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Topic:Laryngeal Dysfunction
Laryngeal dysfunction in horses refers to a range of conditions affecting the larynx, which is a critical structure involved in breathing and vocalization. These conditions can impact the horse's performance and respiratory efficiency. Common types of laryngeal dysfunction include recurrent laryngeal neuropathy (RLN), arytenoid chondritis, and laryngeal hemiplegia. These disorders may result in abnormal respiratory noises and exercise intolerance. Diagnosis typically involves endoscopic examination to assess the structure and function of the larynx. This page compiles peer-reviewed research studies and scholarly articles that explore the etiology, diagnosis, and management of laryngeal dysfunction in horses.
Preliminary study of laryngeal sacculectomy in horses, using a neodymium:yttrium aluminum garnet laser technique. In an attempt to ablate the laryngeal saccule as an alternative method of sacculectomy (conventially done through a laryngotomy incision for laryngeal hemiplegia) a neodymium:yttrium aluminum garnet laser was used transendoscopically in noncontact fashion in 6 horses. The procedure was easy, quick, and labor-saving, with few complications. Endoscopically, the lased sacculectomy site appeared healed at postsurgical day 42. On postsurgical day 42, microscopic examination revealed mucosal remnants under the granulation bed. Laser energy caused thermal damage to tissues adjacent to the lased saccu...
Upper airway function during maximal exercise in horses with obstructive upper airway lesions. Effect of surgical treatment. Upper airway pressure was measured during maximal exercise in 10 Thoroughbred racehorses with naturally occurring upper airway obstruction. Left laryngeal hemiplegia and arytenoid chondropathy resulted in substantial increases (30-40 cm H2O) in inspiratory upper airway pressure (Pl), whereas complicated aryepiglottic entrapment and subepiglottic cysts produced only modest increases (15 cm H2O) in Pl. Uncomplicated aryepiglottic entrapment and grade IV pharyngeal lymphoid hyperplasia produced only slight increases (3-5 cm H2O). In general, surgical procedures restored airway pressures to within...
Evaluation of upper respiratory tract function during strenuous exercise in racehorses. Forty-six racehorses with a history of poor performance underwent endoscopic evaluation of laryngeal and pharyngeal function while exercising on a high-speed treadmill. This evaluation allowed the definitive diagnosis of intermittent or continual upper respiratory tract obstruction as a cause of poor performance, as well as the documentation of the dynamic functional anatomy of the obstruction. Ten of the horses (22%) were determined to have a functional abnormality of the upper respiratory tract. These abnormalities included epiglottic entrapment (1 horse), persistent dorsal displacement of t...
Clinical evaluation of laryngeal sensation in horses. Sensory innervation of the larynx was examined by tactile stimulation with a blunt biopsy forceps passed through a flexible videoendoscope. Twenty horses with no evidence of laryngeal motor deficit were stimulated on 10 sites by touch with the forceps. Unilateral neurectomies of the internal branch of the left cranial laryngeal nerve were performed on 5 other horses. These horses were stimulated by touch on the same sites preoperatively and up to 1 week postoperatively. In all 25 horses the motor response of the larynx was recorded on videotape and evaluated by 2 observers blind as to treatmen...
Staphylectomy for treatment of dorsal displacement of the soft palate in two foals. Dorsal displacement of the soft palate associated with dysphagia and aspiration pneumonia was diagnosed in 2 young foals. The displacement appeared to be congenital. Clinical signs associated with the condition were resolved after staphylectomy. Dorsal displacement of the soft palate is usually recognized in adult animals as an upper respiratory tract disease, but may be a contributing factor to dysphagia and lower respiratory tract disease in young animals.
Use of videoendoscopy during exercise for determination of appropriate surgical treatment of laryngeal hemiplegia in a colt. Videoendoscopy of the larynx during treadmill exercise was used to determine the surgical treatment of upper airway obstruction in a Standardbred colt. Surgical correction of right-sided laryngeal hemiplegia, first by laryngoplasty, then subtotal arytenoidectomy, was ineffective. Videoendoscopy indicated, and upper airway flow mechanics confirmed, that the laryngeal opening was adequate at rest, but obstruction occurred during exercise. On the basis of the appearance of the larynx during high airflow rates on slow-motion playback of the videorecording, total arytenoidectomy was performed, whic...
Further evidence for a central nervous system component in equine laryngeal hemiplegia. Evidence for a central nervous system component of the distal axonopathy associated with equine laryngeal hemiplegia was found in this survey of 33 horses (control, 15; subclinical, 8; clinical, 10). Significantly higher numbers of axonal spheroids were present in sections of the lateral cuneate nuclei in layngeal hemiplegic horses than in those unaffected by the disease.
Xeroradiographic evaluation of the equine larynx. The normal radiographic anatomy of the equine larynx was determine by use of xeroradiography and dissection. The body and laminae of the thyroid cartilage, the muscular process of the arytenoid cartilages, and the dorsal lamina and arch of the cricoid cartilage had radiographic evidence of mineralization (calcification) and/or ossification in clinically normal horses. There was a significant (P less than 0.01) increase in the degree of mineralization of the thyroid and arytenoid cartilages with advancing age. Horses with diagnosis of arytenoid chondrosis (arytenoid chondral dysplasia, arytenoi...
Attempts to restore abduction of the paralyzed equine arytenoid cartilage. III. Nerve anastomosis. The purpose of this project was to attempt restoration of abduction of a recently denervated left dorsal cricoarytenoid muscle in the horse by anastomosing the first cervical nerve to the abductor branch of the left recurrent laryngeal nerve. Ten horses were used in the study. In six horses the left recurrent laryngeal nerve was transected and ligated while the ventral branch of the left first cervical nerve was anastomosed to the abductor branch of the left recurrent laryngeal nerve. The remaining four horses also had the left recurrent laryngeal nerve transected and ligated but had no nerve ...
Attempts to restore abduction of the paralyzed equine arytenoid cartilage. II. Nerve implantation (pilot study). The purpose of this project was to attempt restoration of abduction of a recently experimentally denervated left dorsal cricoarytenoid muscle by implanting a transected nerve-end into the paralyzed muscle. In six ponies the cut end of the second cervical nerve was implanted into a slit made in the left dorsal cricoarytenoid muscle. The nerve end was secured in place with one 5-0 polypropylene suture connecting the epineurium to the epimysium. The left recurrent laryngeal nerve was transected during this procedure. All six ponies showed signs of complete left laryngeal hemiplegia immediately af...
Attempts to restore abduction of the paralyzed equine arytenoid cartilage. I. Nerve-muscle pedicle transplants. The purpose of this project was to adapt a surgical technique from humans and dogs to horses in which a portion of an accessory muscle of respiration and its nerve supply is transplanted to a denervated dorsal cricoarytenoid muscle. Anatomical dissections in seven horses revealed two possible donor nerve-pedicle grafts: the omohyoid and the sternothyrohyoid, both innervated by a branch of the first and second cervical nerves. Histochemical evaluations in two ponies of the dorsal cricoarytenoid, omohyoid and sternothyrohyoid muscles revealed similar proportions of fiber types 1 and 2 in all thr...
Sternothyrohyoideus myectomy in horses: 17 cases (1984-1985). Review of medical records of 78 horses admitted to the George D. Widener Hospital for Large Animals with dorsal displacement of the soft palate revealed 94% of these horses to have evidence of an intermittent abnormal "gurgling" respiratory noise at the time of exercise. Sternothyrohyoideus myectomy was used as a primary treatment for 17 of these horses, with a success rate of 58%. Anatomic dissection of 30 horses indicated that the midcervical region is the optimal site for sternothyrohyoideus myectomy to alleviate dorsal displacement of the soft palate.
Costal diaphragmatic O2 and lactate extraction in laryngeal hemiplegic ponies during exercise. Diaphragmatic O2 and lactate extraction were examined in seven healthy ponies during maximal exercise (ME) carried out without, as well as with, inspiratory resistive breathing. Arterial and diaphragmatic venous blood were sampled simultaneously at rest and at 30-s intervals during the 4 min of ME. Experiments were carried out before and after left laryngeal hemiplegia (LH) was produced. During ME, normal ponies exhibited hypocapnia, hemoconcentration, and a decrease in arterial PO2 (PaO2) with insignificant change in O2 saturation. In LH ponies, PaO2 and O2 saturation decreased well below tha...
Effects of ventriculectomy, prosthetic laryngoplasty, and exercise on upper airway function in horses with induced left laryngeal hemiplegia. Effects of ventriculectomy and prosthetic laryngoplasty on upper airway flow mechanics and blood gas tensions in exercising horses with induced left laryngeal hemiplegia were assessed. Five adult horses were trained to stand, trot (4.5 m/s), and gallop (7.2 m/s) on a treadmill (6.38 degrees incline). Inspiratory and expiratory airflows (VImax, VEmax, respectively) were measured using a 15.2-cm diameter pneumotachograph in a face mask. Inspiratory and expiratory transupper airway pressures (PuI, PuE, respectively) were determined as pressure differences between barometric pressure and lateral t...
Epiglottic entrapment. A transnasal surgical approach to divide the aryepiglottic fold axially in the standing horse. Transnasal, axial division of the aryepiglottic fold was performed to correct entrapment of the epiglottis in 20 sedated, standing horses, using a hooked bistoury and topical anesthesia. Presenting complaints included decreased exercise tolerance or loss of racing performance, abnormal respiratory noise, and coughing. The surgical procedure was technically easy to perform with a minimum of instrumentation. The horses were rested an average of 18 days before race training or riding was resumed. Evaluation of racing records or contact with owners indicated that most affected horses competed succ...
Management of arytenoid chondropathy and failed laryngoplasty in horses: 75 cases (1979-1985). By use of endoscopy, 75 horses with respiratory noise and/or exercise intolerance were determined to have structural arytenoid cartilage abnormalities (60 primary, 11 after previous laryngeal surgery), or failed left laryngoplasty (4 horses) for laryngeal hemiplegia in which the arytenoid cartilage still appeared normal. Eighty-eight percent of the horses were either Thoroughbred (54 horses; 72%) or Standardbred (12 horses; 16%) racehorses; only 9 horses (12%) had occupations not related to racing. Seventy-six percent of the racehorses were 2 to 4 years old; all non-racehorses were greater tha...
Association of arytenoid chondritis with equine lymphocyte antigens but no association with laryngeal hemiplegia, umbilical hernias and cryptorchidism. Associations were sought between ELA A1-A10 and W11 antigens and the presence of laryngeal hemiplegia, arytenoid chondritis, umbilical hernias and cryptorchidism in Thoroughbreds and/or Quarter Horses. No significant associations were detected between laryngeal hemiplegia and any ELA antigen in Thoroughbreds. The association between arytenoid chondritis and A9 was significant with a relative risk (RR) of 15.6 and aetiologic fraction (EF) of 0.80 in Thoroughbreds. There were apparent associations based on RR between A4 and A5 in Quarter Horses with umbilical hernias (RR = 7.5 and 6.1 respective...
The intraneural distribution of myelinated fibres in the equine recurrent laryngeal nerve. The intraneural course of nerve fibres in the equine recurrent laryngeal nerve was investigated by partially ligating the nerve at a proximal site, and 3-8 weeks later, tracing the course and spatial relationships of intact and degenerating fibres along the distal stump. This nerve was chosen because of its great length, the fact that it is a nonbranching motor nerve and because of debate about the course of abductor and adductor nerve fibres in the recurrent laryngeal nerve. Six ponies were used and in each the recurrent nerve was partially ligatured about 20 cm from the larynx, using a fine ...
Outcome of treatment in 35 cases of guttural pouch mycosis. This paper describes the outcome of treatment of 30 cases of guttural pouch mycosis by ligation of the internal carotid artery on the cardiac side of the lesion and lavage of the affected pouch with natamycin. Twenty-three horses recovered fully following this treatment while laryngeal hemiplegia persisted in one case and slight dysphagia caused by pharyngeal hemiplegia in another. The remaining five horses died or were destroyed. Five horses with guttural pouch mycosis, which had shown no epistaxis but had pharyngeal hemiplegia, were treated by topical natamycin alone. Only two of these survi...
The pathogenesis of equine laryngeal hemiplegia–a review. Recent research on the muscular and nervous changes which occur in idiopathic equine laryngeal hemiplegia has indicated that many of the traditional concepts of the aetiology of this disease are erroneous. In light of the new knowledge gained, the various predispositions and possible causes of laryngeal hemiplegia are discussed, and it is suggested that the underlying mechanism of axonal damage in this neuropathy of horses may be related to abnormal energy metabolism in the axon.
Experimental crush of the equine recurrent laryngeal nerve: a study of normal and aberrant reinnervation. Experimental reinnervation of the equine larynx in healthy ponies was studied after the recurrent laryngeal nerve was crushed, using endoscopic, electromyographic, and microscopic techniques. In 12 ponies, the recurrent laryngeal nerve was crushed unilaterally in the midcervical area. All showed postoperative paralysis of the larynx on the operated side. In 8 ponies, recovery of movement of the vocal folds occurred at different times (2.5 to 8 months) after surgical operation was done. These movements, which were often abnormal, included trembling and asynchronism. In 2 of these ponies, comple...
Laryngotracheal injury associated with nasotracheal intubation in the horse. Laryngotracheal damage following short-term nasotracheal intubation was studied in 7 healthy horses. A flexible fiberoptic endoscope was used to examine the upper respiratory tract of each horse before nasal intubation with a cuffed silicone endotracheal tube and again at 1 hour, 24 hours, and 48 hours after extubation. Any abnormalities still evident at 48 hours were evaluated at 7 days after extubation. Mucosal damage involved the nasal meatus (5 of 7 horses), the arytenoid cartilages (5 of 7 horses), the trachea (5 of 7 horses), the dorsal pharyngeal recess (4 of 7 horses), the vocal folds ...
Equine laryngeal hemiplegia. Part V. Central nervous system pathology. Evidence of long central nerve fibre degeneration (axonal spheroids) in the lateral cuneate nuclei was found in all eight Thoroughbreds affected clinically and subclinically with equine laryngeal hemiplegia, but in only one of six control animals. It was considered that these spheroids may signify a central nervous component of the disease process of laryngeal hemiplegia although until further investigations are performed no firm conclusions regarding the relationship of these findings with laryngeal hemiplegia could be made. Examination of the left and right nucleus ambiguus of clinical and s...
Equine laryngeal hemiplegia. Part IV. Muscle pathology. This study confirmed that neurogenic muscle pathology exists in intrinsic laryngeal muscles supplied by the recurrent laryngeal nerves in horses subclinically and clinically affected with laryngeal hemiplegia. An important additional observation was the occurrence in three out of four laryngeal hemiplegic horses of neurogenic muscle changes in a hindlimb muscle, the extensor digitorum longus, a muscle supplied by another long peripheral nerve. This finding suggests that a polynenropathy exists in laryngeal hemiplegic horses, and supports the classification of this disease as a distal axonopath...
Equine laryngeal hemiplegia. Part III. A teased fibre study of peripheral nerves. Individual nerve fibres were isolated from the recurrent laryngeal and some distal hindlimb nerves, in an investigation of equine laryngeal hemiplegia. One hundred teased fibres were obtained from each of three sampling sites on both left and right recurrent laryngeal nerves, from 15 Thoroughbred horses. These fibres were graded descriptively and internode lengths measured. A distal distribution of pathology was demonstrated in all groups studied, but was most severe in the clinical group of horses. The predominant change was one of short thinly myelinated internodes interspersed amongst norma...
