Management of postoperative dysphagia after prosthetic laryngoplasty or arytenoidectomy. Issue 3 (4th February 2020) - Luedke, Lauren K.
Abstract: Objective: To evaluate the efficacy of various treatments for dysphagia after laryngeal surgery. Study design: Retrospective. Animals: Horses treated for dysphagia after laryngeal surgery. Methods: Medical records of horses treated for dysphagia after prosthetic laryngoplasty (PLP) or partial arytenoidectomy (PA) were reviewed. Signalment, prior surgery, preoperative videoendoscopic diagnosis, and surgical treatments were recorded. Short‐ and long‐term follow‐up were obtained. Chi‐square and logistical regression were performed to correlate independent variables and outcomes. Results: Forty‐four percent of horses with prior PLP and 88% of horses with prior PA had persistent resting dorsal displacement of the soft palate (DDSP). Vocal fold augmentation (VFA) as a single treatment was most commonly performed (n = 22), followed by laryngoplasty removal (LPR; n = 1). Fifteen horses received a combination of treatments: VFA (n = 15), LPR (n = 4), laryngeal tie‐forward (LTF; n = 2), and esophageal release (n = 1). Short‐term clinical outcomes were reported; 80% of horses treated with VFA (n = 35) had resolution of dysphagia, and 20% were improved. Among the 33 horses available to long‐term follow‐up, 31 (94%) returned to some level of work, and DDSP during work was reportedly resolved in 23 of 25 horses. Conclusion: Vocal fold augmentation resulted in resolution of symptoms relating to dysphagia in 81% of horses. Twenty percent of horses treated with LPR had sustained resolution of dysphagia. A combination of LPR, VFA, LTF was performed in 18% of horses. Clinical significance: Treatment options directed at altering laryngeal geometry and/or position of the larynx were successful in resolving 86% of dysphagia in horses previously regarded as very difficult to treat.