Alar fold resection in 25 horses: Clinical findings and effect on racing performance and airway mechanics (1998-2013).

Abstract

To report clinical findings and performance in horses in which alar fold collapse (AFC) had been diagnosed and surgically treated and to assess form and degree of respiratory obstruction. Retrospective case series. Twenty-one standardbreds, 2 coldblooded trotter racehorses, 1 thoroughbred, and 1 Icelandic horse. Alar fold collapse was diagnosed on the basis of continuous abnormal expiratory flutter noise coinciding with filling of the false nostrils during exercise on a high-speed treadmill that was alleviated by suturing the alar folds (AF) temporarily in a dorsal position. In 5 cases, nasopharyngeal airway pressures were assessed. Performance after complete, bilateral AF resection was assessed by reviewing career race records and by owner or trainer telephone interviews. Horses presented because of poor performance, abnormal respiratory noise, or both. Additional dynamic disorders were identified in 12 of 21 standardbreds (intermittent dorsal displacement of the soft palate: n = 10; collapse of the roof of the nasopharynx: n = 2). Expiratory nasopharyngeal pressures seemed elevated in horses with AFC (range, +10.8 to +21.8 cm H2 O) compared with normal reference values. Dorsal fixation as well as complete surgical resection of the AF improved expiratory nasopharyngeal pressures to reported normal levels. At a mean of 68 months (range, 7-121) follow-up, 20 of 25 horses had competed after surgery, and 13 of 17 of the harness racehorses had established or improved their kilometer racing time marks. Alar fold collapse caused mild to moderate expiratory obstruction and may have contributed to secondary nasopharyngeal collapse in this population. Complete surgical resection seems effective for treating AFC. Nasopharyngeal pressure measurement is a potential tool for confirming the diagnosis of AFC.