New treatment for entrapped epiglottis promises fewer relapses

The best solution for an entrapped epiglottis may be removal of the entire fold of cartilage.

A new technique for freeing an entrapped epiglottis could offer a lower chance of relapse compared to more traditional approaches, according to surgeons at Hagyard Equine Medical Institute in Kentucky.

The epiglottis is a movable fold of cartilage that lies at the base of the tongue. It bends upward when a horse swallows to direct feed and water through the esophagus. Inflammation or anomalies in the horse’s airway structures can lead to entrapment, which occurs when the epiglottis becomes stuck on tissue called the aryepiglottic fold. A horse with epiglottic entrapment makes a gurgling noise while working and may be unable to sustain athletic effort due to reduced airflow.

A trapped epiglottis can become unstuck on its own, but when that doesn’t occur or if the problem recurs frequently, surgical intervention is typically appropriate says Matt Coleridge, BVMS, currently an equine surgical resident at Auburn University College of Veterinary Medicine. In the standard procedure a surgeon, guided by an endoscope, splits the tissues of the aryepiglottic folds. “The traditional hooked bistoury technique, when performed correctly, is very quick and very effective,” says Coleridge. Depending on the tools used, however, relapse rates for this type of surgery range from 5 to 40 percent.

Hagyard surgeons Michael Spirito, DMV, and Dwayne Rodgerson, DVM, along with Coleridge added a step to the standard epiglottic surgery to reduce the chances of recurrence. Instead of simply splitting the tissues causing the entrapment, the surgeons remove it. “Our technique excises that entrapping tissue and in doing so removes the possibility of that tissue filling back in as it heals and the horse re-entrapping again,” he says. In a published study of eight horses who underwent the revised procedure, none had complications from the surgery or recurrence of the entrapment in the follow-up period.

Based on these results, Coleridge says he recommends the technique as a first-line approach to epiglottic entrapment cases, as well as for previously treated horses that have since experienced recurrence or secondary complications.

Reference: “Endoscopic, transoral, reduction of epiglottic entrapment via wire snare technique,” Veterinary Surgery, October 2014

This article first appeared in EQUUS issue #451, April 2015. 




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