Upper esophageal incompetence in five horses after prosthetic laryngoplasty.
Authors: Barakzai Safia Z, Dixon Paddy M, Hawkes Claire S, Cox Alistair, Barnett Timothy P
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Upper Esophageal Incompetence Following Prosthetic Laryngoplasty Prosthetic laryngoplasty is a widely used procedure to manage laryngeal hemiplegia, but this case series by Barakzai and colleagues documents an important post-operative complication—upper esophageal incompetence—that may develop months to years after surgery in a subset of horses. Five horses presented with clinical signs ranging from postoperative coughing to severe dysphagia, with endoscopic findings of saliva pooling at the upper esophageal opening and oesophageal reflux both at rest and during exercise (observed in four horses 21–58 months post-operatively). Necropsy of one severely affected horse revealed proximal oesophageal dilation with food impaction and marked fibrosis and muscular thickening of the cricopharyngeus and thyropharyngeus, suggesting iatrogenic injury to the caudal pharyngeal constrictor muscles, upper oesophageal intrinsic musculature, or their nerve supply during the laryngoplasty procedure. Whilst the incidence appears low, equine practitioners should remain alert to signs of post-operative coughing, dysphagia, or respiratory distress persisting beyond the immediate recovery period, as these may indicate upper oesophageal dysfunction; careful surgical technique around the pharyngeal structures and consideration of long-term follow-up endoscopy in symptomatic horses may help identify and potentially manage this complication early.
Read the full abstract on PubMed
Practical Takeaways
- •Prosthetic laryngoplasty carries a risk of upper esophageal incompetence developing months to years post-operatively; monitor for persistent or delayed-onset coughing and dysphagia.
- •Iatrogenic damage to pharyngeal muscles, esophageal musculature, or their innervation during laryngoplasty can compromise swallowing safety—careful surgical technique minimizing collateral trauma is essential.
- •Horses with post-laryngoplasty coughing, especially when eating, warrant endoscopic evaluation to assess for esophageal reflux or obstruction before complications progress to food impaction.
Key Findings
- •Five horses developed upper esophageal incompetence 21-58 months after prosthetic laryngoplasty with saliva emanating from the esophageal opening.
- •All 5 horses exhibited postoperative coughing, with 2 horses coughing severely during eating.
- •Esophageal reflux was documented at rest (1 horse) and during exercise (4 horses).
- •Necropsy of one horse revealed proximal esophageal dilation with food impaction and fibrosis of caudal pharyngeal constrictor muscles.