Do dogs and cats need a dentist?

As man needs a dentist, also animals do. The author gives us some reasons for the treatment of animals, taking dogs and cats as an example.

Antimicrobial therapy for gastrointestinal, pancreatic, and hepatic disorders

Antimicrobials are a common part of a symptomatic approach to the treatment of gastrointestinal disorders. Without an etiologic diagnosis, antimicrobial therapy is likely to be of little value and, in the worst case, may harm the patient either by altering normal gastrointestinal flora or by producing direct toxicity. This review is a systematic appraisal of antimicrobial therapy for gastrointestinal disease, beginning with the oral cavity, proceeding through the gastrointestinal tract and concluding with pancreatic and hepatic disorders. The intent is to highlight specific etiologies which form the basis for rational therapeutic choices. Controversies concerning the need for antimicrobial therapy or therapeutic alternatives are also explored. The review concludes with a discussion of adverse gastrointestinal effects of antimicrobial therapy.

Problems associated with basic oral surgical techniques

The veterinarian must be able to diagnose several types of dental problems. History, physical examination, clinical pathology, and radiography are important in making an accurate diagnosis. Basic oral surgery includes various extraction techniques and management of their associated complications. Knowledge of dental anatomy and proper surgical technique can make an extraction curative rather than a frustrating procedure with multiple complications.

Epidemic oral ulceration in largemouth bass (Micropterus salmoides) associated with the leech Myzobdella lugubris

An epidemic of severe ulcerations of the tongue and buccal cavity was documented in subadult and adult largemouth bass (Micropterus salmoides) from Currituck Sound, North Carolina (USA). Other external clinical signs were not present. Between November 1986 and May 1987, reports from fishermen indicated that as many as 90% of large (greater than 300 mm total length) bass were affected. Older fish were the most commonly involved. The leech, Myzobdella lugubris (= Illinobdella moorei), was consistently present on or near the lesions. Lesions were heavily infected with several different bacteria that were apparently secondary invaders. Stressful (high) salinity or an interruption in the normal migratory cycle of the parasite are suggested as possible causes for this condition in these bass.

[Experience gained by treating Alsation dogs]

In the paper an attempt is made to describe important features in the anatomy and pathology of the Alsation's dentition and how if differs from the human, thus leading to other therapeutic measures. The experience of the author is based upon examination and treatment of 80 institutionalized Alsations bred at the school of dogs in the Royal Danish Air Force, Karup. The dogs are submitted to regular veterinary control every 3 months. Two case reports describe typical treatments performed at the Infirmary for dogs.

Squamous-cell carcinoma and oral, pharyngeal and nasal lesions caused by foreign bodies in feed. Cases from a long-term study in rats

In a carcinogenicity study 443 out of 956 rats had chaff from oat and barley in the mouth between the molars and the gingiva. These foreign bodies caused chronic irritation and inflammation. In 173 animals disruption of tissue caused by the foreign bodies led to pathological communication between the mouth, pharynx and nose. Carcinomas in the oral, pharyngeal or nasal cavity were found in 101 of the 443 animals. Twenty-two animals died and 96 were killed because of intestinal gaseous distension. The intestinal distension was related significantly to the pathological communication between the mouth and pharynx/nose. The study shows that the foreign body-induced chronic irritation and inflammation in the epithelium of the mouth, pharynx and nose can lead to formation of squamous-cell carcinomas. The pathogenesis of the intestinal distension is discussed.

Effects of migrating Gasterophilus intestinalis larvae (Diptera: Gasterophilidae) on the mouth of the horse

Lesions were formed in the mouth of the horse by first- and second-stage Gasterophilus intestinalis larvae. The lesions resulted as larvae burrowed through the top millimeter of the tongue and then became embedded in the interdental gingiva. Appearance of the lesion was dependent on the degree of larval burrowing activity and healing that had taken place. Active tunneling production occurred at the posterior end of the lesion. Extensive change in configuration and color was apparent along the longer lesions with active larvae. Virtually all tissue in the path of the larvae was removed while forming a tunnel. Tissue destroyed included tops of the lamina propria mucosae evaginations and the deeper portions of the lamina epithelialis mucosae. Histopathologic findings showed that the tissue removed included the nerve and blood supply of the proprial evaginations. Hemorrhage and exocytosis into the tunnels included erythrocytes mixed with some macrophages, lymphocytes and scant numbers of eosinophils. Air shafts excavated in the tongue by larvae enabled bacteria to enter into the tunnels. Bacteria became adhered to larvae and initiated microabscesses. Microabscesses were composed of clotted erythrocytes, bacteria, disintegrating epithelial cells, and large numbers of neutrophils. Cells surrounding the tunnel exhibited pyknosis, epithelial hydropic degeneration and became separated from each other. Healing of tongue lesions occurred as epithelial cell growth below raised the tunnel upward and affected tissue desquamated. Interdental gingiva invaded by larvae were hyperemic and denuded of epithelia. Recession and ulceration of the gingiva produced periodontal pockets. Extensive invasion by larvae led to compound periodontal pockets. Larval mouth hooks were embedded in the submucosa of the pockets and tore at engorged capillaries. The cephalic portion of embedded larvae became surrounded by a cellular exudate containing erythrocytes and mononuclear cells. Attachment of second-stage larvae at the root of the tongue did not produce observable damage.

The protective effects of sucralfate and ranitidine in foals experimentally intoxicated with phenylbutazone

The effects of sucralfate and ranitidine on the gastrointestinal manifestations of phenylbutazone (PBZ) toxicity in horse foals were determined by complete blood count, serum chemistry profile, and gross and histological necropsy examinations. Twenty-eight, three to four month old Belgian-cross foals were randomly assigned to one of four groups. Phenylbutazone was administered at a dosage of 10 mg/kg of bodyweight (BW) per day, intravenously (IV), in equally divided doses to three of the groups. In addition to PBZ, ranitidine was administered at 2 mg/kg BW, IV, twice daily, to one group of seven foals (PBZ/ranitidine group), and sucralfate was administered at 4 g, orally, twice daily to another group of seven foals (PBZ/sucralfate group). A fourth group received normal saline IV and corn syrup orally, twice daily, as placebos (control group). Treatments were administered for ten days. Clinical signs included oral ulceration (in all PBZ-treated foals) and diarrhea (5/7 and 2/7 foals from the PBZ and PBZ/ranitidine groups, respectively). A reduction in total protein and albumin was greatest in the PBZ group and least in the PBZ/ranitidine and PBZ/sucralfate groups when compared to the control group. The PBZ group lost weight during the treatment period. At necropsy, the PBZ group had the greatest area of oral ulceration compared to the other treatment groups. All foals treated with PBZ had gastric ulcers; however, the PBZ group had the most severe gastric epithelial necrosis compared to the other three treatment groups. Duodenal villous atrophy, epithelial necrosis and mucosal inflammation, and a reduction in epithelial mitotic figures were seen in all PBZ-treated foals.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteroides species from the oral cavity and oral-associated diseases of cats

One hundred and sixty-seven strains of Bacteroides were isolated from 71 subcutaneous fight-wound abscesses of cats, 21 cases of feline pyothorax, normal gingival margins from 10 cats and 6 cases of feline gingivitis. Bacteroides species constituted (as a proportion of all anaerobic isolates examined) 44.5% from subcutaneous abscesses, 33.7% from pyothoraxes, 37.5% from normal gingiva and 27.7% from diseased gingiva. Bacteroides tectum comprised 43.7% or 73 of 167 strains, followed by the black- or brown-pigmented asaccharolytic feline species of B. gingivalis, B. salivosus and Group B, comprising 32.3% or 54 of 167 strains. B. heparinolyticus (some 10% or 17 of 167 strains) was the next most common species described. The remainder consisted of two strains of B. fragilis and 21 unspeciated strains. Bacteroides tectum was frequently isolated from subcutaneous abscesses (43.7%) and pyothoraxes (46.6%), and it constituted some 33% of anaerobic isolated from normal gingiva. Bacteroides heparinolyticus was more commonly encountered in purulent lesions (abscesses and pyothoraxes) than in the oral cavity.

[Eosinophilic granuloma of the oral cavity in a Siberian husky]

An ulcerative sublingual inflammation was found to be present in a Siberian Husky dog. Histological examination revealed an eosinophilic granuloma. Treatment with corticosteroids was successful.

Epidemiologic and clinical aspects of feline immunodeficiency virus infection in cats from the continental United States and Canada and possible mode of transmission

The epidemiologic features of feline immunodeficiency virus (FIV) infection were evaluated in 2,765 cats from the United States and Canada. Of these cats, 2,254 were considered by veterinarians to be at high risk for the infection, and 511 were healthy cats considered to be at low or unknown risk. Of the cats in the high-risk group, 318 (14%) were found to be infected with FIV. The infection rate among low- or unknown-risk cats was 6 of 511 (1.2%). Male cats in the high-risk group were 3 times more likely to be infected than were females, similarly as were cats greater than 6 years old, compared with younger cats; domestic cats, compared with purebred cats; and free-roaming cats, compared with confined cats. Feline immunodeficiency virus and FeLV infections did not appear to be linked with each other; 16% of FeLV-infected cats in the high- and low-risk groups were coinfected with FIV. In contrast, there was a pronounced linkage between FIV and feline syncytium-forming virus (FeSFV) infections. Seventy-four percent of FeSFV-infected cats in the high-risk study group were coinfected with FIV, compared with a 38% FIV infection rate among cats that were not infected with FeSFV. The major clinical manifestations associated with FIV infection in cats that were surveyed included chronic oral cavity infections (56%), chronic upper respiratory tract disease (34%), chronic enteritis (19%), and chronic conjunctivitis (11%). Bacterial infections of the urinary tract (cystitis), skin, and ears were seen in a small proportion of cats.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic flunixin meglumine therapy in foals

Effects of a therapeutic dose of flunixin meglumine on gastric mucosa of horse foals were determined by endoscopy, double-contrast radiography, and gross and histologic examinations. Foals were administered 1.1 mg of flunixin meglumine/kg of body weight, PO/day for 30 days in an encapsulated form that was divided into 2 doses/day (group 1; n = 3) or by IM injection once a day (group 2; n = 7). Three control foals (group 3; n = 3) were administered capsules (n = 1) containing dextrose powder or IM injections (n = 2) of vehicle solution without flunixin meglumine. All 3 groups-1 foals given flunixin meglumine PO developed oral ulcers. Group-2 foals given flunixin meglumine IM did not develop oral ulcers. One control foal (group 3) developed 1 oral ulcer that healed during the study. Endoscopic examination revealed linear crease-like mucosal lesions in the glandular portion of the stomach in 2 group-2 foals. Radiographic evidence of gastric ulcers was observed in only 1 gastrogram of a group-1 foal. Foals were euthanatized, and necropsy revealed erosions and/or ulcers of the glandular portion of the stomach. Oral ulcers were observed in all 3 group-1 foals. Erosions of the glandular portion of the stomach developed in all 10 foals given flunixin meglumine, but did not develop in group-3 foals. Ulceration of the glandular portion of the stomach was present in 1 group-2 foal.

Oral lesions in rhesus monkeys associated with infection by simian AIDS retrovirus, serotype-I (SRV-1)

Simian acquired immunodeficiency syndrome (SAIDS) is a retrovirus-induced immunodeficiency disease that affects certain nonhuman primates and has many parallels to human AIDS. We examined 72 rhesus monkeys (Macaca mulatta) exposed to SAIDS retrovirus serotype-1 (SRV-1) and 81 healthy control monkeys at the California Primate Research Center to determine the prevalence of oral lesions. At the time of examination, 69 of the 72 monkeys exposed to SRV-1 had serologic and/or virologic evidence of SRV-1 infection. None of the 81 control monkeys had any evidence of infection with SRV-1. Acute necrotizing ulcerative gingivitis (ANUG), oral yeast infections, and noma occurred in 10% (p less than 0.01), 4%, and 1%, respectively, of the study group of 72 animals but were found in none of the control animals. Thus, ANUG occurs rather frequently in rhesus monkeys with evidence of SRV-1 infection. The reproducible immunodeficiency that follows inoculation of SRV-1 in rhesus monkeys promises to be a useful model for studying the pathogenesis of ANUG associated with immunodeficiency.

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse. II. Radiological findings

The radiographic findings in 167 horses subjected to radiography of the facial area, nasal cavity and paranasal sinuses are recorded. Cases were grouped according to clinical diagnosis and the common and disparate radiographic features between and within groups are discussed. Dental disease occurred most frequently and accounted for about 30 per cent of cases, most of which had periapical infection. This disorder presented as two distinct clinical entities in almost equal numbers affected teeth with roots rostral to the maxillary sinus usually produced facial swelling, whereas those with roots within the sinus were generally associated with nasal discharge as a result of secondary sinusitis. In the former group periapical changes could readily be identified on radiographs, but in the latter group affected teeth could be recognised with confidence in only about half the cases. Primary sinusitis was the commonest specific condition recorded and accounted for 32 cases, three of which were mycotic. Using lateral erect projections, comparison of the radiographic features of primary sinusitis and sinusitis secondary to dental disease showed some useful differentiating signs. In four ponies, rhinitis associated with sinusitis led to disruption of the intra-nasal structures but mycotic rhinitis, nasal ulceration and an intra-nasal foreign body produced no radiographic abnormalities. Sixteen cases of suture periostitis were recorded, with varying degrees of new bone formation, and of 13 animals presented for evaluation of trauma, pre-diagnosed fractures were demonstrated in 10 and complications due to sinusitis in three.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral diseases and veterinary dentistry

Oropharyngeal disease is common in dogs and cats. Signs are seldom apparent to the owner until the disease is well advanced, and often are not specific for a particular disease. Signs include inappetence, pawing at the mouth, drooling of saliva, dysphagia, and halitosis. These signs can result from primary oral disease, or from effects of systemic or skin disease. Oral examination requires a cooperative patient; sedation may be necessary so that the entire oral cavity can be examined without causing the animal pain or risking injury to the examiner.

Diseases of the lips and oral cavity of domestic animals

Oral and lip lesions in domestic animals, as in man, may be due to a vast number of diseases. While some of these diseases are unique to each species, the majority of them are similar to human afflictions. These represent an untapped resource in comparative medicine, and research in this area can only benefit both man and the domestic animals he is dependent upon.

Soft tissue surgery of the head and neck

A variety of surgical techniques and procedures have been described for diseases of soft tissues of the oral cavity. Mandibulectomy and maxillectomy have been described for the management of oral neoplasia. These procedures involve removal of parts of the mandible and maxilla in the affected regions of the mouth. Salivary mucocele or sialocele is defined as an abnormal accumulation of saliva in the tissues of the head and neck. Depending on the location of the salivary collection, swelling can occur in the ventral neck, under the tongue, or in the oropharynx just posterior to the tonsil. In the dog this condition is managed most successfully by excision of the mandibular and sublingual salivary glands on the affected side. The ventral approach is preferred because of ease of drainage postoperatively. Diseases of the soft palate which lend themselves to surgical correction include elongation of the soft palate and hypoplasia of the soft palate. Corrective surgery for both of these conditions is desirable and the surgical results are excellent. Tonsillectomy and removal of the tonsillar crypts is recommended along with excision of the elongated soft palate to enlarge the size of the airway.

Repair of a traumatically induced oronasal fistula in a cat with a rostral tongue flap

Repair of an extensive oronasal fistula in a cat was accomplished by the use of a tongue flap. The dorsal surface of the tongue was debrided of mucosa and the edges were trimmed to produce a bleeding surface. Rotation of the tongue 180 degrees upon its long axis allowed the debrided surface to be sutured in apposition with the palatine mucosa. The mouth was wired closed and the cat was fed blenderized canned cat food for 4 weeks through a pharyngostomy tube. The tongue pedicle was amputated in successive stages to stimulate collateral circulation. Complications included a partial dehiscence along one edge of the suture line, which was corrected by resuturing.

Feline dental disease

Periodontal disease and chronic gingivitis/stomatitis are the most common feline dental diseases. With routine dental care and increased emphasis on home oral hygiene, these diseases can be controlled. Cats can be seen with a number of other dental disorders, and improved treatment methods such as restorations of early subgingival resorptive lesions, endodontic therapy, and orthodontic therapy can be performed successfully. More study and research are necessary about the gingivitis/stomatitis syndrome and subgingival resorptive lesions so that improved prevention and treatment recommendations can be made.

Diagnosis and treatment planning

It must be emphasized that any examination of a supposedly healthy patient must be thorough and careful, for the early detection of disease demands that minute and inconspicuous deviations from the normal be evaluated carefully. The detection of disease occurs during the examination procedure, and from a practical point of view, it appears that clinicians employ at least the following three types of examination, depending upon circumstances: the comprehensive examination; the screening examination; and the emergency or limited examination. Although the latter two types represent a justifiable compromise with respect to the comprehensive examination in light of limitations of time or resources, the general inaccessibility of the patient in veterinary practice suggests that one should make the most of the opportunity for examination when it presents itself. A complete, thorough examination is not, by definition, a time-consuming and expensive procedure, particularly if there is no disease present. Exam-related expense is more a function of a differential diagnostic effort once clinical abnormality is detected, and then it is certainly justified. The term "diagnosis" originates from a Greek word meaning to distinguish or to discern. For the clinician, it refers to the process of identification of a disease by investigating, in all their manifestations, the signs and symptoms presented by the patient. The word diagnosis describes not just a "disease identified," but the process by which the identification is made. The procedure for making a diagnosis includes the following four primary steps: Collection of the facts. Analysis of the data for relative importance. Correlation between synthesized data and descriptive features of suspected diseases. Selection of the disease that best explains the collected facts and apparent disturbed physiologic processes of the patient. The process of diagnosis usually results in the naming of a disease. It is well to remember that a name is only a shorthand method of describing a set of signs and symptoms characteristic of a particular disease state. Emphasis should always be focused upon the clinical facts collected, not on the name of the disease selected. Oral disease in animals results from an extremely diverse variety of environmental, dietary, and genetic circumstances. The clinical appearances of the disease process can vary considerably within a single species and may vary enormously from one species to another, particularly considering the contrasts between some captive environments and other natural habitats.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral surgery. Basic techniques

Some of the clinical problems most frequently seen in veterinary dentistry and their surgical solutions are discussed. Extraction of teeth, surgical repositioning of teeth, tooth transplant, oral abscesses of tooth origin, impaction of teeth, repair of maxillary canine oronasal fistula, and simple techniques for oral wiring are among the issues considered.

Elaeophorosis in white-tailed deer: pathology of the natural disease and its relation to oral food impactions

The lesions of naturally occurring elaeophorosis in white-tailed deer (Odocoileus virginianus) were studied. Arterial changes caused by adult Elaeophora schneideri occurred mainly in cephalic arteries and were characterized by circumferential intimal thickening, disruption of the internal elastic lamina, and verminous thrombosis. Microfilariae caused focal necrosis and fibrosis in the myocardium, but produced only minor changes in other tissues. Radiographic studies indicated that E. schneideri can cause impairment of the cephalic arterial circulation in white-tailed deer. Eleven of 14 (78%) infected deer had oral food impactions, with sublingual impactions being most common. Seven deer with impactions had other oral pathologic conditions, such as gingivitis, loose or absent premolar and/or molar teeth, and remodeling and/or lysis of mandibular bone. The evidence indicates a relation between food impactions and infection by E. schneideri in white-tailed deer, but no definitive connection was established.

Focal mucinosis in dogs: seven cases and review of cutaneous mucinoses of man and animals

Seven dogs had one or more asymptomatic nodules, papules, or plaques on the skin or oral mucosa. The primary histologic feature was the accumulation of excess mucin within the dermis or submucosa. Based upon the clinical presentation and the histopathologic changes, it was proposed that these lesions represent the canine analogue of focal mucinosis in man, and that the same name be applied to the lesion in dogs. The criteria for the diagnosis of focal mucinosis were: (1) the presence of a single (rarely multiple) papule, nodule, or plaque which may be firm, rubbery, or soft, (2) the accumulation of mucin which disrupts and separates collagen fibers, (3) mild to extensive fibroblast proliferation, and (4) a mild mononuclear cell infiltration. The mucinoses of man and animals were reviewed.

Aetiology of food-related oral lesions in chickens

Brown Leghorn chickens fed on a mash diet developed ulcerated oral lesions with extensive epithelial erosion and large colonies of bacteria. Some birds had lesions by six weeks old and by 30 weeks oral lesions were present in all birds fed on a mash diet. These lesions occur infrequently in birds fed a pelleted diet and the relatively extensive lesions shown by birds on a mash diet heal quickly (in many cases within two weeks) when the birds are transferred to a pelleted diet. The cause of the lesion is unknown but there was no evidence for food impaction, mechanical damage to the epithelium, specific dietary constituents or blocked salivary ducts. The lesions may be due to poor oral hygiene which results from the lack of mechanical stimulation of the oral epithelium to which fine particles of mash adhere.

Skeletal and blood biochemical characteristics of sheep during growth and breeding: a comparison of flocks with and without broken mouth

Two-hundred female Scottish Blackface sheep ranging in age from 3 months to 5 1/2 years were used to investigate the relationships between blood biochemical characteristics, skeletal metabolism and dental health on 5 farms, 3 with broken mouth and 2 with no incidence of the disease. Skeletal growth to 6 months of age was faster in lambs from control flocks than in lambs from affected farms although growth thereafter was slower in the control group. A generally lower protein intake on control farms may account for this reduced growth rate. In general, adult dimensions of bones were attained between 14 and 30 months of age but age of maturation varied between bones; tibial endochondral growth ended after 14 to 21 months while the rib still showed evidence of endochondral growth at 70 months of age. This growth was episodic, being maximal during lactation and possible causes are discussed. There was no significant differences in calcium or phosphorus status between control and affected populations, an inadequate phosphorus intake during pregnancy was common to both groups. Lower serum magnesium concentration in affected than in control sheep was a consistent finding and is discussed.

TDP-1, a toxic component causing tibial dyschondroplasia in broiler chickens, and trichothecenes from Fusarium roseum 'Graminearum'

Fusarium roseum 'Graminearum' was isolated from overwintered oats in Alaska and was tested for its ability to cause tibial dyschondroplasia (TDP) in broiler chickens. The water-soluble fraction was tested and found to cause TDP. In addition, diacetoxyscirpenol and 7-hydroxydiacetoxyscirpenol were identified in the acetonitrile fraction of the extracts and caused mild mouth lesions in chickens. Six major water-soluble components were purified by thin-layer chromatography and tested for toxicity to chick embryos. One of the six components, called TDP-1, was found to be lethal to chick embryos. There was a 100% incidence of TDP in chickens fed a diet containing 75 ppm (wt/wt) of pure TDP-1, thus establishing the cause and effect relationship between TDP and TDP-1. Analyses by thin-layer chromatography and mass spectrometry revealed that TDP-1 is polar and ninhydrin positive, exhibits fluorescence with UV irradiation, and is a nitrogen-containing component with an empirical formula of C15H20N2O4.

Effects of toxic doses of phenylbutazone in ponies

Toxic doses of phenylbutazone (10 mg/kg of body weight) were administered to 10 ponies once daily for 14 days. Clinical signs of toxicosis similar to those seen in other species included CNS depression, anorexia, oral ulcers, and soft feces. Six ponies died in 7 to 20 days; 1 pony was euthanatized during an acute abdominal crisis; and 3 ponies survived the study. At necropsy, the major lesions were oral and gastrointestinal ulcerations and renal changes.

Subacute toxic effects of dietary T-2 toxin in young mallard ducks

Young Mallard ducks (Anas platyrhynchos) were fed diets containing purified T-2 toxin at levels of 20 or 30 ppm for two or three weeks. Ingestion of T-2 toxin was associated with reduced weight gain and delayed development of adult plumage. Affected ducks developed caseonecrotic plaques throughout the upper alimentary tract, especially in oropharynx and ventriculus. Several ducks also developed severe ulcerative, proliferative esophagitis and proventriculitis. Generalized atrophy of all lymphoid tissues consistently occurred. The manifestations of T-2 mycotoxicosis in Mallard ducks were mostly attributable to irritant toxicity to the alimentary mucosa. The T-2 toxin caused neither hematopoietic suppression nor a hemorrhagic syndrome in ducks. These alimentary lesions of T-2 mycotoxicosis in ducks do not resemble diseases of native waterfowl presently being recognized in routine surveillance of waterfowl mortality in Saskatchewan.

Persistent dorsal displacement of the soft palate associated with epiglottic shortening in two horses

Persistent dorsal displacement of the soft palate was diagnosed in 2 Thoroughbred horses examined because of decreased exercise tolerance and a respiratory noise during strenuous exercise. The persistent dorsal displacement of the soft palate was caused by an epiglottis that was approximately 2/3 normal size, and thus was incapable of maintaining the soft palate in a normal subepiglottic position. Contrast pharyngography suggested a primary epiglottic abnormality. Visual assessment of the lesion was accomplished by exploratory ventral laryngotomy and endoscopy of the oropharynx per os. Surgical intervention did not appreciably improve exercise capacity.