Page 157 - Manual of Equine Field Surgery

Dorsal Displacement of the Soft Palate 153

Staphylectomy is often used in conjunction POSTOPERATIVE CARE

with sternothyrohyoideus myectomy. A compos-

ite procedure has been described that includes a

ventriculectomy in addition to myectomy and Postogerativ-e Care {or Myedomy and

partial staphylectomy.18 Staphylectomy has also .. Jfenedomy Procedures

been used in conjunction with epiglottic aug-

Exercise Restridions: The horse should be
mentation for cases of flaccid epiglottis.16 rested in a stall for at least 1 week with controlled

An alternative combination procedure has handwalking followed by return to normal exercise

been described and reviewed that combines a over the next 2 to 3 weeks.

sternothyroideus myectomy, small staphylectomy, Medications: Perioperative therapy may consist

and caudal soft palate photothermoplasty.19 The of antibiotics and nonsteroidal antiinflammatory

procedure is performed through a typical laryn- drugs. These generally do not need to be contin-

gotomy approach. Prior to penetrating the ued beyond the first postoperative day unless a

cricothyroid membrane, both caudal margins of drain is in place.

the thyroid cartilage are exposed and the ster- Suture Removal: The sutures are removed in

nothyroideus muscles are transected at their 1 O to 14 days.

musculotendinous junctions. The cricothyroid Other: A towel stent or neck bandage may be

membrane is then incised to expose the laryngeal applied over the incision site and maintained for
2 to 4 days after surgery (Figure 25-13). The stent
lumen. The caudal free edge of the soft palate is or bandage protects the wound and provides

grasped with Allis tissue forceps, and a C02 laser counterpressure to the wound to reduce edema,

is used (at a power setting of 35 W and focused hematoma, and seroma formation. The Penrose

spot size of 0.22 mm) to make several lines in a drain should be removed in 2 to 3 days.

sweeping motion through the oral mucosa of the

soft palate, parallel to and extending rostral 4 to

5 cm from the caudal free margin of the palate.

A small ( 4 mm x 8 mm), semicircular section of

tissue is then sharply resected from the caudal free

margin of the soft palate. The cricothyroid mem-

brane is closed with polyglactin 910 in a simple

continuous pattern. The remaining layers are left

to heal by second intention. 0

Laser ablation of the caudal aspect of the soft

palate can also be performed i11 the standing

sedated horse using the Nd:YAG or diode laser or

electrocautery with endoscopic visualization in an

attempt to increase the rigidity of the palate. To

perform the procedure effectively, the palate must

be displaced during the procedure. Maintaining

this position can be difficult due to swallowing,

I )) J.. ..
etc., in the conscious horse.17 I I \

'

I 1\ .t;
I l
I 'i

Tie-Forward Procedure I I ~L ,,~

A tie-forward procedure has also been described ' \ 'u
I

in which a suture is placed from the basihyoid ~ ~
'

bone to each wing of the thyroid cartilage at the )j~
~

insertion site of the sternothyroideus muscle.i':"

•
This suture maintains the larynx in a rostral and Figure 25-13 Towel stent sutured in position for

slightly more dorsal position. Therefore, instead sternohyoideus myectomy, sternothyroideus tenectomy

of preventing caudal retraction of the larynx by for either DDSP or modified Forssell's procedure. The

means of the myotomy-tenotomy procedures, the stent is applied to protect the incision and to apply pres-

"tie-forward» procedure maintains the larynx in a sure to the incision site to minimize postoperative

hematoma or seroma formation.
fixed cranial position.