Variations in the application of equine prosthetic laryngoplasty: A survey of 128 equine surgeons.
Authors: Byrne Christian A, Hotchkiss Joel W, Barakzai Safia Z
Journal: Veterinary surgery : VS
Summary
# Equine Prosthetic Laryngoplasty: Current Practice Remains Variable Despite Technical Evolution Recurrent laryngeal neuropathy (RLN) affects many performance horses, and whilst prosthetic laryngoplasty is the gold standard surgical intervention, significant variation exists in how equine surgeons apply this technique—a gap this 2023 survey sought to quantify. Researchers distributed questionnaires to 678 diplomate surgeons across North America and Europe, receiving 128 complete responses predominantly from experienced practitioners, and collected detailed information on surgical restraint methods, prosthesis configurations, materials, anchoring techniques, and perioperative antimicrobial protocols. The findings revealed substantial consensus on certain elements—82.8% of surgeons used two prostheses, 97.7% employed a single loop to anchor at the arytenoid cartilage, and 44.5% administered systemic antimicrobials for 1–3 days—yet considerable variation persisted regarding anaesthetic approach (with 35.9% now routinely performing the procedure under standing sedation rather than general anaesthesia), prosthesis material selection, and local antimicrobial use (adopted by 37.5% of respondents). The implications for practice are twofold: standardisation around evidence-based techniques could improve outcomes and facilitate knowledge transfer, particularly regarding biomechanical advantages of alternative anchoring methods and prosthesis materials, whilst the widespread adoption of standing sedation represents a meaningful shift towards less invasive surgical management that merits further investigation into its safety and functional outcomes.
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Practical Takeaways
- •While two-prosthesis techniques with single-loop arytenoid fixation dominate practice, evidence suggests alternative biomechanical approaches may offer advantages—consider exploring these if outcomes warrant it
- •Standing sedation is increasingly used for laryngoplasty (36% of respondents), offering potential advantages in recovery and cost—evaluate feasibility in your facility
- •Antimicrobial protocols vary widely with no consensus on duration or local vs. systemic use—audit your current practice against evidence-based guidelines to optimize outcomes
Key Findings
- •82.8% of surgeons use 2 prostheses for laryngoplasty, with single loop anchoring at arytenoid cartilage being most common (97.7%)
- •35.9% of surgeons now perform laryngoplasty under standing sedation rather than general anesthesia
- •44.5% of surgeons administer perioperative systemic antimicrobial therapy for 1-3 days, while 37.5% use local antimicrobial therapy
- •Significant variation exists in prosthesis material selection and surgical restraint methods despite most surgeons targeting grade 2 intraoperative arytenoid abduction