Upper respiratory tract surgery

Respiratory procedures at the clinic can include diagnosis and management of upper respiratory tract infections to laryngeal and soft palate surgery.

There are many different procedures which can be carried out for the management and treatment of upper respiratory tract disorders. Many of the diagnostics necessary can be performed in either an ambulatory setting or at the clinic.

The most common procedures we perform out on the road are upper and lower airway fluid samples including tracheal washes, broncho-alveolar lavages and guttural pouch washes.  We are also able to perform endoscopy (using a videoscope) to visualise the upper airway and investigate the cause of any respiratory noise heard at rest or during exercise.

Acute and Chronic Equine Asthma, Strangles, Pneumonia and IAD (Inflammatory Airway Disease) are diagnosed by visualising the airway and performing tracheal, bronchoalveolar and guttural pouch washes. The fluid sample obtained is then analysed to finalise the diagnosis. These conditions can be treated at home.

The use of video endoscopy to inspect the upper airway during rest and exercise is frequently performed in Racehorses and Sports Horses. Recurrent Laryngeal Neuropathy (RLN) and Dorsal Displacement of the Soft Palate (DDSP) are the most frequently diagnosed conditions associated with respiratory noise; both of which require surgical correction in order to maintain and improve performance.  

Surgical corrections of many upper airway conditions can be performed under standing sedation. This reduces the risk to the patient and decreases recovery time.

Ventriculocordectomy (Hobday) and Laryngoplasty (Tieback) are performed in order to correct for paralysis of the cartilage on the left side of the larynx (Recurrent Laryngeal Neuropathy, RLN). The reduces abnormal patterns of airflow in the airway and helps to ensure that adequate airflow reaches the lungs. The overall success rate is good, and horses return to normal work.

Soft palate cautery and/or a ‘Tie Forward’ can be performed to return the soft palate to its intended position. The soft palate functions to separate the mouth from the back of the nose, and should lie under the epiglottis. Cautery is intended to reduce the flexibility of the soft palate, and therefore reduce the likelihood of it becoming dislodged. The ‘Tie Forward’ moves the larynx forwards to make a more secure seal between the soft palate and epiglottis. Again, the overall success rate is good, and horses return to normal work.

Equine sinusitis is another commonly diagnosed upper airway condition in the horse. Most commonly, this presents with foul smelling nasal discharge from one nostril, facial swelling, loss of performance and change in demeanour. The primary causes of sinusitis are upper respiratory tract infection or virus, upper cheek tooth root infections possibly due to fracture, and cysts or tumours within the sinus.

Investigating the cause of sinusitis must be carried out before it can be treated and antibiotics often do not solve the problem.  This usually involves a dental examination, x-rays of the head and endoscopy of the upper airway. In some cases, more advanced imaging is required and the horse will be referred for a CT scan in this case.

Surgery to lavage the infected sinus is performed under standing sedation and the sinus is visualised using a video-endoscope via a small hole made into the frontal bone of the horse’s head, known as a ‘trephine’. The endoscope is passed through the hole enabling thorough examination of the sinus, and then repeated flushing if required.

If dental issues are the underlying cause of the sinusitis, the tooth can be extracted under sedation either orally or if more difficult repulsed through a bone flap, however this is avoided where possible. A bone flap may also be used to remove sinus masses or cysts or deep pus which cannot be accessed using a small trephine.

It can take up to six weeks for full recovery from sinus surgery and for the infection to be fully cleared.

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