Effect of ventriculectomy versus ventriculocordectomy on upper airway noise in draught horses with recurrent laryngeal neuropathy.

REASONS FOR PERFORMING STUDY: Little is known about the efficacy of bilateral ventriculectomy (VE) or bilateral ventriculocordectomy (VCE) in draught horses. OBJECTIVES: To compare the effect of VE and VCE on upper airway noise in draught horses with recurrent laryngeal neuropathy (RLN) by use of quantitative sound analysis techniques. HYPOTHESIS: In competitive draught horses with grade 4 RLN, VE and VCE reduce upper airway noise during exercise, but VCE is more effective. METHODS: Thirty competitive hitch or pulling draught horses with grade 4 RLN were evaluated for upper airway sound during exercise. Respiratory rate (RR), inspiratory (Ti) and expiratory time (Te), the ratio between Ti and Te (Ti/Te), inspiratory (Sli) and expiratory sound levels (Sle), the ratio between Sli and Sle (Sli/Sle), and peak sound intensity of the second formant (F2) were calculated. Eleven horses were treated with VE and 19 with VCE. After 90 days of voice and physical rest and 30 days of work, the horses returned for post operative upper airway sound evaluation and resting videoendoscopy. RESULTS: VE significantly reduced Ti/Te, Sli, Sli/Sle and the sound intensity of F2. Respiratory rate, Ti, Te and Sle were unaffected by VE. VCE significantly reduced Ti/Te, Ti, Te, Sli, Sli/Sle and the sound intensity of F2, while RR and Sle were unaffected. The reduction in sound intensity of F2 following VCE was significantly greater than following VE. After VE and VCE, 7/11 (64%) and 15/18 (83%) owners, respectively, concluded that the surgery improved upper airway sound in their horses sufficiently for successful competition. CONCLUSIONS: VE and VCE significantly reduce upper airway noise and indices of airway obstruction in draught horses with RLN, but VCE is more effective than VE. The procedures have few post operative complications. POTENTIAL RELEVANCE: VCE is recommended as the preferred treatment for RLN in draught horses. Further studies are required to evaluate the longevity of the procedure's results.

The effect of compacted cancellous bone grafting on the healing of subchondral bone defects of the medial femoral condyle in horses.

OBJECTIVE: To compare the quality of second-intention healing and that of compacting sternally harvested cancellous bone into subchondral bone defects of the medial femoral condyle in horses. STUDY DESIGN: A controlled experiment using a surgical technique that minimizes soft tissue trauma, customized for consistency among horses. ANIMALS OR SAMPLE POPULATION: Ten horses, aged 2 to 5 years, free of hindlimb lameness and with radiographically normal stifles. METHODS: After a 12.7-mm-diameter x 19-mm-deep defect was created into randomly selected medial femoral condyles, bone and cartilage healing was evaluated over a 6-month period in control horses (n = 5) and horses receiving a compacted cancellous bone graft (n = 5). Healing was evaluated using lameness assessment, radiographic and microradiographic interpretation, arthroscopic appearance, percent bone fill, proteoglycan content, and histology. RESULTS: Six months after surgery, there was no significant difference between grafted and ungrafted defects with respect to lameness, radiographic score, or percent bone fill. Histologically, grafted defects were characterized by the presence of dead graft and secondary cyst formation in four defects. Ungrafted defects filled with fibrous tissue and no cyst formation were identified. CONCLUSIONS: Grafted defects do not heal better than ungrafted defects, and lameness was not affected by surgical technique. CLINICAL SIGNIFICANCE: Cartilage healing is similar in grafted and ungrafted defects in the equine medial femoral condyle at 6 months, suggesting that surgical debridement alone of cystic structures remains the treatment of choice.

Effect of the neodymium:yttrium aluminum garnet laser on postoperative neuroma formation after neurectomy in rats.

The effect of neodymium:yttrium aluminum garnet (Nd:YAG) laser-performed neurectomy was compared with conventional scalpel-performed neurectomy, using the rat sciatic nerve model. Sixteen male Sprague-Dawley rats underwent unilateral transection of the sciatic nerve by 1 of 3 methods. The sciatic nerve of rats under general anesthesia was transected by use of a steel scalpel blade (group 1, n = 5); a contact Nd:YAG laser at 6W of power (group 2, n = 6); or an Nd:YAG laser at 12 W of power (group 3, n = 5). Thirty days after surgery, all rats were euthanatized and the nerves were harvested, imbedded in paraffin, fixed, and sectioned for light microscopy. Neurodegenerative changes and perineurial cell proliferation were least severe in the nerves transected by use of a steel scalpel (group 1), and were most severe in nerves transected by use of laser at 6 W of power (group 2). There was a significant difference in prevalence of perineurial proliferation between the scalpel and laser neurectomy groups (P = 0.029). There was no significant difference in prevalence of neuroma formation or neurodegeneration between the laser and scalpel neurectomy groups, although neuromas were found in 3 rats (2 from group 2 and 1 from group 3). Within the limits of this study, we found that the Nd:YAG laser was less successful than sharp division, using a scalpel, in preventing neuroma formation after nerve transection.

Surgical treatment for epiglottic entrapment in horses: 51 cases (1981-1992).

Medical records of 51 horses with epiglottic entrapment were reviewed, and the outcome after surgical treatment was evaluated by use of results from a survey of owners and from race records. Horses with epiglottic entrapment and no additional problem (uncomplicated) of the nares, nasal passages, pharynx, or larynx (upper airway) that were treated by transoral axial division (group 1) or resection via laryngotomy (group 2), and horses with epiglottic entrapment complicated by an additional upper airway abnormality (group 3) were compared. The cost of treatment, duration of hospitalization, time to first race start after surgery, and complication rate were significantly (P < 0.05) less in horses in group 1, compared with those in horses of group 2. Owner survey indicated that a significantly greater percentage (82%) of horses in group 1 had a successful outcome after transoral axial division, compared with that (27%) of horses in group 2. Analysis of race records indicated that performance was similar between horses in groups 1 and 2, and significantly more horses with an additional upper airway lesion (group 3) failed to return to racing than did horses with uncomplicated epiglottic entrapment (groups 1 and 2). Transoral axial division of the ary-epiglottic fold is recommended as an appropriate treatment for uncomplicated epiglottic entrapment. Resection via laryngotomy should be reserved for treatment of epiglottic entrapment associated with excessively thick and scarred aryepiglottic folds and for intermittent epiglottic entrapment in horses for which surgical correction is deemed appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of partial arytenoidectomy as a treatment for equine laryngeal hemiplegia.

The efficacy of partial arytenoidectomy was assessed in 6 Standardbred horses, with surgically induced laryngeal hemiplegia, at rest (Period A) and during exercise at speeds corresponding to maximum heart rate (Period C) and 75% of maximum heart rate (Period B). Peak expiratory and inspiratory airflow rate (PEF and PIF), and expiratory and inspiratory transupper airway pressure (PUE and PUI) were measured and expiratory and inspiratory impedance (ZE and ZI) were calculated. Simultaneously, tidal breathing flow-volume loops (TBFVL) were acquired using a respiratory function computer. Indices derived from TBFVL included airflow rates at 50 and 25% of tidal volume (EF50, IF50, EF25, and IF25) and the ratios of expiratory to inspiratory flows. Measurements were made before left recurrent laryngeal neurectomy (baseline), 2 weeks after left recurrent laryngeal neurectomy (LRLN) and 16 weeks after left partial arytenoidectomy coupled with bilateral ventriculectomy (ARYT). After LRLN, during exercise Periods B and C, Z1 and the ratio of EF50/IF50 significantly increased and PIF, IF50 and IF25 significantly decreased from baseline values. At 16 weeks after ARYT, Z1 returned to baseline values during Periods B and C. Although PIF, IF50, IF25, PEF/PIF, and EF50/IF50 returned to baseline values during Period B, these indices remained significantly different from baseline measurements during Period C. After ARYT, TBFVL shapes from horses during Period C approached that seen at the baseline evaluation. Partial arytenoidectomy improved upper airway function in exercising horses with surgically induced left laryngeal hemiplegia, although qualitative and quantitative evaluation of TBFVLs suggested that some flow limitation remains at near maximal airflow rates. These results indicate that, although the procedure does not completely restore the upper airway to normal, partial arytenoidectomy is a viable treatment option for failed laryngoplasty and arytenoid chondropathy in the horse.

Extensor tendon lacerations in horses: 50 cases (1982-1988).

Medical records of 50 horses with extensor tendon lacerations affecting 53 limbs over 7 years (1982 to 1988) were reviewed to determine the clinical features and prognosis for athletic soundness after treatment. Mean and median ages were 4.8 and 3 years, respectively. Eighty-nine percent of the injuries involved the hind limbs, with approximately equal distribution between the right and left limbs. Hind limb lacerations involved the long digital extensor tendon (28 limbs), lateral digital extensor tendon (3 limbs), or both tendons (16 limbs). Forelimb lacerations involved the common digital extensor tendon (2 limbs), lateral digital extensor tendon (1 limb), or both tendons (3 limbs). Joint involvement was found in 6 cases. Wound management varied according to wound characteristics, financial constraints of owners, and clinician preference. External coaptation consisted of a 3-layered cotton bandage in 33 limbs, splint and cotton bandage in 12 limbs, fiberglass or plaster-of-Paris cast in 5 limbs, and no form of coaptation in 3 limbs. Follow-up information for 40 cases at least 1 year after injury revealed that 29 (73%) horses had returned to athletic soundness, 7 (18%) horses were pasture sound, 3 horses were chronically lame, and 1 horse was euthanatized during treatment because of wound sepsis. Depending on the hind limb tendons involved, return to athletic soundness ranged from 62% (long digital and lateral digital extensor tendons lacerated) to 80% (long digital extensor tendon lacerated) The small number of forelimb lacerations precluded any comparative data.(ABSTRACT TRUNCATED AT 250 WORDS)

Diseases of the nasal cavity.

Conditions of this portion of the respiratory tract are relatively uncommon. This article reviews these conditions and discusses the different modes of therapy. The conditions covered are redundant alar folds, diseases of the nasal septum, fungal infections, neoplasms, nasal polyps, and ethmoid hematomas. The different surgical approaches to the nasal cavity are reviewed, and surgery of removal of the nasal septum and the alar fold are described.

Jejunal intussusception in adult horses: 11 cases (1981-1991).

Medical records of 11 adult horses with jejunal intussusception examined at 5 veterinary teaching hospitals between 1981 and 1991 were reviewed. Nine of 11 horses had signs of acute abdominal discomfort for < 24 hours, whereas 2 horses had a history of chronic signs. Five of 11 horses had an intraluminal or intramural mass associated with the jejunal intussusception. Two horses died or were euthanatized prior to surgery. Partial jejunal resection and jejunojejunal anastomosis were performed in 9 horses. One horse died during surgery and 2 were euthanatized prior to hospital discharge because of postoperative complications. Four of the 6 horses that were discharged from the hospital survived from 16 months to 6 years and returned to their previous level of performance. One horse died 3 months after surgery from unknown causes, and 1 horse was lost to long-term follow-up evaluation.

Epiglottic augmentation by use of polytetrafluoroethylene to correct dorsal displacement of the soft palate in a standardbred horse.

A 2-year-old 400-kg Standardbred colt with a history of exercise intolerance was determined to have dorsal displacement of the soft palate (DDSP). Standing endoscopy revealed a soft, flaccid, and hypoplastic epiglottis and arytenoid cartilages that moved symmetrically and abducted fully. Lateral laryngeal radiography was used to calculate a corrected thyroepiglottic length of 6.48 cm. Videoendoscopy during exercise on a high-speed treadmill at standardized treadmill speeds was performed weekly for 3 consecutive weeks. The soft palate dorsally displaced at each examination. A sternohyoideus/sternothyroideus myectomy was followed by 2 weeks of stall rest and 2 weeks of treadmill training. Because endoscopy during exercise at standardized treadmill speeds caused the horse to dorsally displace the soft palate once a week for 3 weeks after the myectomy, this surgery was deemed ineffective in this horse. Epiglottic augmentation was performed by injecting 7 ml of polytetrafluoroethylene into the ventral submucosal space of the epiglottis. After 21 days of stall rest and 5 weeks of pasture rest, the horse was placed on a 2-month treadmill conditioning program. Using endoscopy at standardized treadmill speeds, exercise efforts to encourage DDSP were unsuccessful, which suggested that epiglottic augmentation by use of polytetrafluoroethylene was an effective surgical treatment to correct dorsal displacement of the soft palate in this horse. It is believed that polytetrafluoroethylene increases the rigidity of the epiglottis, allowing it to maintain the ventral position of the soft palate.

A one-stage repair of third-degree perineal lacerations and rectovestibular fistulae in 17 mares.

Third-degree perineal lacerations or rectovestibular fistulae in 17 mares were repaired surgically by a one-stage method. Primary healing occurred in 14 mares; there were one complete dehiscence and two partial dehiscences with fistula formation. Twelve of 13 mares that were bred became pregnant; nine carried foals to term and two are still pregnant. Two mares have each produced one unthrifty foal. One mare repeatedly aborts in the first trimester. Four mares have produced several healthy foals with no further problems. One mare suffered further perineal trauma while foaling.

Arthroscopic removal of an osteochondral fragment from the caudal pouch of the lateral femorotibial joint in a colt.

An osteochondral fragment was removed from the caudal pouch of the lateral femorotibial joint in a 2-year-old Trakehner colt by use of arthroscopic surgery and a lateral approach. The approach to this aspect of the femorotibial joints was developed in another horse. The fragment was not attached and resembled an osteochondritis dissecans lesion. The intermittent lameness associated with the fragment resolved after surgical removal. A positive response to diagnostic anesthesia of the femorotibial joint in the absence of a confirmed diagnosis (following radiographic and arthroscopic evaluations of the other aspects of the stifle joint) is an indication for arthroscopic exploration of the caudal pouches of the femorotibial joints of stifles in horses.

Long-term effects of desmotomy of the accessory ligament of the deep digital flexor muscle in standardbreds: 23 cases (1979-1989).

Desmotomy of the accessory ligament of the deep digital flexor muscle (inferior check desmotomy) permitted Standardbred foals affected with flexural deformities to reach their full athletic potential. Long-term effects of inferior check desmotomy were examined in 23 Standardbreds over a 10-year period. Six of 11 foals that were treated surgically either raced 6 times and obtained a race record or were training sound (if yearlings). All 12 horses with flexural deformity that did not receive an inferior check desmotomy had an unfavorable outcome (no race record). Foals that had surgery performed at a younger age apparently had a better chance of racing or training sound because no foals treated surgically after 8 months of age had a favorable outcome and only 1 foal that was older than 5 months at the time of surgery had a favorable outcome. In 5 foals that had surgery with an unsuccessful outcome, 3 were greater than or equal to 1 year old at the time of surgery and were lame when training was started on the limb(s) with the desmotomy.

Pharmacologic treatment of priapism in two horses.

Benztropine mesylate was used successfully to treat priapism that developed during anesthesia in 2 horses. After IV injection, there was a rapid resolution of signs in both horses, and no side effects were observed. The choice of an effective method to treat priapism is challenging because precise causes in most patients have not been well-defined. Benztropine mesylate is a synthetic compound resulting from the combination of the active portions of atropine and diphenhydramine, and is believed effective because of its central acetyl-choline-antagonizing properties.

Failure of subtotal arytenoidectomy to improve upper airway flow mechanics in exercising standardbreds with induced laryngeal hemiplegia.

Upper airway flow mechanics and arterial blood gas measurements were used to assess the efficacy of subtotal arytenoidectomy for treatment of induced left laryngeal hemiplegia in horses. Measurements were collected with the horses at rest, and trotting or pacing on a treadmill (6.38 degrees incline) at speeds of 4.2 and 7.0 m/s. Experimental protocols were performed after right common carotid artery exteriorization (baseline), after left recurrent laryngeal neurectomy (LRLN), and after left subtotal arytenoidectomy. At baseline, increasing treadmill speed progressively increased peak inspiratory and expiratory flow (VImax and VEmax, respectively), peak inspiratory and expiratory transupper airway pressure (PuI and PuE, respectively), respiratory frequency (f), tidal volume (VT), minute volume (VE), and heart rate. Inspiratory and expiratory times (TI and TE, respectively) and arterial oxygen tension (PaO2) decreased with increased treadmill speed; inspiratory and expiratory impedance (ZI and ZE, respectively) did not change. After LRLN, VImax, f, and PaO2 significantly (P less than 0.05) decreased at exercise, whereas PuI, TI, and ZI significantly increased. Minute volume decreased at exercise after LRLN, but the changes were not significant; LRLN had no effect on VEmax, PuE, ZE, heart rate, arterial carbon dioxide tension (PaCO2), or VT. Subtotal arytenoidectomy did not improve upper airway flow mechanics or blood gas measurements impaired by laryngeal hemiplegia.

Complications of castration and ovariectomy.

This article discusses the complications of castration and ovariectomy and their treatment and prevention. These two procedures were chosen because castration is the most common surgical procedure performed by the equine practitioner and ovariectomy is associated with a high number of complications.

Radiographic and arthroscopic findings in the equine stifle.

The radiographic and arthroscopic findings in the equine stifle were compared. Survey radiography, contrast arthrography, and arthroscopy were performed on both stifles of 10 horses. Nine of the horses were euthanatized to evaluate the effects of the techniques on the joints. Techniques for double-contrast arthrography and arthroscopy were developed, and the findings were compared. Survey radiography identified only osseous structures. Double-contrast arthrography of the femoropatellar joint demonstrated articular surfaces of the trochlea, patella, and joint capsule. Those of the femorotibial joint defined the medial meniscus but not the lateral meniscus. On arthroscopy of the femoropatellar joint, intra-articular structures could be readily visualized. In the femorotibial sacs, structures were more difficult to identify. Gross examination of the stifle joint at necropsy revealed no overt effects of arthroscopy.