Surgical advancement of the larynx (laryngeal tie-forward) as a treatment for dorsal displacement of the soft palate in horses: a prospective study 2001-2004.
Authors: Woodie J B, Ducharme N G, Kanter P, Hackett R P, Erb H N
Journal: Equine veterinary journal
Summary
# Editorial Summary: Laryngeal Tie-Forward for Dorsal Displacement of the Soft Palate Dorsal displacement of the soft palate (DDSP) remains a significant cause of exercise-induced upper airway obstruction in racehorses, and this prospective study evaluated whether surgical advancement of the larynx could restore normal anatomical positioning and improve performance. Woodie and colleagues treated 116 horses (predominantly racehorses) with naturally occurring DDSP using laryngeal tie-forward suturing, which mechanically replaces the stabilising function of the thyrohyoideus muscles; laryngeal positioning was assessed radiographically pre- and post-operatively, whilst functional outcomes were determined through follow-up interviews with connections and analysis of racing records in a subset confirmed by treadmill videoendoscopy. The procedure achieved a median 4 cm rostral advancement of the thyroid cartilage, positioning the larynx more rostrally and dorsally than baseline, with 87% of the 98 horses with available follow-up data demonstrating improved performance; amongst the 20 horses with confirmed DDSP diagnosis, 80% showed significantly increased performance indices and earnings (P = 0.007), and across the entire cohort, 82% exhibited measurable performance improvement (P = 0.0001). For practitioners managing exercise-intolerant horses with DDSP, particularly racehorses where performance metrics are quantifiable, laryngeal tie-forward offers a mechanically sound surgical alternative with demonstrable efficacy, although the authors appropriately note that wider clinical experience may strengthen confidence in recommending this technique as a first-line intervention.
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Practical Takeaways
- •Laryngeal tie-forward is an effective surgical alternative for exercise-induced DDSP in racehorses, with objective improvements in both laryngeal position and measurable performance metrics
- •Expected success rate is approximately 80-87% for performance improvement, though the technique still requires more clinical experience before widespread adoption
- •This procedure may be particularly valuable for horses with confirmed DDSP when conservative management has failed and return to performance is critical
Key Findings
- •Laryngeal tie-forward procedure moved the thyroid cartilage a median of 4 cm rostrally and positioned the larynx more rostral and dorsal than preoperatively
- •87% of 98 horses with follow-up showed improved performance, 12% unchanged, and 2% worse after surgery
- •80% of 20 horses with confirmed DDSP diagnosis via treadmill videoendoscopy showed significantly increased performance index and earnings (P = 0.007)
- •Overall population showed 82% significant improvement in performance index and earnings post-surgery (P = 0.0001)