Equine laryngeal hemiplegia part II: some clinical observations

Use of successive dynamic videoendoscopic evaluations to identify progression of recurrent laryngeal neuropathy in three horses

CASE DESCRIPTION

3 racehorses were evaluated because of poor performance or abnormal noise originating from the upper portion of the respiratory tract.

CLINICAL FINDINGS

During maximal exercise, initial dynamic videoendoscopy of the upper respiratory tract revealed complete arytenoid cartilage abduction in 2 horses and incomplete but adequate abduction of the left arytenoid cartilage in 1 horse. Subsequent exercising endoscopic evaluation revealed severe dynamic collapse of the left arytenoid cartilage and vocal fold in all 3 horses.

TREATMENT AND OUTCOME

2 horses were treated with prosthetic left laryngoplasty and raced successfully. One horse was retired from racing.

CLINICAL RELEVANCE

Idiopathic laryngeal hemiplegia can be a progressive disease. Successive dynamic videoendoscopic upper airway evaluations were used to confirm progression of left laryngeal hemiplegia in these 3 horses. Videoendoscopy of the upper respiratory tract during exercise should be considered as part of the clinical evaluation of horses with signs of upper respiratory tract dysfunction.

Placement of a long term tracheal cannula in a Thoroughbred racehorse with bilateral laryngeal dysfunction

A Thoroughbred horse with bilateral laryngeal dysfunction was treated by placement of a long term tracheal cannula in order to restore full athletic function. The horse initially presented with right-sided arytenoid dysfunction that was considered to be due to a congenital malformation of the laryngeal cartilage. This was corrected by a right-sided laryngoplasty and ventriculectomy. The horse re-presented 1 year later with idiopathic left laryngeal hemiplegia. The decision was made to place a long-term tracheal cannula due to the low success rate and high complication rate associated with other surgeries used to correct bilateral arytenoid dysfunction. A three-piece tracheotomy cannula and stopper were positioned under general anaesthesia. The horse rapidly adjusted to the tracheal cannula and no post-surgical complications were encountered. The horse resumed training 4 weeks postoperatively. Due to the rules governing racing in Australia the horse was exported to New Zealand where he continued his racing career. It was concluded that tracheotomy is a straightforward technique associated with minimal complications and can provide an excellent prognosis for return of full airway function in racing horses. It is recognised that many issues need to be considered prior to more general acceptance of this technique, including assessment of animal welfare issues and public perception. In appropriate cases consideration should be given to using long term placement of a tracheotomy cannula as a treatment option to restore maximal airflow in horses with upper airway obstruction.

Post-anaesthetic pulmonary oedema in horses: a review

OBJECTIVES

To review information on the pathogenesis, diagnosis and treatment of post-anaesthetic pulmonary oedema in horses.

DATABASES USED

Pubmed 1970-present, personal files.

Clinical and endoscopic evidence of progression in 152 cases of equine recurrent laryngeal neuropathy (RLN)

Examination of the long-term histories and clinical findings was performed in 351 horses suffering from recurrent laryngeal neuropathy (RLN) to examine for possible evidence of progression of this disorder. Fifty-two out of 351 cases (15%) had evidence of progression of the degree of laryngeal dysfunction over a median period of 12 months (range 1.5-48 months) with the onset of progression occurring at median age 7 years. In 30 cases, there was both endoscopic (median deterioration of 3 endoscopic grades; range 1-5 grades) and clinical evidence, with 29 (97%) of these horses concurrently developing sudden-onset, abnormal exercise-related respiratory 'noises' and 13 (43%) concurrently reporting reduced exercise performance. In the remaining 22 horses there was solely clinical evidence of RLN progression, including the sudden onset of abnormal exercise-related respiratory sounds in 16 (73%) and the worsening of such sounds in 6 (23%), associated with reduced exercise performance in 13 (59%) of these 22 cases. Endoscopically, 13 (59%) of the latter 22 cases had marked (total or almost total) RLN that did not appear compatible with their previous exercise-performance histories. This evidence of progression of RLN may be of particular significance in disputes concerning horses that are apparently normal at pre-purchase examination but are later shown to have RLN and also in the surgical treatment of less severe cases of RLN.

Laryngeal paralysis: a study of 375 cases in a mixed-breed population of horses

Referred cases (n = 375) of laryngeal paralysis (1985-1998) from a mixed-breed equine population included 351 (94%) cases of recurrent laryngeal neuropathy (RLN) (idiopathic laryngeal hemiplegia) and 24 cases (6%) of laryngeal paralysis from causes other than RLN. Laryngeal movements were classified endoscopically into one of 6 grades, in contrast to the usual 4 grades. The RLN cases had a median grade 4 laryngeal paralysis, of which 96% were left-sided, 2% right-sided and 2% bilaterally affected. RLN cases included 204 (58%) Thoroughbred, 96 (27%) Thoroughbred-cross, 23 (7%) draught, 16 (5%) Warmbloods and 10 (3%) other breeds, including only 4 (1%) ponies. The median age of RLN cases at referral was 6 years (range 2-12) and their median height was 170.2 cm. The work of RLN horses included National Hunt racing (42%), flat racing (1%), hunting (19%), eventing (16%) and miscellaneous work (22%). Reported presenting signs in RLN-affected horses included abnormal exercise-related respiratory sounds in 90% and reduced exercise tolerance in only 64%. However, many horses were referred before their exercise tolerance could be fully assessed. Forty percent of the RLN cases had intercurrent disorders, including 10% with additional upper respiratory and 7% with lower respiratory tract diseases. The 24 nonidiopathic RLN cases included 12 with bilateral laryngeal paralysis, 11 (92%) of which were ponies. Bilateral laryngeal paralysis occurred with hepatic encephalopathy in 7 cases and following general anaesthesia in 2 cases. The 12 cases of acquired unilateral laryngeal paralysis included 7 caused by guttural pouch mycosis.

Morphology of the nerve endings in laryngeal mucosa of the horse

To discuss the significance of laryngeal sensation on various disorders of the horse, we studied the morphological and topographical characteristics of sensory structures in the laryngeal mucosa using immunohistochemistry and immunoelectron microscopy. Various sensory structures, i.e. glomerular endings, taste buds and intraepithelial free nerve endings, were found in the laryngeal mucosa by immunohistochemistry for protein gene product 9.5 (PGP 9.5) and neurofilament 200kD (NF200). Glomerular nerve endings were distributed mainly in the epiglottic mucosa; some endings were also found in the arytenoid region arising from thick nerve fibres running through the subepithelial connective tissue. Some terminals directly contacted the epithelial cells. Taste buds were distributed in the epithelium of the epiglottis and aryepiglottic fold. In the whole mount preparation, the taste buds were supplied by the terminal branching of the thick nerve fibres. In some cases, the taste buds were arranged around the opening of the duct of the epiglottic glands. The intraepithelial free nerve endings were found to be immunoreactive for substance P (SP) and calcitonin gene-related peptide (CGRP). These nerve endings were surrounded by the polygonal stratified epithelial cells in the supraglottic region, and by the ciliated cells in the subglottic region. The density of the intraepithelial free nerve endings was highest in the corniculate process of the arytenoid region and lowest in the vocal cord mucosa. The densities of CGRP- and SP-immunoreactive nerve endings in the arytenoid region were (mean +/- s.d.) 30.6+/-12.0 and 10.0+/-4.9 per unit epithelial length (1 mm), respectively and in the vocal fold mucosa, 1.1+/-0.9 and 0.8+/-0.7, respectively. Approximately one half of the CGRP immunoreactive nerve endings were immunoreactive for SP, and most SP-immunoreactive nerve endings were also immunoreactive for CGRP. Well-developed subepithelial plexus with numerous intraepithelial fibres were observed in flat or round mucosal projections that existed on the corniculate process of the arytenoid region. In conclusion, the laryngeal mucosa of the horse seems to have morphology- and/or location-dependent sensory mechanisms against various endo-and exogenious stimuli.

Clinicopathological features of equine primary hepatic disease: a review of 50 cases

The clinicopathological features of 50 cases of equine hepatic disease were reviewed. There was a wide range of clinical signs and at least 50 per cent of the animals exhibited either dull demeanour, anorexia, abdominal pain, cerebral dysfunction and/or weight loss. Life-threatening complications of hepatic failure recorded were: gastric impaction in 10 cases, bilateral laryngeal paralysis in seven cases and coagulopathy in five cases. All the cases had high activities of gamma-glutamyl transferase (GGT) and most had high activities of glutamate dehydrogenase (GLDH) and high concentrations of bile acids. Fewer of the horses had abnormal concentrations of bilirubin, albumin and globulin. The horses that were euthanased or died had significantly higher concentrations of GGT, GLDH and bile acids than the survivors. There were biochemical data for 18 cases with signs of hepatic encephalopathy, all of them had plasma ammonia levels greater than 90 micromol/litre but this was not significantly correlated with the clinical severity of the condition. Half of the cases with hepatic encephalopathy were hyperglycaemic, none was hypoglycaemic, and none had abnormally low levels of plasma urea.

Respiratory emergencies in the adult horse

Responding to an equine respiratory emergency requires rapid localization of the problem and appropriate choices for therapy. Localizing the cause of respiratory distress is aided by history and thorough physical examination. When examining the patient, one must focus on the presenting signs as indicators of URT or LRT dysfunction. Table 3 summarizes the characteristic presenting signs based on respiratory tract location and suggests the initial treatment course indicated. Respiratory distress in the absence of signs related to the pulmonary system suggests inadequate oxygen delivery secondary to a nonpulmonary problem such as shock or severe anemia, which is just as compromising to the animal but requires an entirely different therapeutic approach (see Allen and Schertel, this issue). Thus, localization of the source of respiratory distress is always the first step in determining successful treatment.

Morphometric study of the recurrent laryngeal nerve in young 'normal' horses

Quantitative measurements were made on cross-sectional preparations of the distal part of the recurrent laryngeal nerve (RLN) from nine young mixed-breed horses to establish reference values for the total number of myelinated fibres, mean fibre diameter and percentage of thickest fibres (over 9.5 microns) and to delineate diameter distribution curves. The total number of myelinated fibres, mean fibre diameter and percentage of thickest fibres for the left RLN were significantly lower than those of the right RLN (P < 0.005). The distribution of fibres was unimodal. The fibre diameter ranged from 1 micron to 17 microns. Approximately, 95 per cent of fibres had a diameter larger than 5 microns.

The pathogenesis of equine laryngeal hemiplegia — a review

Recent research on the muscular and nervous changes which occur in idiopathic equine laryngeal hemiplegia has indicated that many of the traditional concepts of the aetiology of this disease are erroneous. In light of the new knowledge gained, the various predispositions and possible causes of laryngeal hemiplegia are discussed, and it is suggested that the underlying mechanism of axonal damage in this neuropathy of horses may be related to abnormal energy metabolism in the axon.

Right-sided laryngeal dysfunction in a horse

A two year old Thoroughbred colt was presented after a clinical diagnosis of right sided laryngeal hemiplegia had been made. On endoscopic examination the right arytenoid cartilage was immobile during respiration while the left moved normally. Post-mortem examination revealed an abnormal shape of the cricoid and thyroid cartilages which resulted in absence of the right cricothyroid articulation. The defect was thought to be congenital in origin.