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19 Cards in this Set
- Front
- Back
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What is the difference between STERTOUS and STRIDOROUS?
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Stertor
~~~ Inspiratory ~~~ Coarse Snoring ~~~ Pharyngeal Obstruction Stridor ~~~ Inspiratory ~~~ High Pitched ~~~ Laryngeal Narrowing ~~~ Extrathoracic Tracheal Narrowing |
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How can STERTOUS and STRIDOROUS help you to localize disease within the respiratory system?
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Stertorous
~~~ Pharyngeal Stridorous ~~~ Laryngeal |
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What are the major components of brachycephalic upper airway obstruction in the dogs?
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Primary Abnormalities
~~~ Stenotic Nares ~~~ Elongated Soft Palate ~~~ Hypoplastic Trachea Secondary Abnormalities ~~~ Everted Laryngeal Saccules ~~~ Laryngeal Collapse |
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What clinical signs are most common in brachycephalic upper airway obstruction in dogs?
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Stertor
Cyanosis Exercise Intolerance Sycope |
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What is the appropriate surgical treatment for each component of the brachycephalic upper airway obstruction syndrome in Dogs?
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Stenotic Nares
~~~ Excise Wedge of Tissue and Cartilage ~~~ ~~~ Wing of Nostril ~~~ ~~~ Internal Alar Fold ~~~ Nostril Opened Internally and Externally Soft Palate ~~~ Resection ~~~ ~~~ Caudal Free Edge Free Margin ~~~ ~~~ ~~~ Just Covers Tip of Epiglottis ~~~ ~~~ Site of Transection Coincides (usually) ~~~ ~~~ ~~~ Caudal Border of Tonsilar Crypts ~~~ Avoid Stretching Palate Cranially ~~~ ~~~ ie Cut It Twice and Its Still Too Short Everted Laryngeal Saccules ~~~ Remove ~~~ ~~~ Securely Grasp ~~~ ~~~ ~~~ Cut Off at Base Larynx ~~~ Access for Collapse ~~~ ~~~ Contacting Corniculate Processes ~~~ ~~~ Overlapping Cuneiform Process ~~~ Collapse Usually = ~~~ ~~~ Permanent Tracheostomy |
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What are the clinical features of laryngeal disease?
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Stridor
Respiratory Distress ~~~ Exacerbated via Soft Tissue Swelling by ~~~ ~~~ Exercise ~~~ ~~~ Excitement ~~~ ~~~ High Ambient Temp Cyanosis Syocope |
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How is the diagnosis of laryngeal paralysis made?
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Laryngoscopy
~~~ Observation of Arytenoid Cartilages During Respiration Laryngeal Paralysis ~~~ Arytenoid Cartilages and Vocal Folds ~~~ ~~~ Remain Closed During Inspiration ~~~ Paradoxical Movement (occasionally) ~~~ ~~~ Arytenoids Move Medially During Inspiration Distinguish From ~~~ Laryngeal Collapse via ~~~ ~~~ Soft or Deformed Laryngeal Cartilages Anesthetic Protocol ~~~ Avoid Abolishing Laryngeal Movement ~~~ Propofol ~~~ ~~~ +/- Doxapram ~~~ ~~~ ~~~ Improves Respiratory Effort |
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What dogs (age/breed) are most likely to be affected by Laryngeal Paralysis?
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Idiopathic (Polyneuropathy?)
~~~ Large Breed ~~~ Older ~~~ MOST COMMON Congenital ~~~ Bouvier des Flandres ~~~ Siberian Husky ~~~ Alaska Husky ~~~ Dalmatians ~~~ ~~~ Young - Onset Polyneuropathy Immune Polyneuritis ~~~ Any Age ~~~ +/- Limb Atrophy and Loss of Limb Reflexes ~~~ Don’t Forget to Check the Pharynx Myasthenia Gravis ~~~ Congenital ~~~ ~~~ English Springer Spaniels ~~~ ~~~ Smooth Haired Fox Terriers ~~~ ~~~ Jack Russell Terriers ~~~ ~~~ A Few Cats ~~~ Acquired ~~~ ~~~ 2 to 3 Years ~~~ ~~~ 9 to 10 Years ~~~ ~~~ Akitas, Terriers, German Shorthaired Pointers, Chihuahuas |
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What are some medical conditions that may cause or contribute to laryngeal paralysis?
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Ventral Cervical Lesion
~~~ Trauma to Nerves ~~~ ~~~ Direct Trauma ~~~ ~~~ Inflammation ~~~ ~~~ Fibrosis ~~~ Tumor ~~~ Other Inflammatory Mass or Lesion Cranial Thorax Lesion ~~~ Tumor ~~~ Trauma ~~~ ~~~ Post Op - Oops ~~~ ~~~ Direct Trauma ~~~ Other Inflammatory Mass or Lesion Polyneuropathy and Polymyopathy ~~~ Idiopathic ~~~ Immune Mediated ~~~ Endocrinopathy ~~~ ~~~ Hypothyroidism ~~~ ~~~ Hypoadrenocorticism ~~~ Other Systemic Disorder ~~~ ~~~ Toxicity ~~~ Congenital Dz |
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What testing should be recommended to look for conditions that may cause or contribute to laryngeal paralysis?
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Rads
~~~ Thoracic ~~~ Cervical Chem Panel ~~~ Baseline T4, Free T4, cTSH Evaluation for Diffuse Neuropathy-Myopathy ~~~ Electromyography ~~~ Nerve Conduction Serology ~~~ Antinuclear AntiBody ~~~ Ach Receptor Antibody ACTH Stimulation Rule Outs ~~~ Concurrent Pulmonary Dz ~~~ Concurrent Pharyngeal Impairment |
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What is the recommended surgical treatment for laryngeal paralysis?
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Enlargement of Laryngeal Lumen
~~~ Must NOT Have Concurrent Pharyngeal Dysfunction Unilateral Arytenoid Lateralization ~~~ aka Tie Back Balance ~~~ Adequate Airway ~~~ Aspiration Pneumonia |
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What is the most common complication of Unilateral Arytenoid Lateralization?
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Aspiration Pneumonia
Suture Breakage or Pullout ~~~ Rarely |
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What is the prognosis for Unilateral Arytenoid Lateralization Surgery for the Treatment of laryngeal paralysis?
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Good
~~~ Uncomplicated Idiopathic Type |
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What is the difference between laryngeal paralysis and laryngeal collapse?
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Laryngeal Paralysis
~~~ Arytenoid Cartilages and Vocal Folds ~~~ ~~~ Remain Closed During Inspiration ~~~ Paradoxical Movement (occasionally) ~~~ ~~~ Arytenoids Move Medially During Inspiration Laryngeal Collapse ~~~ Obliteration of Laryngeal Lumen ~~~ ~~~ Collapse of ~~~ ~~~ ~~~ Tissues ~~~ ~~~ ~~~ Mucosa ~~~ Soft Tissue Sucked Into Lumen During Inspiration ~~~ Eventual Softening of Laryngeal Cartilages ~~~ ~~~ Also Sucked In During Inspiration |
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What surgical procedure is typically recommended to manage clinically significant laryngeal collapse?
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Tracheostomy
~~~ Permanent |
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Laryngeal paralysis is rarely seen in cats. What is a more common cause of laryngeal obstruction in cats?
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Granulomatous Laryngitis
Lymphosarcoma ~~~ Invasion from Surrounding Tissue |
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How will you diagnose Granulomatous Laryngitis or Laryngeal Lymphasarcoma?
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Palpation
Laryngoscopy Laryngeal Radiographs US CT Definitive Diagnosis ~~~ Biopsy ~~~ ~~~ Cytology ~~~ ~~~ Histology |
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What are the indications for a temporary tracheostomy? (Note: should be familiar enough with procedure to perform in an emergency)
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Presentation or Anticipation of Life Threatening Dyspnea
Upper Respiratory Tract Obstructions ~~~ Severe Inflammation ~~~ Neoplastic Masses ~~~ Laryngeal Paralysis ~~~ Laryngeal Collapse ~~~ Foreign Body |
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What are the Basic Surgical Steps for a temporary tracheostomy?
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Surgery
~~~ 5 cm Ventral Midline Incision ~~~ ~~~ Just Caudal to Larynx ~~~ Sharp Incision and Separation of Sternohyoid Muscles ~~~ Tracheal Rings Isolated ~~~ ~~~ Transverse Incision Between +/- Rings 4 and 5 ~~~ ~~~ ~~~ Opening Ventral 1/3 to ½ of Circumference ~~~ ~~~ ~~~ AVOID Recurrent Laryngeal Nerves and Other Important Bits ~~~ Short Non Reactive Tube (ie NOT Red Rubber or PCV) ~~~ ~~~ ½ Diameter of Lumen ~~~ ~~~ Stay Sutures Around Rings on Either Side of Incision ~~~ Close Muscles and Skin Cranial and Caudal to Tube |
