FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Vet Surg / Technique for guttural pouch bead removal using a novel thre...
Veterinary surgery : VS2024; 53(7); 1219-1230; doi: 10.1111/vsu.14141

Technique for guttural pouch bead removal using a novel three-dimensional (3D)-printed instrument.

Abstract: The aim of the present study was to determine if a three-dimensional (3D)-printed instrument technique would improve lavage removal of plastic beads (guttural pouch [GP] chondroid mimics) through a dorsal pharyngeal recess (DPR) fenestration. We hypothesized that using a 3D-printed instrument placed through the DPR fenestration would remove more beads, reduce lavage time and incur less soft tissue damage than using a lavage tube control or instrument placement through the salpingopharyngeal ostium (SPO). Methods: Experimental cadaveric study. Methods: A total of 30 cadaveric equine heads. Methods: DPR fenestration was performed using transendoscopic laser and 50 plastic 12 mm beads were placed into one GP of horse heads. Four removal procedures using a 3D-printed instrument or lavage tube control placed through the DPR fenestration or the SPO were compared. Number of beads removed and number of 2-min lavage cycles to recover ≥96% of beads or three consecutive no-yield cycles were recorded. Endoscopic soft tissue damage was graded. Data were compared by generalized estimating equations (GEE) model and Fisher's exact test (p < .05). Results: More beads (median 48 beads; range 0-49) were removed faster (median 24 beads/cycle; range 12-50) using the 3D-printed instrument compared to control (median 6 beads; range 0-29, 0.66 beads/cycle, range 0-49). There was no difference between total beads removed or removal speed between placement sites. There was no difference in soft tissue damage between procedures. Conclusions: Our 3D-printed instrument enabled efficient plastic bead removal. Conclusions: DPR fenestration and use of our 3D-printed instrument represents an alternative to current chondroid removal techniques, warranting investigation in clinical cases.
© 2024 American College of Veterinary Surgeons.
Get Full Text
Publication Date: 2024-07-26 PubMed ID: 39058256DOI: 10.1111/vsu.14141Google 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.
LinkedInCopy
  • 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.

Overview

  • This study evaluated a novel three-dimensional (3D) printed instrument designed to remove plastic beads from the guttural pouch (GP) in horses more effectively and efficiently than current lavage techniques.
  • The researchers compared the new instrument’s performance with traditional lavage methods through different anatomical entry points using equine cadaver heads.

Background and Purpose

  • The guttural pouch is a large air-filled sac in horses that can develop chondroids—hardened mucosal masses needing removal.
  • Current removal methods typically involve lavage (washing out) but may be inefficient, time-consuming, or cause soft tissue damage.
  • The study aimed to test a newly designed 3D-printed instrument that could potentially improve bead (simulated chondroid) removal.
  • Hypotheses included improvements in bead removal quantity, speed, and reduced soft tissue damage compared to lavage tubes and different insertion sites.

Methods

  • Study Type: Experimental study using 30 cadaveric equine heads.
  • Preparation:
    • Dorsal pharyngeal recess (DPR) fenestration was performed using a transendoscopic laser to create an entry point.
    • Fifty plastic beads, each 12 mm, were placed inside the guttural pouch to mimic chondroids.
  • Removal Techniques Compared:
    • Use of the custom-made 3D-printed instrument inserted through the DPR fenestration.
    • Control method using a standard lavage tube inserted through the DPR fenestration.
    • Insertion of instruments through the salpingopharyngeal ostium (SPO) for both control and 3D-printed instrument.
  • Assessment Metrics:
    • Number of beads removed per procedure.
    • Number of 2-minute lavage cycles needed to remove ≥96% of beads or until three consecutive no-yield cycles.
    • Endoscopic grading of soft tissue damage resulting from the procedure.
  • Statistical Analysis:
    • Used generalized estimating equations (GEE) model and Fisher’s exact test with significance defined as p < 0.05.

Results

  • Bead Removal Efficiency:
    • The 3D-printed instrument removed a median of 48 beads out of 50, ranging between 0 and 49 beads.
    • Speed of removal was significantly faster with the 3D-printed device (median 24 beads per cycle) compared to control lavage tube (median 6 beads per cycle).
    • Control lavage tubes showed much lower efficiency and speed in bead removal.
  • Comparison of Entry Sites:
    • No statistically significant difference in the total number of beads removed or removal speed between DPR fenestration and SPO entry methods.
  • Soft Tissue Damage:
    • No difference in endoscopic soft tissue damage was observed between the 3D-printed instrument and control procedures regardless of entry site.
    • This suggests that the novel technique does not increase trauma risk.

Conclusions and Implications

  • The novel 3D-printed instrument enabled quicker and more effective removal of simulated chondroids from the guttural pouch compared to traditional lavage tubes.
  • DPR fenestration combined with this instrument represents a promising alternative surgical approach for chondroid removal, facilitating easier bead evacuation without increasing tissue damage.
  • Findings encourage further clinical trials to assess the instrument’s utility and safety in live horses with actual chondroid disease.
  • This technique could potentially improve equine guttural pouch surgery outcomes by reducing procedure time and enhancing cleanup efficiency.

Cite This Article

APA
Cardona GC, Dahlgren LA, Byron CR, McKenzie HC, Werre SR, Bogers SH. (2024). Technique for guttural pouch bead removal using a novel three-dimensional (3D)-printed instrument. Vet Surg, 53(7), 1219-1230. https://doi.org/10.1111/vsu.14141

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English
Volume: 53
Issue: 7
Pages: 1219-1230

Researcher Affiliations

Cardona, Guillermo C
  • Ocean State Equine Associates, North Scituate, Rhode Island, USA.
Dahlgren, Linda A
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Byron, Christopher R
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
McKenzie, Harold C
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Werre, Stephen R
  • Laboratory for Study Design and Statistical Analysis, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.
Bogers, Sophie H
  • Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.

MeSH Terms

  • Animals
  • Horses / surgery
  • Printing, Three-Dimensional
  • Cadaver
  • Foreign Bodies / veterinary
  • Foreign Bodies / surgery
  • Therapeutic Irrigation / veterinary
  • Therapeutic Irrigation / instrumentation
  • Therapeutic Irrigation / methods

Grant Funding

  • Virginia Tech's Equine Research Competition

References

This article includes 27 references
  1. Christmann U, Pink C. Lessons learned from a strangles outbreak on a large Standardbred farm. Equine Vet Educ. 2017;29:138‐143.
  2. Boyle AG, Timoney JF, Newton JR, Hines MT, Waller AS, Buchanan BR. Streptococcus equi infections in horses: guidelines for treatment, control, and prevention of strangles‐revised consensus statement. J Vet Intern Med. 2018;32:633‐647.
  3. Newton JR, Wood JL, Dunn KA, et al. Naturally occurring persistent and asymptomatic infection of the guttural pouches of horses with Streptococcus equi. Vet Rec. 1997;140:84‐90.
  4. Dixon PM, James OA. Equine guttural pouch empyema, why does it become chronic? Equine Vet Educ. 2018;30:80‐84.
  5. DeLoache P, Whelchel D, Beetz R, Carter J, Eichelberger A, Pusterla N. Guttural pouch empyema caused by Corynebacterium pseudotuberculosis in a pregnant mare. Equine Vet Educ. 2018;30:76‐79.
  6. Fogle CA, Gerard MP, Johansson AM, Breuhaus BA, Blikslager AT, Jones SL. Spontaneous rupture of the guttural pouch as a complication of treatment for guttural pouch empyema. Equine Vet Educ. 2007;19:351‐355.
  7. Verheyen K, Newton JR, Talbot NC, et al. Elimination of guttural pouch infection and inflammation in asymptomatic carriers of Streptococcus equi. Equine Vet J. 2000;32:527‐532.
  8. Schaaf KL, Kannegieter NJ, Lovell DK. Surgical treatment of extensive chondroid formation in the guttural pouch of a Warmblood horse. Aust Vet J. 2006;84:297‐300.
  9. Hardy J, Léveillé R. Diseases of the guttural pouches. Vet Clin North Am Equine Pract. 2003;19:123‐158.
  10. Perkins JD, Schumacher J, Kelly G, et al. Standing surgical removal of inspissated guttural pouch exudate (chondroids) in ten horses. Vet Surg. 2006;35:658‐662.
  11. Freeman DE. Complications of surgery for diseases of the guttural pouch. Vet Clin North Am Equine Pract. 2008;24:485‐497, vii.
  12. Munoz JA, Stephen J, Baptiste KE, et al. A surgical approach to the lateral compartment of the equine guttural pouch in the standing horse: modification of the forgotten “Garm technique”. Vet J. 2008;177:260‐265.
  13. Hawkins JF, Frank N, Sojka JE, Levy M. Fistulation of the auditory tube diverticulum (guttural pouch) with a neodymium:yttrium‐aluminum‐garnet laser for treatment of chronic empyema in two horses. J Am Vet Med Assoc. 2001;218:405‐407, 361.
  14. Jukic CC, Cowling NR, Perkins NR, van Eps AW, Ahern BJ. Evaluation of the effect of laser salpingopharyngostomy on the guttural pouch environment in horses. Equine Vet J. 2020;52:752‐759.
  15. Krebs W, Schmotzer WB. Laser fenestrated salpingopharyngeal fistulas for treatment of bilateral guttural pouch tympany in a foal. Equine Vet J. 2007;19:419‐423.
  16. Watkins AR, Parente EJ. Salpingopharyngeal fistula as a treatment for guttural pouch mycosis in seven horses. Equine Vet J. 2018;50:781‐786.
  17. Gehlen H, Ohnesorge B. Laser fenestration of the mesial septum for treatment of guttural pouch chondroids in a pony. Vet Surg. 2005;34:383‐386.
  18. Koch DW, Ericksen KA, Easley JT, Hackett ES. Clinical outcome of horses with guttural pouch infection following transpharyngeal fenestration. J Am Vet Med Assoc. 2022;260:1211‐1215.
  19. Tate LP Jr, Blikslager AT, Little ED. Transendoscopic laser treatment of guttural pouch tympanites in eight foals. Vet Surg. 1995;24:367‐372.
  20. Barton AK, Cehak A, Rohn K, Ohnesorge B. Transendoscopic laser surgery to correct nasopharyngeal obstruction caused by head flexion in horses. Vet Surg. 2014;43:418‐424.
  21. Koch DW, Easley JT, Nelson BB, Delcambre JJ, McCready EG, Hackett ES. Comparison of two techniques for transpharyngeal endoscopic auditory tube diverticulotomy in the horse. J Vet Sci. 2018;19:835‐839.
  22. Cramp PA, Prange T, Nickels FA. Standing equine surgery of the upper respiratory tract. Vet Clin North Am Equine Pract. 2014;30:111‐141.
  23. Barakzai SZ, Macaulay E, Burrows IL. Creation of salpingopharyngeal fistulae for the management of guttural pouch tympany and persistent guttural pouch empyema. Equine Vet Educ. 2022;35:358‐363.
  24. Berger N. Eeg PH: Veterinary Laser Surgery. 1st ed. Blackwell Publishing; 2006.
  25. Hawkins JF, Andrews‐Jones L. Neodymium:yttrium aluminum garnet laser ventriculocordectomy in standing horses. Am J Vet Res. 2001;62:531‐537.
  26. Henderson CE, Sullins KE, Brown JA. Transendoscopic, laser‐assisted ventriculocordectomy for treatment of left laryngeal hemiplegia in horses: 22 cases (1999–2005). J Am Vet Med Assoc. 2007;231:1868‐1872.
  27. Cook WR. The clinical features of guttural pouch mycosis in the horse. Vet Rec. 1968;83:336‐345.

Citations

This article has been cited 0 times.
Subscribe to our newsletter
Join 99,002 horse owners like you who receive our email updates on horse health and nutrition.