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aiming at visualising it is unnecessary. Alternatively, a thyroarytenoid suture may be used by placing the suture through the caudo-dorsal portion of the lamina of the thyroid cartilage. In the arytenoid cartilage, the suture
is passed medio-laterally. Along the rostro-caudal axis, both sutures are placed in the middle of the arytenoid articular surface. Along the ventro-dorsal axis, the two sutures are evenly spaced, at the ventral and dorsal third of the arytenoid articular surface. The sutures are tied but not excessively tightened, as low-tension sutures have proved equally efficient in decreasing airway resistance and decrease the portion of the rima glottidis remaining uncovered when the epiglottis is closed. In doubt, an assistant may extubate the animal and control transorally that the arytenoid abduction is satisfactory. The lamina
of the thyroid cartilage is released, the thyropharyngeus muscle fibres are apposed in a cruciate pattern and the wound is closed routinely. If it has not been assessed intra-operatively, the arytenoid abduction is controlled postoperatively by transoral visualisation.
Figure 1: Schematic representation of the placement of a cricoarytenoid suture without disruption of the cricothyroid joint
In dogs without clinical signs of concurrent disease,
the prognosis after UAL is fair. In a recent study, the 1-, 2-, 3-, and 4-year survival rates were 93.6%, 89.1%, 84.4%, and 75.2%, respectively3. However, as described above, most affected animal suffer from generalised neuromuscular disease, which is the main determinant of their long-term prognosis. In one study, 6 of 11 dogs with acquired LP died or were euthanized within 15 months
of diagnosis as a result of progression of clinical signs associated with their polyneuropathy4.
An Urban Experience
Aspiration pneumonia is the most commonly described complication after surgical treatment for LP, being a greater risk when a megaoesophagus is present3. After unilateral arytenoid lateralisation, it has been reported to occur in 8 to 32% of cases. Aspiration pneumonia can occur months to years after surgery and operated dogs remain are at risk for the remainder of their lives, but it seems that the risk decreases over time. Perioperative administration of metoclopramide was initially thought to lower the risk of aspiration pneumonia5, but this was not confirmed in more recent studies3, 6.
References
1. Monnet E. Surgical Treatment of Laryngeal Paralysis. Vet Clin North Am Small Anim Pract. 2016;46: 709-717.
2. MacPhail CM, Monnet E. Outcome of and postoperative complica- tions in dogs undergoing surgical treatment of laryngeal paralysis: 140 cases (1985-1998). Journal of the American Veterinary Medical Association. 2001;218: 1949-1956.
3. Wilson D, Monnet E. Risk factors for the development of aspira- tion pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis: 232 cases (1987-2012). J Am Vet Med Assoc. 2016;248: 188-194.
4. Thieman KM, Krahwinkel DJ, Sims MH, Shelton GD. Histopatholog- ical confirmation of polyneuropathy in 11 dogs with laryngeal paral- ysis. Journal of the American Animal Hospital Association. 2010;46: 161-167.
5. Greenberg MJ, Reems MR, Monnet E. Use of perioperative metoclo- pramide in dogs undergoing surgical treatment of laryngeal paralysis: 43 cases (1999-2006). Vet Surg. 2007;36: E11.
6. Milovancev M, Townsend K, Spina J, Hurley C, Ralphs SC, Trump- atori B, et al. Effect of Metoclopramide on the Incidence of Early Postoperative Aspiration Pneumonia in Dogs with Acquired Idiopathic Laryngeal Paralysis. Vet Surg. 2016;45: 577-581.
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