A modified laryngoplasty approach promoting ankylosis of the cricoarytenoid joint.

Authors: Parente Eric J, Birks Eric K, Habecker Perry

Journal: Veterinary surgery : VS

DOI: 10.1111/j.1532-950X.2010.00773.x PubMed: 21204857Log in to save

Summary

# Editorial Summary: Modified Laryngoplasty for Recurrent Laryngeal Neuropathy Recurrent laryngeal neuropathy (RLN) remains a significant cause of exercise-induced upper airway obstruction in horses, with conventional laryngoplasty frequently losing effectiveness over time as the sutured arytenoid cartilage gradually re-adducts. Parente and colleagues tested whether deliberately promoting ankylosis (bony fusion) of the cricoarytenoid joint—rather than relying on suture tension alone—could provide more durable abduction in eight horses, comparing three controls receiving standard laryngoplasty against five receiving a modified procedure designed to induce joint fusion. At three months post-operatively, the modified group demonstrated significantly better maintenance of arytenoid abduction (measured by endoscopic right:left quotient ratios), lower translaryngeal impedance (indicating better airway patency), and histological evidence of fibrous bridging across the cricoarytenoid joints, whilst the control group showed substantial loss of abduction. Critically, the mechanical stability of the airway remained significantly superior in the modified group even when sutures were deliberately cut, suggesting the ankylosis itself—not suture tension—was providing the functional benefit. These findings suggest that inducing cricoarytenoid ankylosis offers a more stable long-term solution to RLN-related airway obstruction than conventional laryngoplasty, potentially reducing recurrence rates and the need for revision surgery, though clinical validation in a larger population would be warranted before widespread adoption.

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Practical Takeaways

•Modified laryngoplasty with cricoarytenoid joint ankylosis provides superior long-term maintenance of arytenoid abduction compared to standard laryngoplasty, reducing the need for revision surgery in horses with laryngeal hemiplegia
•The procedure achieves mechanical stability through joint fusion rather than relying on suture tension alone, offering more durable results for performance horses
•Consider this modified approach for horses requiring laryngoplasty, particularly those with high performance demands where loss of abduction would be career-limiting

Key Findings

•Modified laryngoplasty resulted in fibrous ankylosis of the cricoarytenoid joint, confirmed histologically in all treated horses
•Loss of arytenoid abduction at 3 months was significantly greater in control laryngoplasty (n=3) versus modified procedure (n=5)
•Translaryngeal impedance was significantly lower in the modified laryngoplasty group compared to control, indicating better airway patency
•Intact sutures maintained lower impedance compared to cut sutures, demonstrating the stabilizing effect of the surgical modification

Conditions Studied

laryngeal hemiplegiarecurrent laryngeal neuropathyupper airway obstruction

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