Long-term survey of laryngoplasty and ventriculocordectomy in an older, mixed-breed population of 200 horses. Part 1: Maintenance of surgical arytenoid abduction and complications of surgery.
Authors: Dixon R M, McGorum B C, Railton D I, Hawe C, Tremaine W H, Dacre K, McCann J
Journal: Equine veterinary journal
Summary
# Editorial Summary: Long-term outcomes of laryngeal paralysis surgery in 200 horses Dixon and colleagues followed 200 mixed-breed horses (median age 6 years) for a median of 19 months after laryngoplasty combined with ventriculocordectomy to quantify how well arytenoid abduction was maintained and systematically document surgical complications—information that had previously been poorly characterised in the literature. Using endoscopic grading immediately post-operatively and at 1 and 6 weeks, the authors found that whilst 62% achieved good abduction on day one, progressive loss occurred over the following weeks, with most horses settling at moderate abduction by week 6; additionally, 10% required re-tightening and 7% required loosening of the prosthesis, the latter group experiencing significant post-operative dysphagia and coughing. Wound complications from the laryngotomy incision were generally minor and self-limiting (discharge lasting <2 weeks in 22% of cases), though post-operative coughing affected 43% of horses overall, with 24% experiencing feed-related coughing and chronic coughing (>6 months) in 14%, though half of these appeared attributable to underlying pulmonary disease rather than the surgery itself. For practitioners, this work emphasises that moderate loss of abduction is expected and physiological, but the correlation between excessive abduction and dysphagia highlights the importance of careful prosthesis tension; the authors' recommendation to suture the cricotracheal membrane also provides a practical means of promoting faster laryngotomy wound healing and reducing discharge complications.
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Practical Takeaways
- •Expect significant loss of arytenoid abduction in most horses within 6 weeks post-LP; plan for possible revision surgery and monitor abduction closely during early recovery period
- •Balance surgical abduction carefully—excessive abduction leads to dysphagia and coughing while insufficient abduction reduces efficacy; aim for moderate grade 2-3 abduction
- •Suturing the cricotracheal membrane promotes rapid laryngotomy wound healing; stainless steel wire prostheses are reliable with minimal long-term wound complications when properly maintained
Key Findings
- •62% of horses achieved good arytenoid abduction on postoperative day 1, but progressive loss occurred such that only moderate abduction remained by 6 weeks
- •10% of cases required re-tightening of prostheses due to excessive loss of abduction, while 7% required loosening due to continuing high abduction and dysphagia
- •Postoperative coughing occurred in 43% of cases and correlated significantly with degree of surgical arytenoid abduction; 24% coughed during eating and 19% coughed independently of eating
- •Laryngotomy wound discharge occurred in 22% of cases for <2 weeks, 7% for <4 weeks, and 2% for >4 weeks; laryngoplasty wound problems were of little long-term consequence with stainless steel wire prostheses