NEW TREAT­MENT FOR EN­TRAPPED EPIGLOT­TIS PROM­ISES FEWER RE­LAPSES

EQUUS - - Medical Front -

A new tech­nique for free­ing an en­trapped epiglot­tis could of­fer a lower chance of re­lapse com­pared to more tra­di­tional ap­proaches, ac­cord­ing to sur­geons at Hag­yard Equine Med­i­cal In­sti­tute in Ken­tucky.

The epiglot­tis is a mov­able fold of car­ti­lage0 that lies at the base of the tongue. It bends up­ward when a horse swal­lows to di­rect feed and wa­ter through the esoph­a­gus. In­flam­ma­tion or anom­alies in the horse’s air­way struc­tures can lead to en­trap­ment, which oc­curs when the epiglot­tis be­comes stuck on tis­sue called the aryepiglot­tic fold. A horse with epiglot­tic en­trap­ment makes a gur­gling noise while work­ing and may be un­able to sus­tain ath­letic ef­fort due to re­duced air­flow.

A trapped epiglot­tis can be­come un­stuck on its own, but when that doesn’t oc­cur or if the prob­lem re­curs fre­quently, sur­gi­cal in­ter­ven­tion is typ­i­cally ap­pro­pri­ate says Matt Co­leridge, BVMS, cur­rently an equine sur­gi­cal res­i­dent at Auburn Uni­ver­sity Col­lege of Ve­teri­nary Medicine. In the stan­dard pro­ce­dure a sur­geon, guided by an en­do­scope0, splits the tis­sues of the aryepiglot­tic folds. “The tra­di­tional hooked bis­toury tech­nique, when per­formed cor­rectly, is very quick and very ef­fec­tive,” says Co­leridge. Depend­ing on the tools used, how­ever, re­lapse rates for this type of surgery range from 5 to 40 per­cent.

Hag­yard sur­geons Michael Spir­ito, DMV, and Dwayne Rodger­son, DVM, along with Co­leridge added a step to the stan­dard epiglot­tic surgery to re­duce the chances of re­cur­rence. In­stead of sim­ply split­ting the tis­sues caus­ing the en­trap­ment, the sur­geons re­move it. “Our tech­nique ex­cises that en­trap­ping tis­sue and in do­ing so re­moves the pos­si­bil­ity of that tis­sue fill­ing back in as it heals and the horse re-en­trap­ping again,” he says. In a pub­lished study of eight horses who un­der­went the re­vised pro­ce­dure, none had com­pli­ca­tions from the surgery or re­cur­rence of the en­trap­ment in the fol­low-up pe­riod.

Based on th­ese re­sults, Co­leridge says he rec­om­mends the tech­nique as a first-line ap­proach to epiglot­tic en­trap­ment cases, as well as for pre­vi­ously treated horses that have since ex­pe­ri­enced re­cur­rence or sec­ondary com­pli­ca­tions.

Ref­er­ence: “En­do­scopic, tran­so­ral, re­duc­tion of epiglot­tic en­trap­ment via wire snare tech­nique,” Ve­teri­nary

Surgery, Oc­to­ber 2014

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