An in vitro comparison of cordopexy, cordopexy and laryngoplasty, and laryngoplasty for treatment of equine laryngeal hemiplegia.
Authors: Jansson N, Ducharme N G, Hackett R P, Mohammed H O
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Surgical Management of Equine Laryngeal Hemiplegia Laryngeal hemiplegia remains a significant performance limitation in horses, and whilst laryngoplasty has become the standard surgical intervention, questions persist about whether additional vocal cord fixation might enhance outcomes. Jansson and colleagues used an in vitro model with cadaveric equine larynges subjected to high inspiratory airflows to compare three surgical techniques: cordopexy alone (vocal cord fixation via suture to the thyroid cartilage), standard laryngoplasty (arytenoid abduction using a cricoid cartilage attachment), and a combined approach integrating both methods. At maximum airflow, the combined technique and standard laryngoplasty produced significantly lower translaryngeal impedance values (0.69 and 0.78 cm H₂O/L/s respectively) compared with cordopexy alone (1.76 cm H₂O/L/s) or untreated controls (4.16 cm H₂O/L/s); both surgical approaches also achieved substantially greater glottic cross-sectional areas (approximately 9.3–9.7 cm² versus 6.94 cm² in controls). For practitioners, these findings suggest that cordopexy as a standalone procedure offers insufficient airway improvement, but combining it with laryngoplasty provides airflow mechanics equivalent to standard laryngoplasty whilst potentially offering additional vocal cord support—a development that may prove particularly valuable in cases where conventional laryngoplasty has failed or where additional stabilisation is deemed necessary.
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Practical Takeaways
- •Cordopexy alone is insufficient for treating laryngeal hemiplegia and should not be used as a standalone procedure; combining it with laryngoplasty provides the benefit of dual stabilization
- •Combined cordopexy with modified laryngoplasty is biomechanically equivalent to standard laryngoplasty in restoring airway patency, offering surgeons an alternative technique with potentially different surgical applications
- •These in vitro results suggest vocal cord fixation paired with arytenoid abduction provides superior airway mechanics; clinical validation is needed before widespread adoption in practice
Key Findings
- •Cordopexy alone failed to improve airway mechanics in hemiplegic larynges, with translaryngeal impedance remaining elevated at 1.76 cm H2O/L/s compared to treated groups
- •Cordopexy combined with modified laryngoplasty achieved equivalent airway mechanics to standard laryngoplasty, with translaryngeal impedance of 0.69 cm H2O/L/s at maximal airflow
- •Both cordopexy plus modified laryngoplasty and standard laryngoplasty increased glottic cross-sectional area to 9.69 and 9.34 cm² respectively, compared to 6.94 cm² in untreated controls
- •The arytenoid right-to-left angle quotient was significantly improved with combined cordopexy-laryngoplasty (1.48) and standard laryngoplasty (1.39) versus cordopexy alone (2.74) or controls (3.66)