After 2 days of treatment for pneumonia with fluids and antibiotics, Yoyo’s respiratory effort is improved, but he is still uncomfortable without supplemental oxygen. He continues to have upper airway stridor and stertor on inspiration and can only spend short periods of time on room air without becoming distressed. The risks of anesthesia in a patient with pneumonia are discussed with the owner. The owner authorizes a sedated upper airway examination and CT scan of the head, neck, and chest to look for the cause of the upper airway disease.
The sedated laryngeal examination shows absent movement of the arytenoid cartilages bilaterally that is consistent with laryngeal paralysis. The soft palate is elongated. There is no evidence of everted laryngeal saccules on examination. The CT scan shows extensive periodontal disease, tonsillar and laryngeal saccular eversion, and nasopharyngeal stenosis. The lungs show atelectasis of the left cranial and bilateral caudal lung lobes.
Yoyo undergoes airway surgery the following day. A soft palate resection and rhinoplasty are performed. No evidence of laryngeal saccule eversion is noted during surgery. An attempt is made at arytenoid lateralization to treat the laryngeal paralysis; however, surgical correction is not possible because of chondromalacia of the arytenoid cartilages.
Yoyo is treated postoperatively with ampicillin–sulbactam (22 mg/kg IV q8h), enrofloxacin (10 mg/kg IV q24h), hydromorphone (0.08 mg/kg IV q6h), acepromazine (0.01 mg/kg IV as needed), and dexamethasone (0.1 mg/kg IV q12h). Oxygen supplementation is continued.