Transendoscopic Nd:YAG Laser Surgery for Treatment of Epiglottal Entrapment and Dorsal Displacement of the Soft Palate in the Horse

Abstract

Transendoscopic neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used to treat 12 standing horses with epiglottic entrapment (EE) or dorsal displacement of the soft palate (DDSP), or both. In four horses, transendoscopic laser staphylectomy was performed. The most common presenting complaints were respiratory stridor, cough, and exercise intolerance. Ten horses with EE healed without epiglottic complications; in one horse, partial adhesion of the aryepiglottic fold to one side of the epiglottis was corrected surgically through a laryngotomy incision. One horse with DDSP had no further signs, one continued to have continual DDSP, and two had induced DDSP. Transendoscopic Nd:YAG laser proved to be a feasible means of correcting EE and selected cases of DDSP.

Surgical Treatment Options for Dorsal Displacement of the Soft Palate

“…[14][15][16][17][18][19] Also, various laser procedures to either resect or cauterize the soft palate, and a tie-forward procedure have been recently described to address DDSP. 10,12,13,17,20 None of these procedures are very effective for persistent DDSP because of the likely damage to innervation of the soft palate and pharynx in these cases.…”

“…An Nd:YAG, CO 2 , or diode laser may be used to transect muscle or to perform the staphylectomy or photothermoplasty procedures. 10,12,13,17,19 …”

“…Various surgical procedures have been described to treat DDSP, including sternothyrohyoideus myectomy, sternothyroideus tenectomy, staphylectomy, and epiglottic augmentation. [1][2][3][4][5][6][7][8][9][10][11][12][13] Various combinations of the procedures have also been described. [14][15][16][17][18][19] Also, various laser procedures to either resect or cauterize the soft palate, and a tie-forward procedure have been recently described to address DDSP.…”

“…13 Towel stent sutured in position for sternohyoideus myectomy, sternothyroideus tenectomy for either DDSP or modified Forssell's procedure. The stent is applied to protect the incision and to apply pressure to the incision site to minimize postoperative hematoma or seroma formation.…”

Possibilities and limitations of minimal invasiv surgery in upper airway diseases of the horse

“…Für die Staphylektomie werden ,,Erfolgsraten" von ca. 60%, für die Myektomie des M. sternothyreohyoideus und M. omohyoideus ,,Erfolgsraten" von ca 60-85% angegeben (Anderson et al, 1995;Harrison and Raker, 1988;Zertuche et al,, 1990), Die Staphylektomie läßt sich entweder über eine Laryngotomie, schonender jedoch transendoskopisch mittels Elektro-oder Laserchirurgie durchführen (VViley, 1993;Tate et al, 1990). Läßt sich als Ursache des DDSP eine Hypoplasie der Epiglottis ermitteln, so wird als Therapiemöglichkeit eine Epiglottis-Vergrößerung mittels Teflon@-lnjektion beschrieben (Peloso et.…”