Arytenoid Chondritis Research Articles

Clinical and Pathological Features in Horses With Advanced Arytenoid Chondritis.

Equine arytenoid chondritis causes airway obstruction and abnormal upper airway noise due to a space-occupying lesion(s) and decreased abduction. Our objective was to compare clinical scores and ultrasonographic findings with gross and microscopic lesions of naturally occurring arytenoid chondritis, in order to guide surgical treatment. Seventeen naturally affected horses with advanced/severe chronic arytenoid chondritis and 4 control arytenoid cartilages were evaluated after partial arytenoidectomy. Cartilages were sectioned caudal to the corniculate process and the body of each arytenoid was measured. We assessed total gross area (TA), percentage of viable cartilage (VC), percentage of viable cartilage on the lateral wall, and medial expansion. Retrospectively, the gross lesions were used to suggest 2 preferred surgical management (SM) groups: those requiring partial arytenoidectomy and those amendable to focal medial resection (a conservative SM). TA of horses with arytenoid chondritis was significantly larger than controls (P = .005), due to a layered lesion composed of cavitation, granulation tissue, fibrosis, inflammation, hemorrhage, and edema, with relatively equal medial and lateral expansion that distorted the geometry of the affected cartilage. The increased TA paralleled the presence of immature cartilage with disorganized primitive mesenchymal cells. TA and SM were positively correlated (P = .01). All cases showed varying degrees of cartilage degeneration or necrosis, more severe medially; those appearing amenable to focal medial resection arytenoid group had significantly more viable cartilage on the lateral wall (P = .02). The gross and histopathologic findings suggest a new surgical approach-focal medial resection-that may save the lateral wall of the arytenoid.

An Exploratory Study into the Implantation of Arytenoid Cartilage Scaffold in the Horse.

Respiratory function in the horse can be severely compromised by arytenoid chondritis, or arytenoid chondropathy, a pathologic condition leading to deformity and dysfunction of the affected cartilage. Current treatment in cases unresponsive to medical management is removal of the cartilage, which can improve the airway obstruction, but predisposes the patient to other complications like tracheal penetration of oropharyngeal content and dynamic collapse of the now unsupported soft tissue lateral to the cartilage. A tissue engineering approach to reconstructing the arytenoid cartilage would represent a significant advantage in the management of arytenoid chondritis. In this study, we explored if decellularized matrix could potentially be incorporated into the high motion environment of the arytenoid cartilages of horses. Equine arytenoid cartilages were decellularized and a portion of the resultant acellular scaffolds was implanted in a full-thickness defect created in the arytenoids of eight horses. The implantation was performed bilaterally in each horse, with one side randomly selected to receive an implant seeded with autologous bone marrow-derived nucleated cells (BMNCs). Arytenoids structure and function were monitored up to 4 months. In vivo assessments included laryngeal ultrasound, and laryngeal endoscopy at rest and during exercise on a high-speed treadmill. Histologic evaluation of the arytenoids was performed postmortem. Implantation of the cartilaginous graft had no adverse effect on laryngeal respiratory function or swallowing, despite induction of a transient granuloma on the medial aspect of the arytenoids. Ultrasonographic monitoring detected a postoperative increase in the thickness and cross-sectional area of the arytenoid body that receded faster in the arytenoids not seeded with BMNCs. The explanted tissue showed epithelialization of the mucosal surface, integration of the implant into the native arytenoid, with minimal adverse cellular reaction. Remodeling of the scaffold material was evident by 2 months after implantation. Preseeding the scaffold with BMNCs increased the rate of scaffold degradation and incorporation. Replacement of arytenoid portion with a tissue-engineered cartilaginous graft preseeded with BMNCs is surgically feasible in the horse, is well tolerated, and results in appropriate integration within the native tissue, also preventing laryngeal tissue collapse during exercise.

Arytenoid chondritis in two calves

ABSTRACT: Although, calf diphtheria and necrotic laryngitis are common infections in the oral cavity’s soft tissues, arytenoid chondritis is addressed as a serious but rarely diagnosed complication in cattle. This paper aimed to describe clinical, laboratory, imaging, and pathological findings in two calves with arytenoid chondritis. A 2-month-old Jersey calf and a 3-month-old Girolando calf presented 40-days history of respiratory distress. In the former, oral endoscopy revealed enlarged and immobile arytenoids with major involvement of the left arytenoid, causing severe distortion and partial obstruction of the rima glottidis. In the latter, latero-lateral radiography of the head revealed radiolucent areas and thickening at the level of the larynx to the dorsal trachea. Pathological examination of one calf showed neutrophilic multifocal inflammatory infiltrate and areas of necrosis in the cricoarytenoid cartilage, surrounded by abscessation. Definitive diagnosis of arytenoid chondritis in these two calves was established on the basis of clinical, laboratory, imaging (endoscopy and radiography), and pathological findings. Daily and careful observation of the herds and the use of ancillary diagnostic methods allowed the early diagnosis of the disease, and accurate diagnosis can improve prognosis and increase treatment success rate.

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch – case report

Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.

Ultrasonography of the larynx in horses: an update

Laryngeal ultrasonography is a useful adjunctive diagnostic technique for investigation of upper airway disorders in horses. A transcutaneous examination can be completed using equipment that is widely available to the...

Oesophageal lumen pH in yearling horses and effects of management and administration of omeprazole.

In human subjects, arytenoid chondritis can be caused by chemical trauma of mucosa attributable to gastro-oesophageal reflux. Although a similar process may be involved in the aetiopathogenesis of arytenoid chondritis in horses, the oesophageal lumen pH in this species is poorly understood. To determine if gastro-oesophageal reflux occurs in horses by characterising oesophageal lumen pH. Blinded, randomised, placebo-controlled, crossover, experimental study. Luminal oesophageal pH in six yearling horses was recorded over four 24 h periods using an ambulatory pH recorder attached to a catheter with two electrodes (proximal and distal) inserted into the oesophagus. Recordings of pH were made during three management protocols. Initially, horses grazed in a paddock (Protocol A). Horses were then moved to stables to simulate sale preparation of Thoroughbred yearlings, and were given either omeprazole (Protocol B) or placebo paste (Protocol C) orally once per day. Protocol A was repeated for each horse (after a 13 day washout period) between Protocols B and C. Summary statistics described pH range and frequency of pH changes. Associations with predictor variables were investigated using linear mixed-effects models. Data are presented as the mean ± s.d. Oesophageal lumen pH ranged from 4.90 to 9.70 (7.36 ± 0.27 and 7.18 ± 0.24 for the proximal and distal electrodes, respectively) and varied frequently (1.2 ± 0.9 changes/min and 0.8 ± 0.8 changes/min for the proximal and distal electrodes, respectively). Oesophageal lumen pH was associated with time since concentrate feeding, activity and time of day, but not with treatment of omeprazole. A small number of horses were used and measurement periods were limited. Gastro-oesophageal reflux occurs in clinically normal yearling horses. Although omeprazole had no detectable effect, oesophageal lumen pH recorded during this study did not fall within the therapeutic range of omeprazole.

Ultrasound features of arytenoid chondritis in Thoroughbred horses

Laryngeal ultrasonography can provide valuable information when considering a diagnosis of arytenoid chondritis, but specific ultrasonographic parameters have not been defined. To compare ultrasonographic findings of the arytenoid cartilages in horses with endoscopically diagnosed arytenoid chondritis with ultrasonographic findings of the arytenoid cartilages in normal horses. Ultrasound images of the larynx were obtained at the level of the arytenoid cartilages in horses with endoscopically diagnosed arytenoid chondritis and horses with normal arytenoid cartilage structure and function. Information obtained from the ultrasound examination included arytenoid cartilage cross-sectional area, arytenoid cartilage echogenicity and arytenoid cartilage shape. Comparisons were performed between affected and unaffected arytenoid cartilages. For horses with multiple examinations, relationships between time point and arytenoid cartilage cross-sectional area were determined. Chondritic arytenoid cartilages were significantly larger and had abnormal shape and echogenicity when compared with normal arytenoid cartilages (P<0.001). For horses with multiple examinations, no significant changes were identified in arytenoid cartilage size over time. Chondritic arytenoid cartilages are increased in size and have abnormal echogenicity and contour in comparison with normal arytenoid cartilages when assessed using laryngeal ultrasonography. Once enlarged, the cartilage does not appear to return to normal size after the infection and/or inflammation has resolved. Ultrasonography is a valuable diagnostic modality when investigating cases of possible arytenoid chondritis or abnormal arytenoid cartilage movement. It has additional benefit in determining the extent of disease when medial masses are present on the surface of arytenoid cartilages, aiding in surgical decision making.

Subtotal or partial unilateral arytenoidectomy for treatment of arytenoid chondritis in five calves

5 calves were evaluated for abnormal respiratory noise associated with variable degrees of respiratory distress. Tachypnea and inspiratory dyspnea were detected at initial evaluation in all calves. Endoscopic evaluation of the upper respiratory tract revealed enlarged and immobile arytenoids. Radiographic (n = 3) and computed tomographic (1) evaluation of the laryngeal area revealed images that were indicative of a large soft tissue mass at the level of the arytenoids obstructing the rima glottis. A presumptive diagnosis of arytenoid chondritis was made. A tracheostomy tube was placed in all calves. Medical treatment (with antimicrobials and anti-inflammatory drugs) was attempted in 4 calves after initial evaluation. Unilateral arytenoidectomy via a laryngotomy was performed under general anesthesia in all calves. Dysphagia and coughing were the most frequent postoperative complications. Three calves survived at least 6 months after the procedure. One calf died of a perforated abomasal ulcer 3 months after the surgery. Another calf died suddenly 1 month after the surgery of an undetermined cause. Unilateral arytenoidectomy was a viable surgical treatment for arytenoid chondritis in calves. Further research in a larger number of affected cattle is needed to determine the advantages or disadvantages of this procedure over other surgical techniques.

Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 Thoroughbred racehorses competing at less than 2400 m (1997–2007)

The success of combined prosthetic laryngoplasty with ipsilateral ventriculocordectomy (LPVC) has not been compared to that of partial arytenoidectomy (PA) in a clinical population. In Thoroughbred (TB) racehorses: (1) earnings after LPVC are unaffected by the severity of recurrent laryngeal neuropathy (RLN) (laryngeal grade III vs. grade IV); (2) LPVC and PA yield similar results in the treatment of grade III RLN; (3) performance outcome following PA is independent of diagnosis (RLN vs. unilateral arytenoid chondritis [UAC]); and (4) neither LPVC nor PA returns horses to the level of performance of controls. Medical and racing records of 135 TB racehorses undergoing LPVC or PA for the treatment of grade III or IV RLN or UAC were reviewed. Racing records of age and sex matched controls were also reviewed. After LPVC, horses with grade III RLN performed better compared to those with grade IV RLN. Furthermore, horses treated for grade III RLN by LPVC showed post operative earnings comparable to controls. Rate of return to racing were similar for PA and LPVC, although LPVC resulted in higher post operative earnings. Performance after PA was similar regardless of diagnosis (UAC or RLN). Finally, neither LPVC when performed for grade IV RLN, nor PA performed for either diagnosis restored post operative earnings to control levels. Thoroughbred racehorses treated by LPVC for grade III RLN show significantly better post operative earnings compared to horses treated for grade IV disease. In grade III RLN, LPVC returns earning potential to control levels. PA and LPVC lead to similar success in terms of rate of return to racing, but PA leads to inferior earnings after surgery. Laryngoplasty should be recommended for all TB racehorses with grade III RLN to maximise return to racing at a high level. This contradicts the common approach of waiting for complete paralysis.

ULTRASONOGRAPHY OF THE EQUINE LARYNX

Nasopharyngeal and laryngeal evaluation is important when examining horses with upper airway signs for poor performance. Currently endoscopy is the most common method to evaluate the equine upper airway. Ultrasonography of the equine larynx has not previously been described. Using six cadaveric specimens and four standing horses, the ultrasonographic appearance of the equine larynx was established. A scanning technique, including useful acoustic windows and the normal ultrasonographic appearance at each site, is described. Ultrasound allowed visualization of portions of the hyoid apparatus, laryngeal cartilages, associated soft tissues, and intrinsic and extrinsic laryngeal musculature, that are not seen using endoscopy. Additionally, real-time ultrasound allowed observation of the movement of the vocal folds and the arytenoid cartilages during respiration. In three horses with arytenoid chondritis, ultrasonography aided in the diagnosis and localization of arytenoid abcessation and perilaryngeal inflammation. The establishment of this technique will serve as the basis for future investigations in the evaluation of clinical patients with upper airway abnormalities.

Arytenoid mucosal injury in young Thoroughbred horses — investigation of a proposed aetiology and clinical significance

AIM: To determine whether trauma to the larynx caused by nasotracheal intubation induced mucosal ulceration of the arytenoid cartilages of adult horses, and to determine the incidence of such ulceration in yearling Thoroughbred horses and its effect on athletic performance. METHODS: Laryngeal trauma was induced in a group of 21 adult horses by introduction of a nasogastric tube into the trachea three times within 5 min. Injury to the arytenoid cartilages or vocal cords was subjectively assessed immediately after intubation, and thereafter at weekly intervals for 10 weeks. The outcome and athletic performance of 33 Thoroughbred yearling horses with idiopathic disease of the arytenoid cartilages, diagnosed at the yearling sales, were evaluated and compared to those of control horses of the same gender and age, from the same sale. RESULTS: Mucosal injury was noted immediately after intubation in every horse. Evidence of injury to the vocal or corniculate processes of the arytenoid cartilages or vocal cords was still apparent in 10/21 (48%) horses 1 week after intubation, five of which developed persistent lesions that remained present and unchanged from 28 days following intubation until the end of the 10-week observation period. All persistent lesions were nodules or focal swellings of the vocal cords or arytenoid cartilages, and there was no evidence of mucosal ulceration, infection or discharge. Mucosal ulceration of the vocal processes was the most common abnormality detected in the yearlings, affecting 16/33 (48%) that were diagnosed with idiopathic arytenoid disease at the yearling sales. Five of the 33 (15%) horses were diagnosed with arytenoid chondritis at the time of sale and were excluded from the performance outcome analysis. Of the 28 horses diagnosed with arytenoid abnormalities excluding chondritis, 19 (68%) raced with no history of respiratory-related problems, two (7%) were subsequently diagnosed with laryngeal hemiplegia, and seven (25%) were lost to follow-up. The case animals were 2.7 times more likely to race than control horses, but there was no difference between cases and controls in the likelihood of starting more than three times. CONCLUSIONS: This study showed that nasotracheal intubation in adult horses could result in immediate mucosal trauma, persistent swelling, and focal scarring of the arytenoid cartilages, but this did not mimic mucosal ulceration or chondritis of the arytenoid cartilages observed in yearling Thoroughbred horses. The population studied, however, may not accurately represent the population in which idiopathic disease occurs. In this study, arytenoid mucosal ulceration detected at sale did not commonly progress to arytenoid chondritis. However, a study of a larger population of horses with untreated, naturally occurring disease is required to confirm these findings. CLINICAL RELEVANCE: It is unlikely that trauma from nasogastric intubation caused arytenoid mucosal ulceration, therefore this procedure should not necessarily be discouraged. This study did not find evidence that horses diagnosed with arytenoid mucosal ulceration at yearling sales had a reduced performance history, therefore it is reasonable to continue to pass horses with uncomplicated arytenoid mucosal ulceration during post-sale endoscopic examination. However, monitoring of the lesions and treatment, if required, may be indicated in the post-sale period.

Dynamic bilateral arytenoid and vocal fold collapse associated with head flexion in 5 Norwegian Coldblooded Trotter racehorses

Dynamic obstruction of the upper airway is a common cause of poor performance in racehorses, often associated with abnormal respiratory noise during exercise (Morris and Seeherman 1991; Kannegieter and Dore 1995). Welldocumented upper respiratory tract disorders diagnosed using traditional resting upper airway endoscopy include left laryngeal hemiplegia (LLH), dorsal displacement of the soft palate (DDSP), epiglottic entrapment, subepiglottic cyst, epiglottic hypoplasia, pharyngeal lymphoid hyperplasia, arytenoid chondritis and rostral displacement of the palatopharyngeal arch. High-speed treadmill (HST) videoendoscopy has improved our ability to appreciate previously unrecognised forms of dynamic airway obstruction (King et al. 2001). Recently described forms of upper airway obstruction diagnosed using HST videoendoscopy are dynamic collapse of the roof of the nasopharynx (Strand and Staempfli 1993), epiglottic retroversion (Holcombe et al. 1997; Parente et al. 1998), intermittent epiglottic entrapment (Weishaupt et al. 1998) and axial deviation of the aryepiglottic folds (King et al. 2001). This report describes 5 cases of upper airway obstruction due to dynamic bilateral collapse of the vocal folds and arytenoid cartilages in Norwegian Coldblooded Trotter (NCT) racehorses, diagnosed by use of slowmotion playback of HST videoendoscopic recordings.

Minimally invasive laser treatment of arytenoid chondritis in horses

Arytenoid chondritis is a performance-limiting condition in horses. The underlying problem is a primary infection in the body or corniculate process of 1 or both arytenoid cartilages of the larynx. When chronic inflammation or abscessation may deform and permanently immobilize the affected cartilages, partial arytenoidectomy is indicated. Before that point, the process can be arrested by local debridement or drainage of the lesions, which has traditionally been accomplished by laryngotomy with the horse under general anesthesia. Infections of the arytenoid cartilages with granulomas and abscesses can be effectively treated in the standing horse by using the diode laser administered by an endoscopically guided ventral stab incision in the cricothyroid membrane.

Hemiplegia laringeana e condrite da artenóide em eqüinos

A domesticação do cavalo, levou o mesmo a ser exigido em funções orgânicas pelas atividades atlética e de trabalho as quais dependem do bom funcionamento da parte superior do aparelho respiratório, entre outras. Assim, patologias que afetam suas estruturas merecem destaque na literatura. Neste artigo são discutidas duas destas patologias (condrite da cartilagem aritenóide e hemiplegia laringeana), seu diagnóstico, achados endoscópicos, tratamentos e prognóstico.

ばんえい競走馬咽喉頭部の内視鏡所見

Sixty-three draft racehorses having abnormal breath sound during exercise were subjected to endoscopy of the laryngopharynx at rest, revealing abnormal findings in all cases. Laryngeal hemiplegia, pharyngeal lymphoid hyperplasia, dorsal displacement of the soft palate and arytenoid chondritis were detected in 56 (88.9%), 50 (79.4%), 6 (9.5%) and 1 (1.6%) horses examined, respectively. The prevalence and degree of pharyngeal lymphoid hvperplasia decreased with age.

Instrumentation and Techniques in Respiratory Surgery

In this article, videoendoscopy in conjunction with high-speed treadmill exercise and other specialized diagnostic techniques used to measure upper airway function are reviewed as they pertain to the four most commonly diagnosed functional upper airway obstructions: (1) laryngeal hemiplegia, (2) arytenoid chondritis, (3) epiglottic entrapment, and (4) intermittent dorsal displacement of the soft palate. Using experimental and clinical findings obtained with these new instruments and diagnostic techniques, current recommendations for surgery of these obstructions are presented.

Association of arytenoid chondritis with equine lymphocyte antigens but no association with laryngeal hemiplegia, umbilical hernias and cryptorchidism.

Associations were sought between ELA A1-A10 and W11 antigens and the presence of laryngeal hemiplegia, arytenoid chondritis, umbilical hernias and cryptorchidism in Thoroughbreds and/or Quarter Horses. No significant associations were detected between laryngeal hemiplegia and any ELA antigen in Thoroughbreds. The association between arytenoid chondritis and A9 was significant with a relative risk (RR) of 15.6 and aetiologic fraction (EF) of 0.80 in Thoroughbreds. There were apparent associations based on RR between A4 and A5 in Quarter Horses with umbilical hernias (RR = 7.5 and 6.1 respectively); however, these were not statistically significant. No significant associations were detected with cryptorchidism in Quarter Horses when the control population included both sexes. When only unaffected males were used as the control group, there was an apparent increase in relative risk with A6 (from RR = 1.7 to 4.3); however this was not statistically significant. Cryptorchidism in Thoroughbreds showed an increased relative risk with A5 regardless of whether the control population included males and females (RR = 4.1) or only males (RR = 4.7) but the increases were not statistically significant.

Neodymium (Nd):YAG laser surgery in the equine larynx: a pilot study.

Laryngeal surgery in the equine is customarily and routinely performed by means of a ventral laryngotomy incision. Such procedures are usually performed under deep general anesthesia with the horse in dorsal recumbency. The objective of this work was to determine the efficacy of an endoscopic approach coupled to a Nd:YAG laser fiber in performing arytenoidectomy. Arytenoidectomy is commonly indicated in the treatment of arytenoid chondritis and in the failure of prosthetic implantation for left laryngeal hemiplegia. This preliminary study was undertaken to determine the feasibility of the endoscopic laser approach to ablate the most difficult of the structures of the larynx, considering tissue structure and density. This procedure was accomplished by using heavy sedation and local anesthesia and was performed in the standing position. This approach appears to be feasible and makes other adjacent structures accessible via the endoscope coupled to a surgical laser. Indications for future pilot applications of laser surgery in the equine larynx are entrapment of the epiglottis, dorsal soft palate displacement, and the ablation of laryngeal cysts and polyps. This pilot study appears to offer a new modality for discrete surgical ablation of this structure, with minimal postoperative complications and a reduced or equivalent convalescent period in this valuable species of animal.