EQUINE VETERINARY EDUCATION / AE / JANUARY 2020
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complete resolution that would allow high level performance as an adult is less likely. In adults, the more common cause for such a condition in the horse is neural insult from fungal disease within the guttural pouch (Fig 2). While treatment of the fungal infection can be instituted and effective, sufficient resolution of the neural disease may require an extended period of time and again could be incomplete (Virgin et al. 2016). There is some evidence that a tie-forward procedure may be beneficial in those horses that persist to have some pharyngeal dysfunction and dysphagia (Dobesova et al. 2012). Despite having an obvious structural abnormality of the palate that could account for the clinical signs demonstrated in the case reported here, the authors did rule out any evidence of neural insult associated with guttural pouch disease. Upper airway endoscopic examination is usually the first
diagnostic tool used to arrive at a diagnosis when a horse is presented with these problems. Generally, it is not advised to use any sedatives during the endoscopic examination in which the clinician wants to make some assessment of function (Lindegaard et al. 2007). I suspect the authors only used
a) a)
sedation in this gelding because of behavioural concerns. Stimulating swallowing during an endoscopic examination can be helpful in seeing evidence of dysphagia as well as seeing subepiglottic cysts that can move between the oro- and nasopharynx. If the palate is persistently above the epiglottis despite multiple stimulated swallows, a lateral radiograph (as was performed in this case report) can yield valuable information about any structural abnormalities associated with the epiglottis or palate. An open mouth view to provide more air contrast within the oropharynx can provide better detail to the soft tissue structures. If an abnormality of the epiglottis is suspected sedation, topical anaesthetic and manipulation of the palate/epiglottis via long equine laryngeal/pharyngeal forceps can be used to determine the abnormality. Infrequently entrapment of the epiglottis can precipitate persistent displacement of the palate, or the ventral surface of the epiglottis can be very abnormal and result in significant performance problem or dysphagia while appearing normal on the dorsal surface. Persistent displacement of the soft palate 5 days after surgery in the case reported here was likely disappointing to the authors. Not performing any further
b) b)
Fig 2: a) Fungal plaque in the ventral medial aspect of the right guttural pouch (near the pharyngeal branch of the vagus nerve) of a horse with evidence of palate displacement and dysphagia. b) Resolution of the fungal plaque coincided with eventual resolution of the dysphagia.
Fig 3: a) Endoscopic view through a laryngotomy of a large palatal cyst prior to laser ablation and b) after laser ablation in a foal in dorsal recumbency. The foal was able to replace her palate to normal position 1 day after surgery.
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