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Laryngeal reinnervation

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Laryngeal reinnervation. First described 1989, but largely unsuccessful. Surgical repositioning and grafting of other respiratory ... Caudal auricular. artery ... – PowerPoint PPT presentation

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Title: Laryngeal reinnervation


1
  • Laryngeal reinnervation
  • First described 1989, but largely unsuccessful
  • Surgical repositioning and grafting of other
    respiratory accessory muscles/nerve to dorsal
    cricoarytenoideus muscle

2
  • 85 successful reinnervation
  • Much lower incidence of complications, ie
    pneumonia

3
  • Pharyngeal collapse
  • Dysfunction of pharyngeal constrictor muscles
    that dilate and stiffen pharynx during
    respiration
  • Increased noise during peak expiration
  • Exact cause unknown
  • Currently no known treatment

4
  • Epiglotticentrapment
  • Loosesubepi-glottic tissue moves dorsally over
    cartilage
  • Impedes air flow
  • Surgical laser repair

5
  • Facial nerve trauma
  • During exercise,nostrils normallyflare
    fromcomma shapeto circular toincreaseair
    flow
  • Via primarilycaninus muscle,innervated by
    facial nerve

6
  • Facial nerveCN VIIalsoinnervatesothermuscles
    offacial expression, including eyelid, sensory
    to caudal 2/3rds of tongue, lacrimal and salivary
    glands

7
  • Neural damage gtcannot flarenostril onaffected
    sideduring exercise
  • Fluttering soundduring exercise
  • Restricted air flow

8
  • Neural damageusually unilateral(one side),lip
    and nostriltowards theunaffectedside
  • Possible droopingeyelid, dry eye

9
  • Horses can also voluntarily relax the muscles to
    nostrils
  • Stops as intensity of exercise increases
  • Fluttering sound from both nostrils, never just
    one
  • Both nostrils that stops when you increase
    intensity goofing around
  • One nostril facial neuropathy

10
  • Guttural pouchdisease
  • Lots of primarypathology here
  • Also causeslots of problemsin nearby
    airwaysdue to the nervesand vasculature in
    close association with guttural pouches

11
  • Internal andexternalbranches of thecarotid
    artery
  • Maxillaryartery and vein
  • Caudal auricularartery

12
  • Cranial nerves that course superficially past
    mucosa of guttural pouches
  • All function in motor innervation of pharynx,
    larynx or accessory respiratory structures
  • IX glossopharyngeal
  • X vagus, pharyngeal branch and recurrent
    laryngeal branch
  • XI spinal accessory
  • XII - hypoglossal

13
  • ANY inflammation, infection or irritation in the
    guttural pouches can cause a secondary neuropathy
    in associated nerves and dysfunction of pharynx
    or larynx, and thus an exercise intolerance and
    decrease in performance.

14
  • Irritation to nerves can also be iatrogenic
    (caused by the vet) if caustic substances are
    instilled
  • Almost anything other than isotonic saline is
    potentially irritating

15
  • Empyema (pus)
  • Most commonguttural pouch disease
  • Primary bacterialinfection, or
  • Drainage fromretropharyngeallymph node abscess
  • Strep equi
  • Guttural pouches can be site of strangles
    chronic carrier infection

16
  • Gutturalpouchempyemawithfluidline

17
  • Complications of empyema
  • Pus from guttural pouch can potentially drain
    into and cause lower respiratory tract infection
  • Dysphagia (problems swallowing)
  • Higher risk of aspiration pneumonia
  • Weight loss

18
  • Gutturalpouchmycosis (fungal)
  • Erosion ofwall intounderlyingvasculature
  • Intermittentepistaxis(nose bleed)

19
  • Guttural pouch mycosis
  • Infrequent occurance, but serious
  • Aspergillus spp most common fungal pathogen
  • Size of fungal lesion does not necessarily
    correlate to severity of infection
  • 50 of affected horses with epistaxis will die of
    fatal hemorrhage if untreated

20
  • Fungallesionsoftenassocdwith
    ananeurysmaldilation ofaffected artery

21
  • Surgicalocclusionof bloodvesselscausesspontan
    eousresolutionof fungal lesion within 30-60
    days without further treatment

22
  • Mycosis can also be treated with systemic and/or
    topical antifungal meds
  • Expensive
  • Potentially nephrotoxic
  • Potential for phlebitis
  • Extended treatment and layup
  • (Why shouldnt you exercise this horse?)
  • Ongoing risk of fatal hemorrhage
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