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Epiglottic Entrapment in Horses

Epiglottic Entrapment in Horses. Erica Fields, DVM. Normal Epiglottis. Curved (dorsally convex), smooth Base nearly vertical Tip at right angle to dorsal surface of the soft palate, pointed, narrow Serrated lateral edges Vascular pattern on dorsal surface

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Epiglottic Entrapment in Horses

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  1. Epiglottic Entrapment in Horses Erica Fields, DVM

  2. Normal Epiglottis • Curved (dorsally convex), smooth • Base nearly vertical • Tip at right angle to dorsal surface of the soft palate, pointed, narrow • Serrated lateral edges • Vascular pattern on dorsal surface • Aryepiglottic folds attach to lateral edges Butler, Clinical Radiology of the Horse

  3. Common Epiglottic Abnormalities • Epiglottic entrapment • Epiglottic shortening (hypoplasia) • Subepiglottic cysts • Ulceration/inflammation Butler, Clinical Radiology of the Horse

  4. Epiglottic Entrapment • Apex and lateral margins become enveloped by ventral mucosa and aryepiglottic folds • Blunted and shortening of epiglottis • Ulceration may occur

  5. Clinical Signs • Exercise intolerance at high speeds • Abnormal respiratory sounds at high speeds; asymptomatic at rest • Jockey may report “holding breath” • Mostly problematic in Thoroughbreds and Standardbreds Equine Surgery / www.ctba.com

  6. Radiographic Appearance

  7. Radiographic Appearance

  8. Radiographic Appearance • Blunt, short epiglottis • May be dorsally or caudally deviated • Must be differentiated from epiglottic shortening • Endoscopy is method of choice for diagnosis

  9. Endoscopic Appearance

  10. Possible Causes • Definitive cause unknown • Onset often coincides with training; inflammation/trauma? • Infection? • Developmental shortening

  11. Treatment Options • Conservative: topical anti-inflammatories • Surgical transection—endoscopic laser transection, Bistoury transection (blind or endoscopic), resection of a section of fold via ventral laryngotomy Russell and Wainscott, 2007

  12. Laser Transection

  13. Laser Transection—Post-op

  14. Outcomes • Relatively high rate of complication with surgery (DDSP, re-entrapment) • Racehorses affected, so prognosis involves return to function, not just survival • Study of horses just off track—0.9% prevalence, NO ADVERSE EFFECT on performance Brown, et al, 2005

  15. Outcomes • Study of clinical horses—0.6% prevalence • Post-op study—26/27 horses raced again; 13/27 improved in handicap, 13/27 decreased handicap Hobo, et al, 1995 and Russell and Wainscott, 2007

  16. References • Brown JA, Hinchcliff KW, Jackson MA, Dredge AF, O’Callaghan PA, McCaffrey JP, Slocombe RF, Clarke AF. Prevalence of pharyngeal and laryngeal abnormalities in Thoroughbreds racing in Australia, and their association with performance. Equine Veterinary Journal. (2005) 37(5): 397-401 • Butler, Clinical Radiology of the Horse • Equine Surgery textbook • Hobo S, Matsuda Y, Yoshida K. Prevalence of upper respiratory tract disorders detected with a flexible videoendoscope in Thoroughbred racehorses. Journal of Veterinary Medical Science. (1995) 57(3): 409-413. • Russell T, Wainscott M. Treatment in the field of 27 horses with epiglottic entrapment. The Veterinary Record. (2007) 161: 187-189.

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