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574 Laryngeal Paralysis

Behavior/Exercise PROGNOSIS & OUTCOME Technician Tips
Limit exercise and discourage barking for 2-4 • The prognosis is good for benign lesions if When preparing for exams of animals with
VetBooks.ir helpful. • Prognosis for malignant laryngeal tumors is tongue depressor (to move the soft palate), an
laryngeal disease, have nearby a laryngoscope,
weeks after surgery. Mild sedation may be
complete resection is possible.
extra endotracheal tube (if the first becomes
Possible Complications
biopsy forceps, formalin, 22- or 23-gauge
• Postoperative swelling guarded: occluded with blood and mucus), long cup
○ Advanced disease is often detected at the
• Dysphagia and/or gagging time of diagnosis. needles of varying lengths (1-inch, 1 10 -inch,
• Pharyngeal dehiscence ○ May not be surgically resectable spinal needles), 6- or 12-mL syringes a n d
• Laryngeal stenosis/webbing microscope slides (for aspiration cytology), and
• Hypoparathyroidism/hypothyroidism (if PEARLS & CONSIDERATIONS cotton-tip swabs (or gauze sponges and forceps
removed during laryngectomy) or suction) for clearing mucus or blood.
• Tumor recurrence or metastasis Comments
• Obstruction, self-trauma of tracheostoma • Leaving the ventral part of the vocal cords Client Education
• Subcutaneous emphysema secondary to intact may help prevent postoperative Vocalization is lost after total laryngectomy.
laryngeal/tracheal incision laryngeal webbing.
• A CO 2 laser works well for surgical dissection SUGGESTED READING
Recommended Monitoring and results in minimal inflammation and Withrow SJ: Tumors of the respiratory system. In
• Monitor closely for upper airway obstruc- hemorrhage. Withrow SJ, editor: Small animal clinical oncology,
tion secondary to postoperative pharyngeal ○ When using a laser, ensure the endotracheal ed 5, Philadelphia, 2013, Saunders, pp 432-462.
swelling. tube is protected from the laser beam.
• Withhold water and food for at least 24-48 • Some patients may benefit from a feeding AUTHOR: Michael B. Mison, DVM, DACVS
EDITOR: Megan Grobman, DVM, MS, DACVIM
hours in the postoperative period. tube for postoperative nutritional support
• Routine laryngoscopic re-evaluation is (pp. 1106 and 1109).
recommended to identify tumor recurrence • Rhabdomyoma, oncocytoma, and granular
or laryngeal stenosis. cell tumors share many cytologic and his-
• Periodic physical and radiographic evaluation tologic features. These neoplasms should be
is recommended to check for recurrence or differentiated using histochemical staining
metastasis. and immunohistochemical analysis.

Laryngeal Paralysis Client Education
Sheet

BASIC INFORMATION RISK FACTORS • Dysphagia or megaesophagus is possible in
• Damage to the recurrent laryngeal nerve dogs with polymyopathy, polyneuropathy,
Definition (blunt trauma, neoplasia, thoracic or cervical or reflux/esophagitis.
Lack of abduction of arytenoid cartilages and surgery) • Aspiration pneumonia/chronic aspiration-
vocal folds secondary to cricoarytenoideus • Any condition resulting in polyneuropathy associated lung injury can develop secondary
dorsalis muscle or recurrent laryngeal nerve or polymyopathy to dysphagia, EERD, esophageal or laryngeal
dysfunction is common in old, large-breed dogs ○ Myasthenia gravis dysfunction.
but rare in cats. ○ Immune-mediated disorder • Noncardiogenic pulmonary edema/
○ Diabetes mellitus acute respiratory distress syndrome with
Epidemiology ○ Hypothyroidism (cause/effect relationship vigorous inspiration against upper airway
SPECIES, AGE, SEX not established) obstruction
• Dogs: males more common; no sex predis- ○ Toxins (lead, organophosphates) Clinical Presentation
position in cats ○ Progressive idiopathic polyneuropathy
• Congenital form: animals < 1 year old • Extraesophageal reflux disease (EERD) DISEASE FORMS/SUBTYPES
• Acquired form: middle-aged/older dogs and • Cervical/intrathoracic masses • Unilateral: clinical signs mild or absent except
cats (mean, 9-11 years of age) • In cats, associations with tick paralysis, in performance dogs or in cats
idiopathic polyneuropathy, bronchogenic • Bilateral: clinical signs apparent in most
GENETICS, BREED PREDISPOSITION carcinoma, trauma, and brainstem lesions animals
• Acquired form commonly reported in Labra- have been reported.
dor retrievers, other large/giant breeds (Saint HISTORY, CHIEF COMPLAINT
Bernards, Newfoundlands, Irish setters). No GEOGRAPHY AND SEASONALITY • Varied progression over months to years
breed predisposition in cats. Hot weather/humidity and panting may • Signs worsened by exercise and increased
• Congenital increase severity of clinical signs. environmental temperature/humidity
○ Autosomal dominant: Bouviers des Flandres Early:
○ Associated with laryngeal paralysis poly- ASSOCIATED DISORDERS • Inspiratory stridor; very common
neuropathy complex: Leonberger dogs, • Soft palate elongation occurs in 20% • Voice change (i.e., dysphonia)
rottweilers, Pyrenean mountain dogs, because of chronic increased inspiratory • Exercise intolerance with associated respi-
Dalmatians, and black Russian terriers effort. ratory noise and/or breathlessness; very
○ Other: bull terriers, Siberian Huskies, • Weakness and muscle wasting evident in up common
white-coated German shepherd dogs to 50% of chronically affected dogs. • Coughing, gagging when eating

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