Endoscope-guided, transoral axial division of an entrapping epiglottic fold in fifteen standing horses.
Authors: Perkins Justin D, Hughes Thomas K, Brain Ben
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Endoscope-Guided Transoral Division of Epiglottic Fold Entrapment Epiglottic fold entrapment (EFE) causes respiratory obstruction and exercise intolerance, and whilst surgical correction is well-established, the anaesthetic risks associated with general anaesthesia present a significant challenge in clinical practice. Perkins, Hughes and Brain's 2007 retrospective review examined 16 horses treated for EFE using a minimally invasive transoral approach with endoscopic guidance, performed under standing sedation with a hooked bistoury to axially divide the entrapping fold. Surgical success was achieved in 15 of 16 cases without requiring general anaesthesia, with no post-operative abnormal respiratory noise detected and all horses returning to their intended use; the single horse requiring conversion to general anaesthesia and one post-operative complication (a shortened, deformed epiglottis) represent acceptably low morbidity rates. This technique substantially reduces the physiological stress and recovery time associated with general anaesthesia whilst maintaining high efficacy, offering practitioners a genuine alternative for managing EFE—particularly valuable for horses with concurrent health conditions or poor anaesthetic candidates. The standing sedation approach warrants consideration as a first-line surgical option for straightforward EFE cases, though careful case selection and operator experience remain essential for optimal outcomes.
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Practical Takeaways
- •EFE can be safely treated in standing sedated horses using endoscopic guidance and a transoral approach, eliminating general anesthesia risks and recovery costs.
- •Success rate is high (94%) with this technique, and horses return rapidly to full function without post-operative respiratory complications in most cases.
- •Consider this procedure as first-line option for EFE, though have contingency plan for general anesthesia in case of procedure difficulty.
Key Findings
- •Axial division of epiglottic fold entrapment was successfully performed in 15 of 16 standing sedated horses using endoscope-guided transoral technique.
- •No horses made abnormal respiratory noise post-operatively and all returned to intended use.
- •One horse required general anesthesia to complete the procedure; one horse developed a short deformed epiglottis post-operatively.
- •Transoral standing approach is a safe and effective alternative to general anesthesia for epiglottic fold entrapment surgery.