EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2018
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Fig 8: Chondroid removed using an endoscopically guided basket snare.
Fig 7: Endoscopic image showing purulent material draining from a distended left guttural pouch via its nasopharyngeal ostium.
lavage and in the absence of chondroids or draining lymph nodes, antibiotic can be infused into the guttural pouches, including gelatin-infused depot antibiotics. Excessive pressure should not be used during lavage as this can tear the guttural pouch lining and cause cellulitis of the head and neck, that may even progress down the fascial planes of the neck resulting in thoracic empyema. As noted above, gross distension of guttural pouches by exudate can be self-perpetuating due to ostium compression
and such cases may be treated by catheterisation (with difficulty) and drainage of the affected pouch(es) that, in turn will allow greatly improved drainage. If stenosis of the guttural pouch ostium is present, it is not usually possible to catheterise the distended pouch and creation of a large drainage ostium by transendoscopic laser surgery on the thin-walled, rostrodorsal aspect of the affected pouch is indicated. Fenestration of the cartilaginous ostium is much more difficult and may later granulate over and become occluded. Unlike in cases of guttural pouch tympany, fenestration of the guttural pouch septum via the contralateral guttural pouch may not be successful with guttural pouch empyema/ chondroids, although success with this technique has been reported (Hawkins et al. 2001). Although earlier descriptions exist of surgical drainage of guttural pouch empyema via Viborg’s triangle, this technique is difficult unless gross distension is present and should be avoided. If small numbers of firm chondroids are present, they can be removed transendoscopically (Fig 8). Larger numbers of chondroids require surgical removal. Surgery on the standing horse has many anatomical and practical advantages over surgery
Fig 9: a) Standing surgical removal of left-sided guttural pouch chondroids under endoscopic guidance using a modified Whitehouse approach: note left-sided nasal discharge in affected horse. b) A loop curette can be endoscopically seen amongst semi-solid chondroids in the affected pouch during this surgery. c) The long-handled spoon shown in the kidney dish with extracted chondroids is also useful in removing chondroids.
© 2016 EVJ Ltd
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