Page 151 - Manual of Equine Field Surgery

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CHAPTER 25

Surgical Treatment Options for Dorsal

Displacement of the Soft Palate

David A. Wilson

spay hook may be useful for the sternothyroideus
INDICATIONS tenectomy procedure.9 A Gelpi or Weitlaner

self-retaining retractor, Allis tissue forceps, long-

Dorsal displacement of the soft palate (DDSP) handled or right-angle scissors, and curved

causes temporary or intermittent exercise intoler- sponge forceps are used for soft palate resection.

ance. A number of factors potentially influence An Nd:YAG, C02, or diode laser may be used to

soft palate position, and accordingly a variety of transect muscle or to perform the staphylectomy

procedures have been described for the treatment or photothermoplasty procedures.10,12,13,17,19

of DDSP. Altering the head position, changing

tack, and using a "tongue-tie" or a figure-eight

noseband are a few of the conservative treatment PREPARATION AND POSITIONING

options that may help horses with DDSP and aid

in the diagnosis and determination of the cause of Most procedures are best performed with the

the displacement. Various surgical procedures horse under general anesthesia in dorsal recum-

have been described to treat DDSP, including b.ency and the head extended; however, withexpe-

sternothyrohyoideus myectomy, sternothyroideus rience, they can be accomplished in the standing

tenectomy, staphylectomy, and epiglottic aug- sedated horse with local anesthesia.

mentation.l" Various combinations of the proce- Staphylectomy procedures require temporary

dures have also been described.P'" Also, various access to the larynx. This is typically accomplished

laser procedures to either resect or cauterize the by using intravenous anesthesia. When an endo-

soft palate, and a tie-forward procedure have been tracheal tube is used, it is removed for the portion

recently described to address DDSP.10,12,13,1?,20
of the procedure requiring access to the larynx.

None of these procedures are very effective for

persistent DDSP because of the likely damage to

innervation of the soft palate and pharynx in ANATOMY

these cases.

The sternomandibularis originates from manu-

brium sterni, extends the entire length of the

EQUIPMENT neck, forming the ventral border of the jugular

furrow; and inserts on the caudal border of the

Rochester-Carmalt forceps, straight Rochester- rarnus of the mandible ( see Figures 23-1 through

an 23-5). At approximately the mid-cervical region,
Pean forceps with longitudinal serrations )
angiotribe or a similar instrument, and a Penrose the paired sternomandibularis muscle diverges

drain are used for the myectomy procedures. A from midline, exposing the underlying paired

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