Bilateral laryngeal paralysis (aplegia) occurring late during the recovery of a horse after orthopaedic surgery
Authors: I. Lutvikadić, K. Hopster, B. Driessen
Journal: Equine Veterinary Education
Summary
# Editorial Summary A 9-year-old Standardbred underwent surgical repair of a comminuted first phalanx fracture under general anaesthesia with the neck maintained in neutral position, but developed complete upper airway obstruction within 30 minutes of extubation, necessitating emergency re-anaesthesia and tracheostomy. Subsequent endoscopic examination revealed bilateral laryngeal paralysis (aplegia), which the authors attributed to an underlying neurological condition rather than anaesthetic misadventure, supported by the emergence of additional neurological signs including hindlimb ataxia and decreased tongue tone consistent with equine protozoal myeloencephalitis (EPM) or neuroborreliosis. Despite intensive care with anti-inflammatory and anti-protozoal therapy, the horse showed only partial neurological recovery—complete resolution of tongue weakness but persistent ataxia—and bilateral laryngeal dysfunction did not improve, ultimately requiring permanent tracheostomy placement. This case highlights that delayed upper airway obstruction in the immediate post-operative period should prompt investigation for systemic neurological disease rather than assuming anaesthetic or positioning complications, as infectious or protozoal aetiologies can develop concurrently with orthopaedic conditions. The findings underscore the importance of thorough neurological assessment and differential diagnosis in horses presenting with acute laryngeal dysfunction after surgery, particularly when initial recovery appears normal but deterioration occurs hours post-extubation.
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Practical Takeaways
- •Bilateral laryngeal paralysis can emerge as a late post-anesthetic complication; maintain high suspicion for underlying systemic neurological disease if paralysis develops after routine recovery
- •Upper airway obstruction in recovering anesthetized horses requires immediate emergency tracheostomy; have equipment and personnel prepared for rapid airway intervention
- •Consider infectious or protozoal causes (EPM, neuroborreliosis) in horses presenting with combined laryngeal dysfunction and neurological signs, as these may respond to specific antimicrobial therapy
Key Findings
- •Bilateral laryngeal aplegia developed 30 minutes post-extubation following routine orthopedic surgery under general anesthesia with neutral neck positioning
- •Associated neurological signs (hindlimb ataxia, decreased tongue tone) suggested underlying protozoal myeloencephalitis as the primary cause rather than anesthesia-related complication
- •Partial neurological recovery occurred with empirical EPM and neuroborreliosis treatment, but laryngeal dysfunction persisted requiring permanent tracheostomy