Overground endoscopic examination following laryngeal tie-forward in horses with dorsal displacement of the soft palate.
Authors: Barnett Timothy P, Colgate Victoria A, Robinson Natalie, Smith Lewis C R, Palmer Lorraine, Barakzai Safia Z
Journal: Veterinary surgery : VS
Summary
# Laryngeal Tie-Forward Surgery for Intermittent Dorsal Displacement of the Soft Palate: Efficacy and Postoperative Assessment Intermittent dorsal displacement of the soft palate (iDDSP) remains a significant cause of exercise-induced upper airway obstruction in performance horses, and laryngeal tie-forward (LTF) surgery is an established surgical intervention, yet postoperative validation of success has been limited. This retrospective analysis of 56 horses examined overground endoscopic (OGE) findings and racing performance following LTF surgery, with some horses receiving concurrent soft palate thermocautery (SPTC) and/or aryepiglottic fold resection. The results were encouraging: a 75% reduction in iDDSP occurrence on postoperative OGE (p <0.001) and a 23% reduction in palatal instability, translating to a 22% increase in the number of horses returning to racing and an 18% increase in placed finishes. Notably, concurrent SPTC provided no additional benefit in reducing iDDSP recurrence, suggesting that LTF alone suffices for most cases. Clinically, these findings underscore that LTF is a reliable surgical option for iDDSP, whilst horses exhibiting suspected upper airway impairment after surgery (which carried 11-fold higher odds of persistent iDDSP on repeat OGE) warrant postoperative endoscopic reassessment rather than assumption of surgical failure—a distinction that could inform both diagnostic protocols and owner communication regarding realistic recovery expectations.
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Practical Takeaways
- •Laryngeal tie-forward is an effective surgical treatment for iDDSP, with three-quarters of horses showing resolution on follow-up endoscopy and improved racing performance
- •Skip concurrent soft palate thermocautery as it does not enhance outcomes and adds operative time and cost
- •If a horse continues showing signs of upper airway obstruction after LTF surgery, perform repeat overground endoscopy to confirm persistent iDDSP rather than assuming treatment failure
Key Findings
- •Laryngeal tie-forward surgery achieved 75% reduction in iDDSP presence on postoperative overground endoscopy (p<0.001)
- •Soft palate thermocautery performed concurrently with LTF provided no additional reduction in iDDSP prevalence
- •22% increase in the number of horses that raced postoperatively and 18% increase in horses that were placed
- •Horses with reported suspected upper airway impairment postoperatively had 11-fold higher odds of persistent iDDSP on repeat endoscopy