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576 Laryngeal Trauma

○ Unilateral arytenoid lateralization improves • Generalized neurologic signs commonly the upper jaw with a piece of rolled
gauze.
clinical signs in small-breed dogs with develop within 1 year of diagnosis of • The examiner should pull the tongue down
VetBooks.ir • Concurrent palate resection in dogs that also • Poor prognosis with progressive polyneu- with a gauze sponge and use a videoendo-
idiopathic laryngeal paralysis.
concurrent laryngeal paralysis and laryn-
geal collapse.
ropathy (rottweiler, Dalmatian, others)
scope or laryngoscope to visualize the larynx.
have elongated soft palate
• Mortality rate of 14%; higher complica-
that normal opening of cartilages during
tion rates among older animals and those Note each inhalation for the examiner so
Possible Complications with concurrent respiratory, esophageal, or inspiration can be differentiated from
• Aspiration pneumonia reported in 8%-35% neurologic disease abnormal, paradoxical movement (abnormal:
of dogs and 30% of cats after unilateral passive inward motion on inhalation, passive
arytenoid lateralization PEARLS & CONSIDERATIONS outward motion on exhalation).
• Coughing/gagging in 10%-16% after
unilateral arytenoid lateralization Comments Client Education
• Respiratory distress requiring temporary • Doxapram helps differentiate a deep anes- • Progressive polyneuropathy/polymyopathy,
tracheostomy; postoperative megaesophagus; thetic plane from laryngeal paralysis. which may be identified in dogs with
concurrent respiratory tract, esophageal, • Laryngeal function is inhibited in normal laryngeal paralysis, can increase the risk of
neurologic, or neoplastic disease dogs with some anesthetic combinations surgical complications.
• Bilateral arytenoid lateralization associated (acepromazine/thiopental, acepromazine/ • Upper airway noise, change in/loss of bark,
with increased risk of postoperative complica- propofol, ketamine/diazepam). and coughing often persist after surgery.
tions and death • Nonsurgical management is initially recom- • There is a lifelong risk of aspiration pneu-
• Complication rate higher (74% vs. 32%) in mended for dogs with unilateral disease or monia after surgery, but survival improves
dogs with neurologic comorbidities clinical signs limited to coughing/dysphonia. with surgery.
• Perioperative metoclopramide does not • Some dogs do better when fed dry food from
Recommended Monitoring decrease the risk of aspiration pneumonia. floor level. Try different food consistencies,
• Monitor for respiratory distress for 12-24 • Laryngeal paralysis is often an initial sign of bowl positions, and feeding strategies to
hours after surgery. generalized, progressive polyneuropathy. reduce postoperative coughing and gagging
• Restrict exercise and reduce barking for 1-2 • Surgical correction improves ability to breathe and to slow down food intake.
months after surgery. but does not reverse voice changes.
• Re-evaluate laryngeal function and repeat SUGGESTED READING
chest films as needed if clinical signs recur. Prevention Monet E: Surgical treatment of laryngeal paralysis.
Affected animals, especially members of Vet Clin Small Anim 46:709-717, 2016.
PROGNOSIS & OUTCOME predisposed breeds, should not be bred. AUTHOR: Karen M. Tobias, DVM, MS, DACVS

• Reduction of respiratory signs and improved Technician Tips EDITOR: Megan Grobman, DVM, MS, DACVIM
exercise tolerance in 90% of dogs after • To assist during laryngeal exam, position
unilateral arytenoid lateralization the dog in sternal recumbency, and hold

Laryngeal Trauma Client Education
Sheet

BASIC INFORMATION • Long-term intubation for positive pressure PHYSICAL EXAM FINDINGS
ventilation • Tachypnea, dyspnea
Definition • Bronchoscopy • Stridor: usually more prominent on inspi-
Trauma resulting in disruption of, or damage • Surgery near the larynx (e.g., mass excision, ration but can be both inspiratory and
to, laryngeal structures (thyroid, cricoid, and tracheal stent) expiratory (fixed obstruction)
arytenoid cartilages) and surrounding soft • Mucous membranes: ± pallor or cyanosis
tissues ASSOCIATED DISORDERS • Thoracic auscultation: referred upper airway
• Polytrauma: head/cervical trauma, respiratory noise, ± harsh lung sounds, ± crackles (e.g.,
Epidemiology compromise, cardiovascular shock noncardiogenic pulmonary edema, pulmo-
SPECIES, AGE, SEX • Subcutaneous emphysema, pneumomedias- nary contusions, aspiration pneumonia)
• Dogs and cats; no age or sex predisposition tinum, and potentially, pneumothorax and • Subcutaneous emphysema in cervical region
• Cats may be predisposed to iatrogenic pneumoretroperitoneum with penetrating wounds or laryngeal fracture
laryngeal trauma from orotracheal Clinical Presentation and laceration
intubation. • ± Hyperthermia (dogs: inability to pant)
HISTORY, CHIEF COMPLAINT • Neurologic deficits associated with cervical
RISK FACTORS • ± History of witnessed trauma (e.g., bite spine injury
• Animal fight/attack wounds, penetrating missile, choking), recent
• Access to outside while unsupervised poses prolonged or difficult intubation, surgery Etiology and Pathophysiology
general increased risk of trauma such as (cervical) or bronchoscopy • Rough or prolonged intubation can cause
impalement, projectile missiles, foreign • Acute onset of dyspnea with stridor trauma to the mucosa, arytenoids, and
bodies, strangulation, and vehicular accidents. • Exercise intolerance vocal folds, resulting in hyperemia or
• Use of choke collars • Dysphonia and/or dysphagia edema, ulceration, and granulation tissue
• Anesthesia with intubation • Cough/hemoptysis formation.

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