Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses.
Authors: Brandenberger Olivier, Martens Ann, Robert Céline, Wiemer Peter, Pamela Hugo, Vlaminck Lieven, Barankova Katerina, Haspeslagh Maarten, Perkins Justin D, Ducharme Norm, Rossignol Fabrice
Journal: Veterinary surgery : VS
Summary
# Anatomy of the Vestibulum Esophagi and Prosthetic Laryngoplasty in Horses During laryngoplasty procedures, surgeons must navigate delicate structures around the arytenoid cartilage, yet the precise anatomical boundaries of the vestibulum esophagi—the cranial portion of the equine oesophagus—have been poorly defined. This cadaveric study of 44 equine specimens examined the anatomical extent of the vestibulum esophagi and quantified the risk of inadvertent penetration during suture placement, a critical consideration given that oesophageal perforation represents a serious post-operative complication. Researchers found that the vestibulum extends across the entire width of the larynx between both thyroid cartilage wings, overlying the arytenoid cartilages and covered by the thyropharyngeus and cricopharyngeus muscles; alarmingly, surgeons unaware of these anatomical boundaries penetrated the adventitia in 72% of suture placements compared to just 9% in informed surgeons, and actually breached the oesophageal lumen in 4.6% of cases. These findings underscore that anatomical knowledge substantially reduces iatrogenic trauma: explicit awareness of the vestibulum's rostral-caudal and lateral extent should guide needle trajectory and depth during muscular process fixation, potentially preventing post-operative oesophageal strictures, fistulation, and associated morbidity. Farriers, veterinarians, and surgical teams should prioritise pre-operative anatomy review and consider conservative needle placement angles when performing or assisting with laryngoplasty procedures.
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Practical Takeaways
- •Understanding the precise anatomical boundaries of the vestibulum esophagi is critical for surgeons performing laryngoplasty—awareness alone reduced complication rates from 72% to 9%
- •When placing sutures through the arytenoid muscular process during laryngoplasty, stay rostral and avoid deep penetration to prevent entering the esophageal lumen or adventitia
- •This anatomical knowledge should be emphasised in surgical training and case planning before performing prosthetic laryngoplasty procedures
Key Findings
- •The vestibulum esophagi spans the entire width of the larynx between thyroid cartilage wings, covering the arytenoid arcuate crest and is covered by thyropharyngeus and cricopharyngeus muscles
- •Surgeons unaware of vestibulum esophagi anatomy had 72% adventitia penetration rate versus 9% for the informed surgeon
- •Lumen penetration occurred in only 4.6% of sutures, exclusively performed by masked (uninformed) surgeons
- •Anatomical knowledge of vestibulum esophagi extent significantly reduces iatrogenic complications during laryngoplasty suture placement