Intra-articular stabilisation of the equine cricoarytenoid joint.
Authors: Cheetham J, Witte T H, Rawlinson J J, Soderholm L V, Mohammed H O, Ducharme N G
Journal: Equine veterinary journal
Summary
Laryngoplasty for recurrent laryngeal neuropathy (RLN) is frequently complicated by early postoperative loss of arytenoid abduction, compromising the surgical outcome and potentially requiring revision. Cheetham and colleagues investigated whether intra-articular injection of polymethylmethacrylate (PMMA) into the cricoarytenoid joint could mechanically stabilise the joint and reduce suture strain during physiological airflow and pressure changes. Using ten equine cadaver larynges subjected to static and dynamic airflow conditions, the team compared four scenarios: bilateral full abduction (control), suture transection on the non-cemented side, suture replacement (control), and suture transection on the PMMA-stabilised side, measuring tracheal pressures, flow rates, and suture strain. PMMA injection significantly reduced the rate of strain increase on the laryngoplasty suture as translaryngeal pressure increased (P = 0.03) and maintained airway mechanics equivalent to bilateral abduction, with no significant differences in tracheal pressure or flow between cemented and non-cemented conditions. These findings suggest that augmenting prosthetic laryngoplasty with intra-articular PMMA stabilisation could mechanically resist the collapsing forces exerted by normal breathing, potentially preserving arytenoid abduction in the critical early postoperative period and improving long-term surgical success rates.
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Practical Takeaways
- •PMMA augmentation of laryngoplasty may reduce early post-operative abduction loss by mechanically stabilizing the cricoarytenoid joint against physiological airflow forces
- •This technique could improve long-term outcomes in horses undergoing laryngoplasty for recurrent laryngeal neuropathy by reducing suture strain
- •Further in vivo studies are needed before clinical adoption, but the biomechanical evidence supports investigation as an adjunctive surgical technique
Key Findings
- •PMMA injection into the cricoarytenoid joint maintained tracheal pressure and flow equivalent to bilateral full abduction in both static and dynamic conditions
- •Cutting the suture on the non-PMMA side resulted in significant increases in tracheal pressure and decreases in tracheal flow (P < 0.05)
- •The rate of increase in suture strain with increasing translaryngeal pressure was significantly reduced with PMMA placement (P = 0.03)
- •PMMA injection resists the collapsing effect of physiological airflows and pressures, reducing force on the laryngoplasty suture