Podcast
Questions and Answers
What is one of the primary functions of the larynx?
What is one of the primary functions of the larynx?
Which breeds are commonly associated with congenital laryngeal paralysis?
Which breeds are commonly associated with congenital laryngeal paralysis?
What is a significant difference between the laryngeal anatomy of cats and dogs?
What is a significant difference between the laryngeal anatomy of cats and dogs?
What is the most common cause of acquired laryngeal paralysis?
What is the most common cause of acquired laryngeal paralysis?
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Which nerve is primarily responsible for the motor supply to the larynx?
Which nerve is primarily responsible for the motor supply to the larynx?
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What happens to the vocal folds when an animal breathes in?
What happens to the vocal folds when an animal breathes in?
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Which type of laryngeal paralysis includes paradoxical motion?
Which type of laryngeal paralysis includes paradoxical motion?
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What is one key intervention for managing dyspneic animals?
What is one key intervention for managing dyspneic animals?
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What is the effect of unilateral arytenoid lateralization surgery?
What is the effect of unilateral arytenoid lateralization surgery?
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What should be avoided for dogs that are mildly symptomatic due to laryngeal paralysis?
What should be avoided for dogs that are mildly symptomatic due to laryngeal paralysis?
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Which area of the trachea is primarily involved in inhalation?
Which area of the trachea is primarily involved in inhalation?
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What should be included in the acute treatment for bronchial collapse?
What should be included in the acute treatment for bronchial collapse?
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Which breed has a higher incidence of bronchial collapse?
Which breed has a higher incidence of bronchial collapse?
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What is the main limitation of surgical treatments for bronchial collapse?
What is the main limitation of surgical treatments for bronchial collapse?
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What is considered a long-term chronic treatment option for managing bronchial collapse?
What is considered a long-term chronic treatment option for managing bronchial collapse?
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What percentage of cases can be successfully managed medically for more than a year?
What percentage of cases can be successfully managed medically for more than a year?
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What is a common complication following the placement of intraluminal tracheal stents?
What is a common complication following the placement of intraluminal tracheal stents?
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What is a possible outcome of using extraluminal prosthetic tracheal rings?
What is a possible outcome of using extraluminal prosthetic tracheal rings?
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What does the normal tracheal width to height ratio indicate?
What does the normal tracheal width to height ratio indicate?
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Which is NOT a clinical sign associated with tracheal collapse?
Which is NOT a clinical sign associated with tracheal collapse?
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What anatomical structure is affected by tracheal collapse?
What anatomical structure is affected by tracheal collapse?
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What outcome can result from the loss of glycoprotein in the trachea?
What outcome can result from the loss of glycoprotein in the trachea?
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Which breed is typically predisposed to tracheal collapse?
Which breed is typically predisposed to tracheal collapse?
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What does a 'goose honk' cough typically indicate?
What does a 'goose honk' cough typically indicate?
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What type of dogs are primarily affected by brachycephalic obstructive airway syndrome (BOAS)?
What type of dogs are primarily affected by brachycephalic obstructive airway syndrome (BOAS)?
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What is a common reason for the development of coughing in tracheal collapse?
What is a common reason for the development of coughing in tracheal collapse?
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What complication can occur if the soft palate swells after a staphylectomy?
What complication can occur if the soft palate swells after a staphylectomy?
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What is the most common result of laryngeal collapse in brachycephalic dogs?
What is the most common result of laryngeal collapse in brachycephalic dogs?
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Which stage of laryngeal collapse involves the eversion of the laryngeal saccule?
Which stage of laryngeal collapse involves the eversion of the laryngeal saccule?
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What is the primary disease that must be treated to address laryngeal collapse?
What is the primary disease that must be treated to address laryngeal collapse?
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What happens to the nasal conchae in brachycephalic dogs due to their skull structure?
What happens to the nasal conchae in brachycephalic dogs due to their skull structure?
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What is a common early clinical sign of respiratory issues?
What is a common early clinical sign of respiratory issues?
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Which diagnostic method is NOT commonly performed clinically?
Which diagnostic method is NOT commonly performed clinically?
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What condition is suggested if there is no motion of the arytenoids during inhalation?
What condition is suggested if there is no motion of the arytenoids during inhalation?
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Which diagnostic tool would indicate a week esophageal function?
Which diagnostic tool would indicate a week esophageal function?
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What is a possible result of administering too deep a level of anesthesia during an upper airway examination?
What is a possible result of administering too deep a level of anesthesia during an upper airway examination?
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What does bilateral laryngeal paralysis with paradoxical motion entail?
What does bilateral laryngeal paralysis with paradoxical motion entail?
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Which diagnostic finding is commonly associated with hypothyroidism in blood work?
Which diagnostic finding is commonly associated with hypothyroidism in blood work?
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What respiratory sign is characterized by difficulty breathing?
What respiratory sign is characterized by difficulty breathing?
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What is a potential complication associated with aspiration pneumonia?
What is a potential complication associated with aspiration pneumonia?
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What is the first step in evaluating arytenoid function during an upper airway exam?
What is the first step in evaluating arytenoid function during an upper airway exam?
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Study Notes
Small Animal Surgical Respiratory Diseases
- Presents a discussion of small animal surgical respiratory diseases, including tracheal collapse, brachycephalic obstructive airway syndrome (BOAS), and laryngeal paralysis.
- The learning objectives focus on describing anatomy and pathophysiology, diagnosing specific conditions, formulating treatment plans, educating clients, understanding surgical options, and assessing prognosis.
- Tracheal collapse is a progressive, irreversible condition where the tracheal width-to-height ratio deviates from 1:1. Laxity of the trachealis muscle progresses, leading to weakness in cartilage rings and possible lumen obliteration. Collapse typically occurs in a dorsoventral direction.
- Pathophysiology includes water loss due to the reduction of glycoproteins and glycosaminoglycans, resulting in cartilage rigidity loss. Coughing can also lead to inflammation, squamous metaplasia of the epithelium, and increased mucous secretion, contributing to the condition.
- Signalment often involves toy and small breed dogs (Yorkies, mini poodles, Pomeranians, Chihuahuas) of middle age.
- Clinical signs associated with respiratory issues include coughing (a "goose honk" sound), episodic dyspnea, exercise intolerance, cyanosis, and syncope, all often exacerbated by palpation.
- Normal respiration involves the expansion of the chest by respiratory muscles, negative pressure within the chest, thoracic expansion, and cervical region compression.
- Extrathoracic trachea collapse occurs during inhalation while intrathoracic trachea collapses during exhalation.
- Pomeranians have a higher incidence of bronchial collapse (up to 83%). Surgical treatment for bronchial collapse is not possible.
- Medical management includes acute oxygen therapy, sedatives, cough suppressants, short-acting corticosteroids, anti-inflammatory doses, bronchodilators.
- Chronic management strategies include controlled exercise (especially when hot), weight loss, and modifications for the environment (avoiding smoke, scented candles, and other irritants), and using a harness instead of a collar for extra support.
- Medications include cough suppressants, sedatives, bronchodilators, corticosteroids, and antibiotics (if a respiratory infection is suspected).
- Medical management is successful in 71% of cases for over a year, possibly eliminating surgical intervention in some cases. Surgery might fail, or the patient may require ongoing medical support.
- Surgical procedures can address the extra-luminal tracheal rings. These treatments do not address possible bronchial collapse, but there is an 75-85% success rate and offer immediate improvement post-operatively. Complications (10-30% of dogs) can occur. Examples are laryngeal paralysis, tracheal necrosis, and pneumothorax.
- Intraluminal tracheal stents treat the entire trachea, but do not address bronchial collapse. Intraluminal stents offer an 83-89% success rate for 1 year follow-up. Post-operative care includes cough suppressants, as needed sedatives, tapering doses of corticosteroids, antimicrobials (2 weeks), and regular re-evaluation with radiographs. Complications include stent fractures, granulation tissue, and stent migration.
- Laryngeal paralysis is a complex anatomical condition involving the epiglottis, thyroid cartilage, cricoid cartilage, arytenoid cartilage, and rima glottidis.
- Cats differ from dogs in that their arytenoid cartilages do not have cuneiform or corniculate processes.
- Laryngeal physiology involves assisting swallowing, pulling cranially for epiglottic coverage, and controlling airway resistance, including reducing resistance during inhalation and controlling the tension on vocal cords (for voice production).
- Laryngeal paralysis results in the loss of ability to abduct arytenoids during inhalation. This process is driven by degeneration of the recurrent laryngeal nerves and loss of function of the cricoarytenoideus dorsalis muscle.
- Congenital laryngeal paralysis is often seen in Siberian Huskies, Dalmatians, Rottweilers, Bouvier des Flandres, and Bull Terriers. Clinical signs begin before 1 year of age. Congenital conditions are frequently accompanied by diffuse neurologic disease.
- Acquired laryngeal paralysis is more common in Labradors, Goldens, Saint Bernards, and Irish Setters with a male dominance. The average age of onset for this type of condition is 9 years. Clinical signs can start acutely (or chronically), often from a progression of a previous chronic condition.
- Diagnosis of respiratory diseases often involves complete blood counts, chemical panels, urinalysis, thyroid panels, thoracic radiographs, swallowing and upper airway examinations.
- Emergency management during respiratory distress can include oxygen, cool environment, sedation (like acepromazine or butorphanol), corticosteroids, and possibly intubation or temporary tracheostomy.
- Medical management involves weight loss, exercise restriction, avoidance of stressful situations (like extreme heat), and harness instead of neck collars.
- Surgical procedures include unilateral arytenoid lateralization.
- Post-operative care involves avoiding food and/or water until the morning following surgery. If no signs of gagging or coughing occur upon intake of food/water, try again later. Patients may benefit from meatballs or canned food to initiate a feeding regimen, gradually increasing the intake of food from solids to kibble over 2-4 weeks. Heavy sedation post-operation should be avoided.
- Complications can include aspiration pneumonia (8-21%), lifelong risk of esophageal dysfunctions, consistent coughing/gagging (up to 33%), persistent recurrent respiratory signs (up to 33%), surgical failure, suture breakage, and cartilage breakdown.
- Outcomes after lateralization are generally positive, improvement is seen in 90% of cases and 70% of patients are still alive after 5 years of monitoring.
- Long-term outcomes of acquired laryngeal paralysis show that it is part of a peripheral neuropathy (GOLPP); 31% have accompanying peripheral neurologic signs, like pelvic limb scuffing, ataxia, and hind limb weakness. Most owners attribute to old age or arthritis.
- Brachycephalic obstructive airway syndrome (BOAS) comprises stenotic nares, elongated soft palate, everted laryngeal saccules, and hypoplastic trachea (among others).
- Diagnostic procedures for BOAS often include evaluation of the nares, palate, pharynx, larynx.
- Surgical treatments for BOAS can be useful if the medical treatment is not successful. Anaesthesia is often a higher risk factor, especially if surgery is done at the latter part of the day.
- Complications of BOAS surgery include dyspnea caused by the swelling of the soft palate post-operation.
- Further complications include death due to issues like aspiration pneumonia or failure to recover from anesthesia.
Brachycephalic Obstructive Airway Syndrome (BOAS)
- BOAS causes various upper airway abnormalities causing increased airway resistance. Typical breeds affected are those where the physical characteristics reduce the size of the airway.
- Primary abnormalities of BOAS include stenotic nares, elongated soft palate, everted laryngeal saccules, and hypoplastic trachea.
- There can be additional, secondary abnormalities to account for.
- There are multiple methods of treating BOAS, some of which might differ depending on which symptoms are prominent.
Other findings in BOAS
- Additional signs of abnormalities other than those listed can also be present
- Abnormal nasal conchae or everted tonsils can be seen in BOAS.
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Description
Explore essential concepts related to the larynx and bronchial collapse in animals. This quiz covers anatomy, conditions, and treatments pertinent to veterinary science. Test your knowledge of congenital issues, surgical interventions, and more within the field of animal health.
