Page 680 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Respir atory system: 3.2 Surgical conditions of the respir atory tr act 655

VetBooks.ir 3.100 3.101

Fig. 3.100 A horse that is racing successfully having Fig. 3.101 Web larynx, or iatrogenic ventral
undergone a left ventriculocordectomy. glottic stenosis. The horse had undergone a laser
Hobday under sedation, and subsequently developed
an adhesion (arrow) from the right vocal cord to the
previous scar.
IATROGENIC VENTRAL
GLOTTIC STENOSIS
Diagnosis
Definition/overview Endoscopic examination is diagnostic (Fig. 3.101).
This is a complication of ventriculocordectomy, A fibrous adhesion joining the site of the two vocal
involving adhesion formation in the ventral larynx. cords is present, and the degree of glottic stenosis is
variable.
Aetiology/pathophysiology
A mucosa-covered, fibrous band of tissue forms, Management
stretching across the laryngeal lumen. Glottic This is a difficult condition to treat, exacerbated by
stenosis is iatrogenic, usually after bilateral ven- the difficulty of client management with any iat-
triculocordectomy or rarely after severe external rogenic condition. The most successful procedure
laryngeal trauma. The condition is particularly appears to be the creation of a mucosal flap on one
common following laser surgery, presumably asso- side of the larynx, folded back and sutured to itself,
ciated with the extended ‘die back’ following the leaving the other side to granulate.
thermal injury of laser. It has been reported after
unilateral laser cordectomy, while bilateral cordec- Prognosis
tomy is almost invariably the cause following con- If a second surgery is successful, then the prognosis
ventional surgery. is good. However, recurrence of the cicatrix is a fre-
quent complication.
Clinical presentation
Ventral glottic stenosis usually presents as a dete- VENTROAXIAL LUXATION OF THE
rioration in respiratory noise following laryngeal APEX OF THE CORNICULATE
surgery. PROCESS (VALACP)

Differential diagnosis Definition/overview
Natural progression of RLN or incorrect diagno- VALACP is another respiratory obstruction at exer-
sis of the respiratory obstruction in the first place cise, which was not appreciated prior to dynamic
should be considered. endoscopy. The apex of the corniculate processes