Large Animal Surgery

Amy FayetteNovember 2005

Equine Respiratory SxGuttural Pouch Diseases

What are the indications for surgery

Exercise intolerancePoor performanceAbnormal resp noiseMucopurulent nasal dischargeSerosanguineous nasal dischargeExternal distortion of facial region

What is the most common respiratory tract diagnostic technique

Endoscopy

What is your diagnosis for this soft fluctuant mass

Epidermal inclusion cyst

How can you treat an epidermal inclusion cyst

Aspiration or surgery

What is the problem with using aspiration

Recurrence

What kind of noise is expected with redundant alar folds

Expiratory

How do you diagnose redundant alar folds

Place large temporary mattress sutures and see if the noise disappears

What is the treatment for redundant alar folds

Surgery

What is the most common complication of surgery for redundant

alar foldsHighly vascular-> hemorrhage

How can you help to decrease the hemorrhage produced by this

procedureLarge carmaltsIce cold saline

What is your diagnosis

Wry nose

What are the clinical signs of diseases of the nasal septum

Decreased or complete obstructionStridorDischarge Facial distortion

What are the preop considerations before operating on the nasal septum

Collect 4-8 L of bloodTracheotomy

What is the aftercare required for surgery of the nasal septum

5-6 days systemic ATBs10 days NSAIDSRemove packing 2 days post opRemove tracheostomy tubeClean and flush with saline

What is your diagnosis

Ethmoid hematoma

What are the CS of progressive ethmoid hematomas

Epistaxis Serosanguinous nasal exudateStridor

What is the suspected cause of ethmoid hematomas

Nasal gastric tubing

What is this instrument

Funnel screw

What is this instrument

Trephine

What is the main post op complication for surgical removal of

ethmoid hematomasHemorrhage

What is an ethmoid hematoma made up of on histopath

Outer: resp epitheliumCentral: hemosiderin-filled macrophages

What is an alternative treatment for ethmoid hematomas

Chemical ablation with formalin

What is the cause of primary sinusitis

UR tract infection

What is the causes of secondary sinusitis

Dental diseaseFacial fxCystsNeoplasia

What are the CS of sinusitis

Nasal discharge: serosanguineousCoughingFacial deformity

What is the treatment for sinusitis

Sinusotomy (trephination)

What is the aftercare instructions for sinusotomy

Leave open and flush dailyATB and NSAIDS

What is the prognosis for sinusitis after sinusotomy

Good-excellent

What is this instrument

Cribbing strap

What is cribbing

Grasp object with incisorsContract neck musclesPull backward

What is another name for cribbing

Windsucker

What are the causes of cribbing

BoredomConfinement Isolation Lack of roughageLearn from others??Genetic??

What are the consequences of cribbing

Colic ??Abnormal wear of incisorsWeight loss

What are some non surgical treatments for cribbing

Remove fixed objectsBitter tasting substancesCribbing strapsAcupunctureShock- aversionNaloxon

What is the possible surgical treatments for cribbing

Removal of sternomandibularis, sternothyroideus, omohyoideusNeurectomy of the ventral branch of accessory nerve

What aftercare should be followed after surgery for cribbing

ATB and NSAIDSChange the environment

What dose of NSAIDS should be given

Should be a bit painful if they try to repeat the behavior so low doses

What is the most common cause of noise

Recurrent laryngeal hemiplegia

What is Recurrent laryngeal hemiplegia

Progresive neurogenic atrophy of the recurrent laryngeal nerve

What is the signalment for Recurrent laryngeal hemiplegia

1-10 years oldLarge breed horsesHereditary

What causes Recurrent laryngeal hemiplegia

Perivascular injectionGuttural pouch mycosisTraumaStranglesOP toxicityPlant poisoningLead toxicityCNS disease

What is the typical history for Recurrent laryngeal hemiplegia

NoiseExercise intolerance

How is Recurrent laryngeal hemiplegia diagnosed

PalpationSlap testEndoscopy during treadmill exercise

What is the slap test

Slap withers during endoscopyObserve adduction of the contralateral arytenoid cartilage

What is the most common surgical treatment for recurrent laryngeal hemiplegia

Laryngoplasty (Tie back)

What are some potential complications with the tie back

procedureSeromaCough Dysphagia

What should be done if an animal is coughing following tieback

Remove sutures

How can you decrease dysphagia after tie back

Feed off the ground

What other surgical procedures can be performed for recurrent laryngeal

hemiplegiaVentriculectomy Reinervation of cricoarytenoid muscleArytenoidectomy

What instrument is this

Roaring burr

What are the complications of ventriculectomy

Granuloma formationMucoceleLaryngeal web

How do you know that you excised enough of the ventricle

Place on the finger tip---should be as big as your distal phalanx

What is arytenoid chondritis

Inflammation and thickening of the arytenoid cartilage

What is the treatment for arytenoid chondritis

Arytenoidectomy

What is a partial arytenoidectomy

Arytenoid body and corniculate process removed

What is a total arytenoidectomy

Arytenoid body, corniculate and muscular process

What is the px for a partial arytenoidectomy

50% of racehorses return to racing

Is partial or total arytenoidectomy recommended

Partial

What is the colloquial term for DDSP

Choking up

What is DDSP

The soft palate is displaced over the epiglottis

What are some treatments of DDSP

Tongue tieStaphylectomyMyectomyEpiglottic augmentationLaser cauterization

What is a staphylectomy

Cutting part of the soft palate

Is epiglottic augmentation commonly done

No because the epiglottis is often normal in size

What is your diagnosis

Guttural pouch tympany

What is guttural pouch tympany

Air filled guttural pouch

What are the causes of guttural pouch tympany

Idiopathic Upper airway infectionPersistent coughingMuscle dysfunction

What are the clinical signs of GP tympany

Nonpainful DyspneaDysphagiaInhalation pneumoniaSecondary empyema

What are the treatments for GP tympany

Needle aspirationIndwelling catheterSurgery for recurrent problems

Which approach to the guttural pouch is illustrated below

hyovertebrotomy

What are the problems with the hyovertebrotomy approach

No ventral drainage

Which approach to the guttural pouch is illustrated below

Viborgs triangle

What are the borders of viborgs triangle

Sternomandibular muscleLinguofacial veinCaudal border of vertical ramus of the mandible

Which approach to the guttural pouch is illustrated below

Whitehouse

Which approach to the guttural pouch is illustrated below

Modified Whitehouse

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

What are the causes of GP empyema

Upper resp tract infectionAbscessation of the retropharyngeal lnnFx of the stylohyoid bone

Is GP empyema usually uni or bilateral

Unilateral

What is the treatment for GP empyema

Indwelling catheterSx

What makes treatment of GP empyema difficult

The presence of chondroids

What is the most common complication following GP sx

Dysphagia

What is your diagnosis

GP mycosis

What are the CS of GP mycosis

EpistaxisDysphagia

Which structure in the GP is most commonly affected by mycosis

Internal carotid artery

Why can you not ligate the carotid artery to stop bleeding

Blood will still come from the other side via the circle of willis

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

What are the treatments for GP mycosis

Arterial ligationFlush guttural pouch with antifungals with horse under GA