Equis ISSN 2398-2977

Larynx: laryngoplasty

Synonym(s): Tie-back, prosthetic, laryngoplasty

Contributor(s): Jonathan Cheetham, Patrick Colahan, Dallas Goble, Graham Munroe, Rachel Murray, Dwayne Rodgerson

Introduction

  • Many different surgical methods have been used to treat laryngeal hemiplegia   Larynx: hemiplegia  .
  • Laryngoplasty or laryngeal abductor muscle prosthesis was conceived in the late 1960s and consists of the extra luminal placement of a prosthesis (suture) between the caudal aspect of the cricoid cartilage and the muscular process of the arytenoid to simulate the action of the cricoarytenoideus dorsalis muscle.
  • At present it remains the treatment of choice for recurrent laryngeal neuropathy.
  • Its major function is to prevent dynamic collapse of the larynx.

Uses

  • Treatment of recurrent laryngeal neuropathy   Larynx: hemiplegia  , usually in association with ventriculectomy.

Advantages

  • Stabilizes and abducts the arytenoid cartilages and associated structures.
  • Restores airflow to normal in exercising horses affected with recurrent laryngeal neuropathy, by preventing collapse of the arytenoid cartilage into the laryngeal lumen (rima glotidis) during exercise.

Disadvantages

  • Technically difficult - requires surgeon experienced with procedure.
  • Requires general anesthesia.
  • Complications not uncommon - most common complications include coughing, loss of arytenoid abduction, especially in the early post-operative period, and aspiration.
  • Amount of abduction achieved at surgery may reduce due to the suture stretching or pulling through the muscular process of the arytenoid or through the cricoid cartilage.
  • The risk of this may be higher in younger horses with immature cartilage.
  • Over abduction may result in a higher incidence of coughing and feed aspiration.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Objective data suggests success rates of approximately 48-72% - variability accounted for by different success criteria, case selection and individual surgeon ability.
  • Experimental data, particularly from treadmill studies, suggest that laryngoplasty +/- ventriculectomy restores laryngeal airway flow mechanics to a near-normal status; adduction and phonation are rendered permanently abnormal.
  • In the long-term there may be gradual loss of abduction over a period of years possibly affecting the later athletic performance.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bienert-Zeit A et al (2014) Laryngeal fistula formation after laryngoplasty in two Warmblood mares. Equine Vet Educ 26 (2), 88-92 VetMedResource.
  • Froydenlund T J & Dixon P M (2014) A review of equine laryngoplasty complications. Equine Vet Educ 26 (2), 98-106 VetMedResource.
  • Mason B J, Riggs C M & Cogger N (2013) Cohort study examining long-term respiratory health, career duration and racing performance in racehorses that undergo left-sided prosthetic laryngoplasty and ventriculocordectomy surgery for treatment of left-sided laryngeal hemiplegia. Equine Vet J 45 (2), 229-234 PubMed.
  • Witte T H, Mohammed H O, Radcliffe C H, Hackett R P, Ducharme N G (2009) Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 Thoroughbred racehorses competing at less than 2400 m (1997-2007). Equine Vet J 41 (1), 70-75 PubMed.
  • Parente E J, Tulleners E P & Southwood L L (2008) Long-term study of partial arytenoidectomy with primary mucosal closure in 76 Thoroughbred racehorses (1992-2006). Equine Vet J 40, 214-218 PubMed.
  • Dixon P M, McGorum D I et al (2003) Long-term survey of laryngoplasty and ventriculocordectomy in an older, mixed-breed population of 200 horses. Part 1: Maintenance of surgical arytenoid abduction and complications of surgery.Equine Vet J 35 (4), 389-396 PubMed.
  • Dixon P M, McGorum B C et al (2003) Long-term survey of laryngoplasty and ventriculocordectomy in an older, mixed-breed population of 200 horses. Part 2: Owners' assessment of the value of surgery. Equine Vet J 35 (4), 397-401 PubMed.
  • Davenport C L, Tulleners E P & Parente E J (2001) The effect of recurrent laryngeal neurectomy in conjunction with laryngoplasty and unilateral ventriculocordectomy in thoroughbred racehorses. Vet Surg 30 (5), 417-421 PubMed.
  • Jansson N, Ducharme N G, Hackett R P & Mohammed H O (2000) An in vitro comparison of cordopexy, cordopexy and laryngoplasty, and laryngoplasty for treatment of equine laryngeal hemiplegia. Vet Surg 29 (4), 326-334 PubMed.
  • Robertson J T (2000) Laryngoplasty - a novel prosthesis. Equine Vet J 32 (1), 5-6 PubMed.
  • Schumacher J, Wilson A M, Pardoe C & Easter J L (2000) In vitro evaluation of a novel prosthesis for laryngoplasty of horses with recurrent laryngeal neuropathy. Equine Vet J 32 (1), 43-46 PubMed.
  • Hawkins J F et al (1997) Laryngoplasty with or without ventriculectomy for treatment of left laryngeal hemiplegia in 230 racehorses. Vet Surg 26 (6), 484-491 PubMed.
  • Tetens J et al (1996) Efficacy of prosthetic laryngoplasty with and without bilateral ventriculocordectomy as treatments for laryngeal hemiplegia in horses. Am J Vet Res 57 (11), 1668-1673 PubMed.
  • Russell A P et al (1994) Performance analysis after prosthetic laryngoplasty and bilateral ventriculectomy for laryngeal hemiplagia in horses, 70 cases (1986-1991). JAVMA 204 (8), 1235-1241 PubMed.
  • Hall L W et al (1990) Use ot the forced oscillating airflow technique to measure the resistance of the equine upper airway, effects of laryngoventriculectomy and laryngoplasty. Res Vet Sci 49 (2), 229-235 PubMed.
  • Williams J W et al (1990) Effects of left recurrent laryngeal neurectomy, prosthetic laryngoplasty, and subtotal arytenoidectomy on upper airway pressure during maximal exertion. Vet Surg 19 (2), 136-141 PubMed.
  • Dean P W et al (1990) Effects of age and prothesis material onin vitrocartilage retention of laryngoplasty prostheses in horses. Am J Vet Res 51 (1), 114-147 PubMed.
  • Shappell K K et al (1988) Effects of ventriculectomy, prosthetic laryngoplasty, and exercise on upper airway function in horses with induces left laryngeal hemiplagia. Am J Vet Res 49 (10), 1760-1765 PubMed.  
  • Tulleners E P et al (1988) Management of artenoid chondropathy and failed laryngoplasty in horses, 75 cases (1979-1985). JAVMA 192 (5), 670-675 PubMed.
  • Derksen F J et al (1986) Effect of laryngeal hemiplegia and laryngoplasty on airway flow mechanics in exercising horses. Am J Vet Res 47 (1), 16-20 PubMed.
  • Greet T R et al (1979) The effect of laryngoplasty on pharyngeal function in the horse. Equine Vet J 11 (3), 153-158 PubMed.
  • Johnson J H et al (1970) Laryngoplasty for advanced laryngeal hemiplegia. Vet Med Small Anim Clin 65 (4), 347-352 PubMed.

Other sources of information

  • Ainsworth D M & Cheetham J (2009)Disorders of the Respiratory System.In:Equine Internal Medicine.Eds: Reed S M, Bayly W M & Sellon D C. 3rd edn. Saunders, St. Louis.
  • Holcombe S J & Ducharme N G (2004)Abnormalities of the Upper Airway.In:Equine Sports Medicine and Surgery - Basic and Clinical Sciences of the Equine Athlete. Eds: Hinchcliff K W, Kaneps A J & Geor R J. W B Saunders, Edinburgh.
  • Parente E J, Tulleners E & Southwood L L (2003)Partial Arytenoidectomy for Treatment of Failed Laryngoplasty or Arytenoid Chondritis.In:Proc 49th AAEP Convention.pp 373-376.


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