Management of bilateral choanal atresia in a foal.
Abstract: A 1-day-old Standardbred foal with a history of extreme respiratory distress after birth consistent with upper airway obstruction was evaluated. A temporary tracheostomy tube was placed by the referring veterinarian. Results: On initial examination, there was evidence of hypoxic-ischemic syndrome, secondary to perinatal asphyxia. Endoscopy revealed obstruction of both nares at the level of the choanae; a diagnosis of bilateral choanal atresia was made. Results: The foal was anesthetized and underwent transendoscopic laser fenestration of the buccopharyngeal membranes. Three weeks after surgery, cicatricial narrowing of the choanae was apparent and further transendoscopic ablation was performed. Recurrent stenosis necessitated revision surgeries involving a combination of laser ablation with topical administration of mitomycin and, subsequently, a combination of radial incisions into the stenotic tissue and repeated bougienage with a cuffed endotracheal tube. The degree of stenosis decreased, and at 1 year of age, the horse was an appropriate size for its age, had choanae that were almost maximally open (> 85%), and had entered training. Mild stenosis was still evident when the horse was reexamined the following year, although there was no evidence of exercise intolerance or respiratory compromise. Conclusions: Bilateral choanal atresia in a foal can be successfully treated via transendoscopic fenestration of the buccopharyngeal membranes, enabling the horse to subsequently participate in athletic activities. Secondary problems resulting from initial asphyxia and recurrent stenosis at the surgical site can be overcome but may require prolonged and extensive treatment.
Publication Date: 2006-12-06 PubMed ID: 17144827DOI: 10.2460/javma.229.11.1784Google 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.
- Case Reports
- 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 study is about the successful treatment of a 1-day-old foal suffering from severe respiratory obstruction, diagnosed as bilateral choanal atresia, using transendoscopic laser fenestration and other surgical techniques. Despite complications like recurring stenosis, the foal recovered and was able to participate in athletic activities without any respiratory issues after a year.
Initial Diagnoses and Treatment
- The research focuses on a 1-day-old Standardbred foal that was presented with a severe upper airway obstruction leading to respiratory distress after its birth.
- Due to the foal’s critical condition, the referring veterinarian had placed a temporary tracheostomy tube to mitigate the distress.
- Upon initial examination, the foal was found to have symptoms indicative of hypoxic-ischemic syndrome, a condition where the brain does not get enough oxygen, a side effect of asphyxia during birth.
- The use of endoscopy revealed that the obstruction was at the level of the choanae (the rear openings of the nasal cavity) in both nostrils, leading to a diagnosis of bilateral choanal atresia (a dense layer of tissue blocking the choanae).
Surgical Intervention
- Under anaesthesia, the foal was subjected to a procedure known as transendoscopic laser fenestration to cut through the blocking membranes.
- Three weeks post the surgery, cicatricial narrowing in the choanae was observed, signalling scar formation and contraction which was corrected through another round of membrane ablation.
- Since the stenosis (narrowing) occurred repeatedly, multiple revision surgeries were conducted which included laser ablation coupled with the topical administration of mitomycin (a medicine to slow tissue growth), radial incisions into the stenotic tissue, and bougienage (a method of widening a passage in the body) with an endotracheal tube.
Post Treatment Progress
- While the treatment helped reduce the stenosis, there was still mild evidence of it even a year later. However, this did not inhibit the growth of the foal or its athletic activities.
- The foal’s choanae were more than 85% open, and it was deemed to have a normal size for its age and had entered training.
- Even though mild stenosis was evident in the review after a year, the horse displayed no exercise intolerance or respiratory problems.
Conclusion
- The study puts forth its successful experience in treating a case of bilateral choanal atresia in a foal by using transendoscopic fenestration of the buccopharyngeal membranes, and handling post-operative complications such as recurrent stenosis.
- This implies that horses suffering from this severe respiratory condition can still expect to recover and be productively involved in athletic activities with the necessary intensive and prolonged treatment.
Cite This Article
APA
James FM, Parente EJ, Palmer JE.
(2006).
Management of bilateral choanal atresia in a foal.
J Am Vet Med Assoc, 229(11), 1784-1789.
https://doi.org/10.2460/javma.229.11.1784 Publication
Researcher Affiliations
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348, USA.
MeSH Terms
- Airway Obstruction / surgery
- Airway Obstruction / veterinary
- Animals
- Choanal Atresia / surgery
- Choanal Atresia / veterinary
- Constriction, Pathologic / surgery
- Constriction, Pathologic / veterinary
- Horse Diseases / surgery
- Horses
- Laser Therapy / methods
- Laser Therapy / veterinary
- Male
- Nasopharynx / pathology
- Nasopharynx / surgery
- Physical Conditioning, Animal / physiology
- Recurrence
- Reoperation / veterinary
- Treatment Outcome
Citations
This article has been cited 2 times.- Schafgans KE, Armstrong PJ, Kramek B, Ober CP. Bilateral choanal atresia in a cat. J Feline Med Surg 2012 Oct;14(10):759-63.
- DeSandre-Robinson DM, Madden SN, Walker JT. Nasopharyngeal stenosis with concurrent hiatal hernia and megaesophagus in an 8-year-old cat. J Feline Med Surg 2011 Jun;13(6):454-9.
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
