Surgical Treatment of Iatrogenic Ventral Glottic Stenosis Using a Mucosal Flap Technique

Objective To describe a novel surgical technique for correcting postoperative ventral glottic stenosis (cicatrix or web formation) and the outcome in 2 Thoroughbred racehorses. Study Design Retrospective case report. Animals Thoroughbreds diagnosed with ventral glottic stenosis (n=2). Methods Horses...

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Veröffentlicht in:Veterinary surgery 2016-05, Vol.45 (4), p.436-442
Hauptverfasser: Kane-Smyth, Justine, Barnett, Timothy P., O'Leary, John Mark, Dixon, Padraic M.
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container_issue 4
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container_title Veterinary surgery
container_volume 45
creator Kane-Smyth, Justine
Barnett, Timothy P.
O'Leary, John Mark
Dixon, Padraic M.
description Objective To describe a novel surgical technique for correcting postoperative ventral glottic stenosis (cicatrix or web formation) and the outcome in 2 Thoroughbred racehorses. Study Design Retrospective case report. Animals Thoroughbreds diagnosed with ventral glottic stenosis (n=2). Methods Horses presenting with iatrogenic ventral glottic stenosis and resultant exercise intolerance and abnormal exercise‐related noise were anesthetized and a midline sagittal skin incision was made over the ventral larynx and between the sternohyoideus muscles overlying the cricothyroid notch. The cricothyroid ligament, attached laryngeal cicatrix, and overlying mucosa were sagittally sectioned at the dorsal aspect of the cicatrix on the left side. The laryngeal mucosa, cicatrix, and underlying cricothyroid ligament immediately rostral and caudal to the cicatrix were sectioned in a medial (axial) direction as far as the right side of the cricothyroid notch. After resection of the majority of the attached cicatrix tissue, the residual mucosal flap (attached to the right side of the larynx) was reflected ventrally and sutured to the attachment of the cricothyroid ligament on the right side of the cricothyroid notch, creating an intact mucosal layer on the right side of the ventral larynx. Results Both horses had good intralaryngeal wound healing with minimal redevelopment of ventral glottic stenosis at 5 and 9 months postoperatively and were successfully returned to racing with complete absence of abnormal respiratory noise. Conclusion The unique laryngeal anatomy of horses, with a cartilage‐free ventral laryngeal area (cricothyroid notch), allowed the use of this novel surgical technique to successfully treat ventral glottic stenosis.
doi_str_mv 10.1111/vsu.12465
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Study Design Retrospective case report. Animals Thoroughbreds diagnosed with ventral glottic stenosis (n=2). Methods Horses presenting with iatrogenic ventral glottic stenosis and resultant exercise intolerance and abnormal exercise‐related noise were anesthetized and a midline sagittal skin incision was made over the ventral larynx and between the sternohyoideus muscles overlying the cricothyroid notch. The cricothyroid ligament, attached laryngeal cicatrix, and overlying mucosa were sagittally sectioned at the dorsal aspect of the cicatrix on the left side. The laryngeal mucosa, cicatrix, and underlying cricothyroid ligament immediately rostral and caudal to the cicatrix were sectioned in a medial (axial) direction as far as the right side of the cricothyroid notch. After resection of the majority of the attached cicatrix tissue, the residual mucosal flap (attached to the right side of the larynx) was reflected ventrally and sutured to the attachment of the cricothyroid ligament on the right side of the cricothyroid notch, creating an intact mucosal layer on the right side of the ventral larynx. Results Both horses had good intralaryngeal wound healing with minimal redevelopment of ventral glottic stenosis at 5 and 9 months postoperatively and were successfully returned to racing with complete absence of abnormal respiratory noise. Conclusion The unique laryngeal anatomy of horses, with a cartilage‐free ventral laryngeal area (cricothyroid notch), allowed the use of this novel surgical technique to successfully treat ventral glottic stenosis.</description><identifier>ISSN: 0161-3499</identifier><identifier>EISSN: 1532-950X</identifier><identifier>DOI: 10.1111/vsu.12465</identifier><identifier>PMID: 27013024</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Animals ; Constriction, Pathologic - surgery ; Constriction, Pathologic - veterinary ; Female ; Glottis - surgery ; Horse Diseases - surgery ; Horses ; Iatrogenic Disease - veterinary ; Laryngeal Diseases - surgery ; Laryngeal Diseases - veterinary ; Laryngeal Mucosa - surgery ; Larynx ; Ligaments ; Male ; Original ‐ Clinical ; Physical Conditioning, Animal ; Postoperative Complications - surgery ; Postoperative Complications - veterinary ; Retrospective Studies ; Surgical Flaps - veterinary ; Surgical techniques ; Veterinary medicine</subject><ispartof>Veterinary surgery, 2016-05, Vol.45 (4), p.436-442</ispartof><rights>2016 The Authors. Veterinary Surgery published by Wiley Periodicals, Inc., on behalf of The American College of Veterinary Surgeons.</rights><rights>Copyright 2016 by The American College of Veterinary Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4815-3fe777a68f128638ffda4d4940e3163c35c16c19a3978c0b2dbb1d411a871e5c3</citedby><cites>FETCH-LOGICAL-c4815-3fe777a68f128638ffda4d4940e3163c35c16c19a3978c0b2dbb1d411a871e5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fvsu.12465$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fvsu.12465$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1416,27922,27923,45572,45573</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27013024$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kane-Smyth, Justine</creatorcontrib><creatorcontrib>Barnett, Timothy P.</creatorcontrib><creatorcontrib>O'Leary, John Mark</creatorcontrib><creatorcontrib>Dixon, Padraic M.</creatorcontrib><title>Surgical Treatment of Iatrogenic Ventral Glottic Stenosis Using a Mucosal Flap Technique</title><title>Veterinary surgery</title><addtitle>Veterinary Surgery</addtitle><description>Objective To describe a novel surgical technique for correcting postoperative ventral glottic stenosis (cicatrix or web formation) and the outcome in 2 Thoroughbred racehorses. Study Design Retrospective case report. Animals Thoroughbreds diagnosed with ventral glottic stenosis (n=2). Methods Horses presenting with iatrogenic ventral glottic stenosis and resultant exercise intolerance and abnormal exercise‐related noise were anesthetized and a midline sagittal skin incision was made over the ventral larynx and between the sternohyoideus muscles overlying the cricothyroid notch. The cricothyroid ligament, attached laryngeal cicatrix, and overlying mucosa were sagittally sectioned at the dorsal aspect of the cicatrix on the left side. The laryngeal mucosa, cicatrix, and underlying cricothyroid ligament immediately rostral and caudal to the cicatrix were sectioned in a medial (axial) direction as far as the right side of the cricothyroid notch. After resection of the majority of the attached cicatrix tissue, the residual mucosal flap (attached to the right side of the larynx) was reflected ventrally and sutured to the attachment of the cricothyroid ligament on the right side of the cricothyroid notch, creating an intact mucosal layer on the right side of the ventral larynx. Results Both horses had good intralaryngeal wound healing with minimal redevelopment of ventral glottic stenosis at 5 and 9 months postoperatively and were successfully returned to racing with complete absence of abnormal respiratory noise. 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Study Design Retrospective case report. Animals Thoroughbreds diagnosed with ventral glottic stenosis (n=2). Methods Horses presenting with iatrogenic ventral glottic stenosis and resultant exercise intolerance and abnormal exercise‐related noise were anesthetized and a midline sagittal skin incision was made over the ventral larynx and between the sternohyoideus muscles overlying the cricothyroid notch. The cricothyroid ligament, attached laryngeal cicatrix, and overlying mucosa were sagittally sectioned at the dorsal aspect of the cicatrix on the left side. The laryngeal mucosa, cicatrix, and underlying cricothyroid ligament immediately rostral and caudal to the cicatrix were sectioned in a medial (axial) direction as far as the right side of the cricothyroid notch. After resection of the majority of the attached cicatrix tissue, the residual mucosal flap (attached to the right side of the larynx) was reflected ventrally and sutured to the attachment of the cricothyroid ligament on the right side of the cricothyroid notch, creating an intact mucosal layer on the right side of the ventral larynx. Results Both horses had good intralaryngeal wound healing with minimal redevelopment of ventral glottic stenosis at 5 and 9 months postoperatively and were successfully returned to racing with complete absence of abnormal respiratory noise. Conclusion The unique laryngeal anatomy of horses, with a cartilage‐free ventral laryngeal area (cricothyroid notch), allowed the use of this novel surgical technique to successfully treat ventral glottic stenosis.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>27013024</pmid><doi>10.1111/vsu.12465</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Animals
Constriction, Pathologic - surgery
Constriction, Pathologic - veterinary
Female
Glottis - surgery
Horse Diseases - surgery
Horses
Iatrogenic Disease - veterinary
Laryngeal Diseases - surgery
Laryngeal Diseases - veterinary
Laryngeal Mucosa - surgery
Larynx
Ligaments
Male
Original ‐ Clinical
Physical Conditioning, Animal
Postoperative Complications - surgery
Postoperative Complications - veterinary
Retrospective Studies
Surgical Flaps - veterinary
Surgical techniques
Veterinary medicine
title Surgical Treatment of Iatrogenic Ventral Glottic Stenosis Using a Mucosal Flap Technique
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