Epiglottic Entrapment in Horses
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Transcript of Epiglottic Entrapment in Horses
Epiglottic Entrapment in Epiglottic Entrapment in HorsesHorses
Erica Fields, DVMErica Fields, DVM
Butler, Clinical Radiology of the HorseButler, Clinical Radiology of the Horse
Normal EpiglottisNormal Epiglottis
Curved (dorsally convex), smoothCurved (dorsally convex), smooth
Base nearly vertical Base nearly vertical
Tip at right angle to dorsal surface of Tip at right angle to dorsal surface of the soft palate, pointed, narrowthe soft palate, pointed, narrow
Serrated lateral edgesSerrated lateral edges
Vascular pattern on dorsal surfaceVascular pattern on dorsal surface
Aryepiglottic folds attach to lateral Aryepiglottic folds attach to lateral edgesedges
Butler, Clinical Radiology of the HorseButler, Clinical Radiology of the Horse
Common Epiglottic AbnormalitiesCommon Epiglottic Abnormalities
Epiglottic entrapmentEpiglottic entrapment
Epiglottic shortening (hypoplasia)Epiglottic shortening (hypoplasia)
Subepiglottic cystsSubepiglottic cysts
Ulceration/inflammationUlceration/inflammation
Epiglottic EntrapmentEpiglottic Entrapment
Apex and lateral margins become Apex and lateral margins become enveloped by ventral mucosa and enveloped by ventral mucosa and aryepiglottic foldsaryepiglottic folds
Blunted and shortening of epiglottisBlunted and shortening of epiglottis
Ulceration may occurUlceration may occur
Equine Surgery / www.ctba.comEquine Surgery / www.ctba.com
Clinical SignsClinical Signs
Exercise intolerance at high speedsExercise intolerance at high speeds
Abnormal respiratory sounds at high Abnormal respiratory sounds at high speeds; asymptomatic at restspeeds; asymptomatic at rest
Jockey may report “holding breath”Jockey may report “holding breath”
Mostly problematic in Thoroughbreds Mostly problematic in Thoroughbreds and Standardbredsand Standardbreds
Radiographic AppearanceRadiographic Appearance
Radiographic AppearanceRadiographic Appearance
Radiographic AppearanceRadiographic Appearance
Blunt, short epiglottisBlunt, short epiglottis
May be dorsally or caudally deviatedMay be dorsally or caudally deviated
Must be differentiated from epiglottic Must be differentiated from epiglottic shorteningshortening
Endoscopy is method of choice for Endoscopy is method of choice for diagnosisdiagnosis
Endoscopic AppearanceEndoscopic Appearance
Possible CausesPossible Causes
Definitive cause unknownDefinitive cause unknown
Onset often coincides with training; Onset often coincides with training; inflammation/trauma?inflammation/trauma?
Infection?Infection?
Developmental shorteningDevelopmental shortening
Russell and Wainscott, 2007Russell and Wainscott, 2007
Treatment OptionsTreatment Options
Conservative: topical anti-Conservative: topical anti-inflammatoriesinflammatories
Surgical transection—endoscopic Surgical transection—endoscopic laser transection, Bistoury laser transection, Bistoury transection (blind or endoscopic), transection (blind or endoscopic), resection of a section of fold via resection of a section of fold via ventral laryngotomyventral laryngotomy
Laser TransectionLaser Transection
Laser Transection—Post-opLaser Transection—Post-op
Brown, et al, 2005Brown, et al, 2005
OutcomesOutcomes
Relatively high rate of complication Relatively high rate of complication with surgery (DDSP, re-entrapment)with surgery (DDSP, re-entrapment)
Racehorses affected, so prognosis Racehorses affected, so prognosis involves return to function, not just involves return to function, not just survivalsurvival
Study of horses just off track—0.9% Study of horses just off track—0.9% prevalence, NO ADVERSE EFFECT on prevalence, NO ADVERSE EFFECT on performanceperformance
Hobo, et al, 1995 and Russell and WainscoHobo, et al, 1995 and Russell and Wainscott, 2007tt, 2007
OutcomesOutcomes
Study of clinical horses—0.6% Study of clinical horses—0.6% prevalence prevalence
Post-op study—26/27 horses raced Post-op study—26/27 horses raced again; 13/27 improved in handicap, again; 13/27 improved in handicap, 13/27 decreased handicap13/27 decreased handicap
ReferencesReferencesBrown JA, Hinchcliff KW, Jackson MA, Dredge AF, Brown JA, Hinchcliff KW, Jackson MA, Dredge AF, O’Callaghan PA, McCaffrey JP, Slocombe RF, Clarke AF. O’Callaghan PA, McCaffrey JP, Slocombe RF, Clarke AF. Prevalence of pharyngeal and laryngeal abnormalities in Prevalence of pharyngeal and laryngeal abnormalities in Thoroughbreds racing in Australia, and their association Thoroughbreds racing in Australia, and their association with performance. Equine Veterinary Journal. (2005) 37(5): with performance. Equine Veterinary Journal. (2005) 37(5): 397-401397-401Butler, Clinical Radiology of the HorseButler, Clinical Radiology of the HorseEquine Surgery textbookEquine Surgery textbookHobo S, Matsuda Y, Yoshida K. Prevalence of upper Hobo S, Matsuda Y, Yoshida K. Prevalence of upper respiratory tract disorders detected with a flexible respiratory tract disorders detected with a flexible videoendoscope in Thoroughbred racehorses. Journal of videoendoscope in Thoroughbred racehorses. Journal of Veterinary Medical Science. (1995) 57(3): 409-413.Veterinary Medical Science. (1995) 57(3): 409-413.Russell T, Wainscott M. Treatment in the field of 27 horses Russell T, Wainscott M. Treatment in the field of 27 horses with epiglottic entrapment. The Veterinary Record. (2007) with epiglottic entrapment. The Veterinary Record. (2007) 161: 187-189.161: 187-189.