Dysphagia caused by focal guttural pouch mycosis: mononeuropathy of the pharyngeal ramus of the vagal nerve in a 20-year-old pony mare.
Abstract: A 20-year-old pony mare was presented to the equine hospital with a ten-day history of dysphagia, regurgitation and coughing. An obstruction of the oesophagus was excluded via endoscopy, but the proximal oesophagus appeared to be distended and circular contractions were missing. A guttural pouch endoscopy revealed a single, black-mottled plaque on the pharyngeal ramus of the vagus nerve in the left guttural pouch, causing a local swelling of this nerve. The pharyngeal ramus seemed to be atrophic distal to the lesion. A biopsy was taken from the lesion and histopathological findings proved the reasonable suspicion of a guttural pouch mycosis with a high degree of purulent-necrotic inflammation and invasion of fungal hyphae. There were no signs of neoplasia, such as melanoma. Daily guttural pouch irrigations with a clotrimazole emulsion (20 g Canesten(®) Gyn(4) solved in 500 ml water), led to a good recovery of the mucosa above the nerve. Periodic endoscopic examination of the left guttural pouch showed that local thickening and distal atrophy of this pharyngeal ramus did not improve, neither did the clinical symptoms. Due to progressive weight loss, acute respiratory distress and aspiration pneumonia, the 20-year-old pony mare unfortunately had to be euthanized three weeks after discharge. This case report emphasizes the enormous importance of a single nerve for the realization of the swallowing process. The one-sided loss of function of the pharyngeal branch of the vagal nerve cannot be compensated neither by the remaining ipsilateral nerves nor by the contralateral normal functioning glossopharyngeal and vagal nerves and thus inevitably leads to severe dysphagia.
Publication Date: 2013-07-11 PubMed ID: 23845027PubMed Central: PMC3710512DOI: 10.1186/2046-0481-66-13Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
This research article discusses the case of a 20-year-old pony mare that suffered from dysphagia (difficulty swallowing), caused by a unique condition known as focal guttural pouch mycosis located on the pharyngeal ramus of the vagal nerve. Despite attempts at treatment, the pony’s underlying symptoms did not improve, resulting in euthanasia.
Clinical Presentation and Investigation
- The case begins with a 20-year-old pony mare showing symptoms of dysphagia, regurgitation, and coughing that had been ongoing for ten days. Through endoscopy, a blockage in the oesophagus was ruled out, although there were signs of distension and lack of typical circular contractions in the proximal oesophagus.
- A guttural pouch endoscopy showed black-mottled plaque affecting the pharyngeal ramus of the vagal nerve located in the left guttural pouch. It led to a localized swelling of the nerve and the pharyngeal ramus appeared to be atrophic distally to the lesion.
Diagnosis and Treatment
- A biopsy confirmed the suspicion of guttural pouch mycosis, a fungal infection associated with necrotic, purulent inflammation. The presence of neoplasia, like melanoma, was not detected.
- Treatment involved daily irrigations of the guttural pouch with a clotrimazole emulsion, which showed a positive effect on the overlying mucosa’s recovery. However, periodic endoscopies showed no improvement in the local thickening and distal atrophy of the affected nerve, and the clinical symptoms persisted.
Outcome and Conclusion
- Due to increasingly severe symptoms, including weight loss, acute respiratory distress, and aspiration pneumonia, the mare was euthanized three weeks after discharge.
- The study concludes by highlighting the critical role of a single nerve in the swallowing process. The loss of function in one pharyngeal branch of the vagal nerve lead to severe dysphagia – a hardship that could not be compensated by the remaining nerves. This case study emphasizes the need for further research into neurological dysfunctions contributing to dysphagia and potential treatment avenues.
Cite This Article
APA
Eichentopf A, Snyder A, Recknagel S, Uhlig A, Waltl V, Schusser GF.
(2013).
Dysphagia caused by focal guttural pouch mycosis: mononeuropathy of the pharyngeal ramus of the vagal nerve in a 20-year-old pony mare.
Ir Vet J, 66(1), 13.
https://doi.org/10.1186/2046-0481-66-13 Publication
Researcher Affiliations
- Department of Large Animal Medicine, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 11, 04103 Leipzig, Germany.
- Department of Large Animal Medicine, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 11, 04103 Leipzig, Germany.
- Department of Large Animal Medicine, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 11, 04103 Leipzig, Germany.
- Department of Large Animal Medicine, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 11, 04103 Leipzig, Germany.
- Institute of Pathology, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 33, 04103 Leipzig, Germany.
- Department of Large Animal Medicine, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 11, 04103 Leipzig, Germany.
References
This article includes 24 references
- Wissdorf H, Otto B, Gerhards H. In: Praxisorientierte Anatomie und Propädeutik des Pferdes. 3. Wissdorf H, Gerhards H, Huskamp B, Deegen EM, editor. Hannover: Schaper M & H; 2010. Luftsack und benachbarte Strukturen; pp. 208–225.
- Albert ICM. “Der Pferdekopf” – ein interaktives Lernprogramm. München: Tierärztlichen Fakultät, Ludwig-Maximilians-Universität; 2010.
- Mayhew IG. In: Large Animal Neurology: A Handbook for Veterinary Clinicians. 1. Mayhew IG, editor. Philadelphia: Lea & Febiger; 1989. Problem 5: Cranial Nerve (III-VII, IX, X, XII) Dysfunction and Horner’s Syndrome; pp. 147–177.
- Lavoie JP, Hinchcliff KW. In: Blackwell’s five-minute veterinary consult: Equine. 2. Lavoie JP, Hinchcliff KW, editor. Ames: Wiley-Blackwell; 2008. Regurgitation/Vomiting/Dysphagia; pp. 666–667.
- Böhme G. In: Lehrbuch der Anatomie der Haustiere. Band IV, Nervensystem, Sinnesorgange, Endokrine Drüsen. 4. Nickel R, Schummer A, Seiferle E, editor. Stuttgart: Parey; 2004. Gehirnnerven, Nervi craniales; pp. 299–349.
- Holcombe SJ, Derksen FJ, Stick JA, Robinson NE. Effect of bilateral blockade of the pharyngeal branch of the vagus nerve on soft palate function in horses. Am J Vet Res 1998;59:504–508.
- Holcombe SJ, Derksen FJ, Stick JA, Robinson NE. Effects of bilateral hypoglossal and glossopharyngeal nerve blocks on epiglottic and soft palate position in exercising horses. Am J Vet Res 1997;58:1022–1026.
- Clayton HM, Flood PF, Rosenstein DS. Clinical Anatomy of the horse. 1. Edinburgh: Mosby Elsevier; 2005. p. 17.
- Millar H. Guttural pouch mycosis in a 6-month-old filly. Can Vet J 2006;47:259–261.
- Edwards GB, Greet T. Disorders of the Guttural Pouches (Auditory Tube Diverticuli). In: Equine Respiratory Medicine and Surgery. 1. McGorum BC, Dixon PM, Robinson NE, Schumacher J, editor. Edinburgh, New York: Saunders Elsevier; 2007. pp. 419–436.
- Archer RM, Knight C, Bishop WJ. Guttural pouch mycosis in six horses in New Zealand. N Z Vet J 2012;60:203–209.
- Lepage OM, Perron MF, Cadoré JL. The mystery of fungal infection in the guttural pouches. Vet J 2004;168:60–64.
- Baptiste KE. The mystery of guttural pouch mycosis: the paradox of advancing knowledge of a rare disease. Vet J 2004;168:1–2.
- Ragle CA. Chapter 7.7 Gutteral pouch diseases. In: Current Therapy in Equine Medicine. 5. Robinson NE, editor. Philadelphia: Elsevier Inc; 2003. pp. 386–390.
- Freeman DE, Hardy J. Chapter 46 – Guttural Pouch. In: Equine Surgery. 4. Auer JA, Stick JA, editor. St. Louis: Saunders Elsevier; 2012. pp. 623–642.
- Markus RG. Untersuchungen zur Therapie der Luftsackmykose des Pferdes - Ligatur der Arteria carotis interna mittels transendoskopischer Clipapplikation. Hannover: Tierärztliche Hochschule; 2002. (Dissertation. Department of horse medicine and surgery & Department of pathology).
- Klebe EA, Holcombe SJ, Rosenstein D, Boruta D, Bartner LR, Tessier C. The effect of bilateral glossopharyngeal nerve anaesthesia on swallowing in horses. Equine Vet J 2005;37:65–69.
- Venker-van Haagen AJ, Hartman W, Wolvekamp WTC. Contributions of the glossopharyngeal nerve and the pharyngeal branch of the vagus nerve to the swallowing process in dogs. Am J Vet Res 1986;47:1300–1307.
- Borges AS, Watanabe MJ. Guttural pouch diseases causing neurologic dysfunction in the horse. Vet Clin North Am: Eq Pract 2011;3:545–572.
- Dixon PM, McGorum BC, Railton DI, Hawe C, Tremaine WH, Pickles K, McCann J. Laryngeal paralysis: a study of 375 cases in a mixed-breed population of horses. Equine Vet J 2001;33:452–458.
- Kipar A, Frese K. Hypoglossal Neuritis with Associated Lingual Hemiplegia Secondary to Guttural Pouch Mycosis. Vet Pathol 1993;30:574–576.
- Greet TR. Outcome of treatment in 35 cases of guttural pouch mycosis. Equine Vet J 1987;19:483–487.
- Church S, Wyn-Jones G, Parks AH, Ritchie HE. Treatment of guttural pouch mycosis. Equine Vet J 1986;18:362–365.
- Huber WG. Chapter 52 – Antifugal and antiviral agents. In: Veterinary Pharmacology and Therapeutics. 6. Booth NH, McDonald LE, editor. Ames: Iowa State University Press; 1988. pp. 850–851.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
