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Thyroarytenoid Lateralization

Clinician's Brief (Capsule)

Surgery, Soft Tissue

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November 2015

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Surgery is indicated for dogs with laryngeal paralysis that have moderate-to-severe clinical signs or decreased quality of life. The goal of surgery is to decrease laryngeal resistance by manipulating structures obstructing the rima glottidis. Several surgical techniques have been described, but morbidity and mortality in affected dogs is high, even with surgical treatment. This study describes a minimally invasive percutaneous technique for thyroarytenoid lateralization in cadaver dogs. Two 18-gauge, 1.5-inch needles were placed from the skin and directed through the thyroid and arytenoid cartilages into the laryngeal lumen. The landmarks for needle placement were easily palpated. Nylon 2/0 suture was passed into the laryngeal lumen with 1 needle and out of the lumen using the second needle. Endoscopic assistance was used to direct needle and suture location and to confirm rima glottidis abduction. The suture was tied through a keyhole approach on the lateral aspect of the thyroid cartilage. 

This technique provided a significant 4.9-fold increase in rima glottidis area compared to baseline. The authors recommend amending the procedure such that tensioning and tying of the suture is under direct endoscopic evaluation to increase the rima glottidis area between only 200% and 250% in order to reduce the risk of aspiration pneumonia. Median duration of the procedure was 11 minutes (range 9.5-15.5 minutes). Complications noted included jugular vein laceration (1/11), damage to the suture (3/11), and penetration of the endotracheal tube (2/11). Further evaluation of this alternative technique is warranted.

Commentary

Surgical intervention is a requirement for dogs with laryngeal paralysis that cannot be controlled medically and must sometimes be done emergently. This procedure may offer an efficient, less invasive approach to stabilize these patients. However, considering the frequent complications encountered in this study, further refinement is warranted before clinical use in patients.—Jason Bleedorn, DVM, DACVS

References

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