Transendoscopic injection of poly-L-lactic acid into the soft palate in horses: A new therapy for dorsal displacement of the soft palate?

Abstract

The purpose of this study was to establish a minimal invasive, transendoscopic technique for injection of poly-L-lactic acid into the free edge of the soft palate that can be performed on the standing sedated horse. Furthermore, whether the implant material induces an increase in fibrous tissue at the injection site, resulting in a greater rigidity of the soft palate, was determined. In 4 horses, the injection was performed bilaterally along the caudal margin of the soft palate, and the influence of the treatment on the soft palate function was determined. Clinical, radiographic and endoscopic examinations at rest were performed before and up to 168 days after injection according to a standardized examination protocol. In 6 horses, the implant material was injected unilaterally into the right half of the caudal margin of the soft palate. After clinical and endoscopic follow-up examinations, 2 horses each were killed 28, 84, and 168 days after the implantation procedure. At necropsy, macroscopic comparison of the treated and the untreated halves of the soft palate showed the influence on the size of the ostium intrapharyngeum and on the soft palate thickness. The localization of the implant material in the soft palate and the tissue response to the poly-L-lactic acid were evaluated histologically. Transendoscopic injection into the soft palate requires neither general anesthesia nor wound management, and it is noted for minimal tissue trauma. After injection, no alteration of the soft palate function was observed in horses with normal upper airway mechanics. One horse with intermittent dorsal displacement of the soft palate showed an improvement of the soft palate function for 112 days after implantation. No significant alteration in the size of the ostium intrapharyngeum was evident in any horse. Histologic assessment indicated the presence of implant material during the entire observation period of 168 days. The implant was accompanied by a granulomatous inflammation, and it was encapsulated by fibrous tissue. This may result in an increase in stiffness, and subsequent a greater rigidity of the soft palate, preventing it from displacement. The injection may therefore be considered an alternative to established therapies in horses showing dorsal displacement of the soft palate because of its unstable free edge.