-square and logistical regression were performed to correlate independent variables and outcomes. RESULTS Forty-four percent of horses with prior PLP and 88% of horses with prior PA had persistent resting dorsal displacement of the soft palate (DDSP). Vocal fold augmentation (VFA) as a single treatment was most commonly performed (n = 22), followed by laryngoplasty removal (LPR; n = 1). Fifteen horses received a combination of treatments: VFA (n = 15), LPR (n = 4), laryngeal tie-forward (LTF; n = 2), and esophageal release (n = 1). Short-term clinical outcomes were reported; 80% of horses treated with VFA (n = 35) had resolution of dysphagia, and 20% were improved. Among the 33 horses available to long-term follow-up, 31 (94%) returned to some level of work, and DDSP during work was reportedly resolved in 23 of 25 horses. CONCLUSION Vocal fold augmentation resulted in resolution of symptoms relating to dysphagia in 81% of horses. Twenty percent of horses treated with LPR had sustained resolution of dysphagia. A combination of LPR, VFA, LTF was performed in 18% of horses. CLINICAL SIGNIFICANCE Treatment options directed at altering laryngeal geometry and/or position of the larynx were successful in resolving 86% of dysphagia in horses previously regarded as very difficult to treat.

[1]  J. Lane,et al.  Outcomes of horses treated with removal of a laryngoplasty prosthesis , 2019, Veterinary surgery : VS.

[2]  C. Robert,et al.  Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses , 2018, Veterinary surgery : VS.

[3]  A. Dart,et al.  A review of recent developments in the clinical application of prosthetic laryngoplasty for recurrent laryngeal neuropathy: Indications, complications and outcome , 2017 .

[4]  J. Hauptman,et al.  Laryngeal advancement surgery improves swallowing function in a reversible equine dysphagia model. , 2016, Equine veterinary journal.

[5]  T. Barnett,et al.  Upper esophageal incompetence in five horses after prosthetic laryngoplasty. , 2015, Veterinary surgery : VS.

[6]  N. Ducharme.  Treatment of Persistent Dorsal Displacement of the Soft Palate , 2014 .

[7]  J. Hawkins.  Evaluation and Management of the Horse with Dysphagia Following Prosthetic Laryngoplasty , 2014 .

[8]  P. Dixon,et al.  A review of equine laryngoplasty complications , 2014 .

[9]  P. M. Dixon,et al.  Characterisation of palatal dysfunction after laryngoplasty. , 2014, Equine veterinary journal.

[10]  P. Dixon,et al.  Long-term maintenance of arytenoid cartilage abduction and stability during exercise after laryngoplasty in 33 horses. , 2013, Veterinary surgery : VS.

[11]  D. Costello,et al.  Alternative injectable materials for vocal fold medialisation in unilateral vocal fold paralysis. , 2012, The Cochrane database of systematic reviews.

[12]  R. Shaker,et al.  Physiology and pathophysiology of glottic reflexes and pulmonary aspiration: from neonates to adults. , 2010, Seminars in respiratory and critical care medicine.

[13]  J. Cheetham,et al.  Successful treatment of persistent dorsal displacement of the soft palate and evaluation of laryngohyoid position in 15 racehorses. , 2009, Equine veterinary journal.

[14]  P. Dixon,et al.  Postoperative race performance is not correlated with degree of surgical abduction after laryngoplasty in National Hunt Thoroughbred racehorses. , 2009, Veterinary surgery : VS.

[15]  P. Belafsky,et al.  Thyrohyoid vocal fold augmentation with calcium hydroxyapatite , 2008, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[16]  Jae-Yol Lim,et al.  PMMA (polymethylmetacrylate) microspheres and stabilized hyaluronic acid as an injection laryngoplasty material for the treatment of glottal insufficiency: in vivo canine study , 2008, European Archives of Oto-Rhino-Laryngology.

[17]  R. Zraick,et al.  Injection Versus Medialization Laryngoplasty for the Treatment of Unilateral Vocal Fold Paralysis , 2007 .

[18]  C. Rosen,et al.  Autologous Fat Graft Absorption in Unilateral Paralyzed Canine Vocal Folds , 2007, The Laryngoscope.

[19]  W. Hartmann,et al.  Effect of laryngoplasty on respiratory noise reduction in horses with laryngeal hemiplegia. , 2010, Equine veterinary journal.

[20]  Byung-Joo Lee,et al.  Intracordal Injection of Autologous Auricular Cartilage in the Paralyzed Canine Vocal Fold , 2004, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[21]  R. Shaker.  Airway protective mechanisms: Current concepts , 2004, Dysphagia.

[22]  B. McGorum,et al.  Long-term survey of laryngoplasty and ventriculocordectomy in an older, mixed-breed population of 200 horses. Part 2: Owners' assessment of the value of surgery. , 2010, Equine veterinary journal.

[23]  B. McGorum,et al.  Long-term survey of laryngoplasty and ventriculocordectomy in an older, mixed-breed population of 200 horses. Part 1: Maintenance of surgical arytenoid abduction and complications of surgery. , 2010, Equine veterinary journal.

[24]  Reza Shaker,et al.  Pharyngoglottal Closure Reflex: Characterization in Healthy Young, Elderly and Dysphagic Patients with Predeglutitive Aspiration , 2002, Gerontology.

[25]  D. Slone,et al.  Treatment of laryngeal hemiplegia in horses by prosthetic laryngoplasty, ventriculectomy and vocal cordectomy , 2002, Veterinary Record.

[26]  J. R. Mcclure,et al.  Career racing performance in Thoroughbreds treated with prosthetic laryngoplasty for laryngeal neuropathy: 52 cases (1981-1989). , 2000, Journal of the American Veterinary Medical Association.

[27]  F. Paulsen,et al.  Osteoarthritis in cricoarytenoid joint. , 1999, Osteoarthritis and cartilage.

[28]  J. Selber,et al.  A Functional Diagnosis of Dysphagia Using Videoendoscopy , 1998, Ear, nose, & throat journal.

[29]  N. E. Robinson,et al.  Effect of bilateral blockade of the pharyngeal branch of the vagus nerve on soft palate function in horses. , 1998, American journal of veterinary research.

[30]  M. Ross,et al.  Laryngoplasty with or without ventriculectomy for treatment of left laryngeal hemiplegia in 230 racehorses. , 1997, Veterinary surgery : VS.

[31]  G. Lewis,et al.  Properties of acrylic bone cement: state of the art review. , 1997, Journal of biomedical materials research.

[32]  Russell Ap,et al.  Performance analysis after prosthetic laryngoplasty and bilateral ventriculectomy for laryngeal hemiplegia in horses: 70 cases (1986-1991). , 1994 .

[33]  D. Slone,et al.  Performance analysis after prosthetic laryngoplasty and bilateral ventriculectomy for laryngeal hemiplegia in horses: 70 cases (1986-1991). , 1994, Journal of the American Veterinary Medical Association.

[34]  J. M. Lumsden,et al.  Epiglottic augmentation by use of polytetrafluoroethylene to correct dorsal displacement of the soft palate in a standardbred horse. , 1992, Journal of the American Veterinary Medical Association.

[35]  R. Bastian,et al.  Videoendoscopic Evaluation of Patients with Dysphagia: An Adjunct to the Modified Barium Swallow , 1991, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.