A systematic review of the efficacy of interventions for dynamic intermittent dorsal displacement of the soft palate

Abstract

SummaryThere are numerous treatments for correction of dorsal displacement of the soft palate (DDSP). However, the efficacy of these treatments is controversial and there is little consensus on how best to treat this condition. The aims of this study were to systematically review the literature and to assess the evidence on the clinical effects of interventions for dynamic intermittent DDSP. A secondary objective was to assess whether factors relating to study quality affected reported success rates. Twenty-three studies were included, covering a wide number of interventions but also differing widely is terms of study design, sample size, method of diagnosis, outcome measure and the number lost to follow-up. The assessment of adverse effects was severely limited because of lack of reporting. The way in which success is measured appears to have a great effect on the reported results. Research synthesis has been severely limited because of the heterogeneity in the included studies. The low level of evidence makes it difficult to draw firm conclusions as to the efficacy of procedures for DDSP. Hence it is currently not possible to determine which procedure is the most appropriate. This systematic review highlights the difficulties of studying palatal dysfunction and suggests areas where improvements can be made in future studies.

Equine Welfare during Exercise: An Evaluation of Breathing, Breathlessness and Bridles

“…They are transient palatal instability (PI) and dorsal displacement of the soft palate (DDSP), the causes of which continue to be discussed [38,39,64,67,68,69,70]. One view emphasises the importance during exercise of an airtight seal between the larynx (the “button”) and the ostium intrapharyngium (the “buttonhole”) in the soft palate so that, when sealed, air cannot enter and dissipate the negative pressure in the oropharynx (Figure 1 and Figure 2) [22,44].…”

“…Palatal vibration upon expiration would also occur [41]. As noted above (Section 2.2.2), PI and DDSP are well-recognised problems in racehorses [39,41,67,68,69,70]. Interestingly, use of a crossed noseband to prevent visible mouth opening and minimise palatal dysfunction [54,144] apparently has some benefits, but the precise mechanism has not yet been clarified [54].…”

How to critically appraise a paper

“…In addition, there are many sources of nonpeer-reviewed literature, including textbooks, reports and proceedings and the internet. Formal systematic reviews are beginning to appear in the equine veterinary literature (Allen et al 2012;Sullivan et al 2015;Dominguez et al 2016), and RCVS Knowledge and the Equine Veterinary Education are beginning to publish knowledge summaries (or critically appraised topics) (RCVS Knowledge 2017). However, it is usually up to the individual reader to assess the scientific validity, strength of evidence and practical relevance of results presented in a paper and the extent to which they can be applied to the particular question they are interested in.…”

The effect of the laryngeal tie‐forward procedure and soft palate cautery on nasopharyngeal diameter in horses

“…It has been highlighted that understanding how interventions for DDSP alter the structure and function of the pharynx in naturally occurring disease is important (Allen and others 2012). Furthermore, it is important to fully understand both the positive and negative effects of treatments in order that the best advice for management of this condition can be given (Allen and others 2012).…”