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treatment of palatal cysts. However, these reports listed a number of complications such as creation of palatal defects including fenestrations (Haynes et al. 1990; Parente 2011) and development of soft palate dysfunction post operatively (Robertson 2007). Previously described oral approaches and the use of endoscopic elevators did not provide sufficient visualisation for either treatment or diagnosis in this case. In this case, visualisation of the caudal border of the soft palate endoscopically was superior to a larnyngotomy or pharyngotomy and the ability to use a surgical laser enabled a minimally invasive approach to be taken. This minimally invasive approach resulted in no post-operative complications developing. It was not clear if laser ablation of the cyst lining would
prevent recurrence of cyst formation but follow-up over a reasonable time period confirmed that this appeared to have been successful. Surgical removal of subepiglottic cysts has been reported to be up to 100% successful in a review of 15 cases over 14 years by Salz et al. (2013). In the latter study, no horses were reported to have recurrence of cysts after removal. Both contact and noncontact ablation of subepiglottic cysts has been described (Palmer 2003). In this case, the cysts were perforated prior to contact laser ablation in part as a diagnostic aid to confirm their cystic nature and this enabled the lining of the cystic cavities to be directly accessed, with the aim of minimising the thermal energy and risk of thermal necrosis to adjacent tissues. A nonsurgical, intralesional, formalin treatment has been reported. This was done in the standing sedated horse and required multiple treatments (Dougherty and Palmer 2008). In this case, formalin was considered but was not attempted due to concerns about the potential for palatal necrosis to occur.
Another potential surgical approach to the larynx has
been described for treatment of arytenoid chondritis. In a case series by Sullins (2002), horses had an endoscope
positioned per nasum to view the arytenoid cartilage. A flexible laser fibre was then inserted through a cannula that had been placed through a one centimetre incision through the cricothyroid membrane. The chondritis lesion on arytenoid cartilage was then vaporised under endoscopic guidance (Sullins 2002). The latter approach could have been used in this case, particularly if instruments had been needed to assist treatment but a tracheostomy incision was easy to perform using minimal equipment and is associated with few complications and in this case worked well. The novel use of a tracheotomy incision for the passage
of the endoscope allowed visualisation for confirmation of diagnosis, access for surgical instrumentation and laser fibres to be passed transendoscopically for treatment. A tracheotomy incision is more invasive but this commonly performed procedure carries a low risk of complications when correctly performed and heals well by secondary intention.
Authors’ declaration of interests No conflicts of interest have been declared.
Ethical animal research No ethical review was required as single case report.
© 2018 EVJ Ltd
Source of funding None.
Antimicrobial stewardship policy
The horse was given perioperative antibiotics. No critically important antibiotics were used in this study.
Acknowledgement The authors wish to thank the staff at the Philip Leverhulme Equine Hospital, the referring vet and owner of the case.
Authorship
D. C. Archer performed the initial case work-up, case treatment and follow-up examinations. M. Sinovich prepared the manuscript with the help of P. G. Kelly and D. C. Archer. All authors reviewed and approved the final manuscript prior to submission.
Manufacturers' addresses 1V
etoquinol, Great Slade, Buckingham, UK.
2Zoetis, Parsippany-Troy Hills, New Jersey, USA. 3MSD Animal Health, Milton Keynes, Buckinghamshire, UK. 4Virbac, Woolpit, Bury St Edmunds, Suffolk, UK. 5Animal Care, York, UK. 6Dechra, Hadnall, Shrewsbury, Shropshire, UK. 7Olympus, Southend-On-Sea, Essex, UK. 8Kruuse, Sherburn in Elmet, Leeds, UK.
References
Aitken, M.R. and Parente, E.J. (2011) Epiglottic abnormalities in mature nonracehorses: 23 cases (1990-2009). J. Am. Vet. Med. Assoc. 238, 1634-1638.
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