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Larynx: ventriculocordectomy

ISSN 2398-2977


Synonym(s): Hobday, Ventriculectomy/Sacculectomy, Cordectomy

Introduction

  • The technique consists of removal of the mucus membrane lining the laryngeal ventricle leading to adhesions between the arytenoid and thyroid cartilages and reduced filling of the ventricles.
  • Many different surgical methods have been used to treat laryngeal hemiplegia Larynx: hemiplegia. The technique of ventriculectomy or sacculectomy has been used for decades though the ability of this technique alone to abduct and stabilize the arytenoid and vocal cords during exercise is questionable.
  • Removal of the vocal cords (bilateral cordectomy) decreases airway obstruction when carried out alongside other procedures.
  • Therefore, many surgeons will combine the two procedures into one: ventriculocordectomy.

Uses

  • Treatment of laryngeal hemiplegia Larynx: hemiplegia particularly the idiopathic form, often performed in conjunction with laryngoplasty Larynx: laryngoplasty, or as a single procedure in horses exercising at slow paces.

Advantages

  • Relatively simple procedure.
  • Possible in standing animal.
  • Minimal complication rate.
  • May modify and/or reduce respiratory noise (stridor) associated with hemiplegia Larynx: hemiplegia.

Disadvantages

  • Dynamic collapse of laryngeal structures during exercise may still occur.

Alternative techniques

Time required

Preparation

  • Aseptic skin preparation: 10 min.
  • Infiltration and action of local anesthetic: 10 min.
  • General anesthesia induction and maintenance: 20 min.
  • Laryngotomy: 10-15 min.
  • Alternatively, standing endoscopic procedure with laser can be performed from start to finish with blocking in under 30 min.

Procedure

  • 5-10 min depending upon technique used and whether cordectomy done as well.

Decision taking

Criteria for choosing test

  • Same as idiopathic laryngeal hemiplegia Larynx: hemiplegia but usually reserved for horses not undertaking significant exercise; racing for short distances with minimal resting asymmetry; economic reasons; and draft horses.
  • Many surgeons perform a ventriculectomy +/- cordectomy along with laryngoplasty Larynx: laryngoplasty.

Risk assessment

Requirements

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Preparation

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Technique

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Broyles A H, Embertson R M, Brett Woodie J & Machado V (2022) The impact of grade of laryngeal function immediately prior to laryngoplasty and ipsilateral ventriculocordectomy on postoperative performance: 623 thoroughbred racehorses (1998-2013). Equine Vet J 54 (5), 856-864 PubMed.
  • Caspers M K, Bell C  & Tatarniuk D M (2021) Transendoscopic ventriculocordectomy using monopolar electrosurgical instrumentation for conjunctive treatment of laryngeal hemiplegia in horses: 24 cases (2017-2019). Front Vet Sci 8, 628410 PubMed. 
  • Barakzai S Z, Wells J, Parkin T D H & Cramp P (2019) Overground endoscopic findings and respiratory sound analysis in horses with recurrent laryngeal neuropathy after unilateral laser ventriculocordectomy. Equine Vet J 51 (2), 185-191 PubMed. 
  • Raffetto J A, Wearn J G & Fischer A T Jr (2015) Racing performance following prosthetic laryngoplasty using a polyurethane prosthesis combined with a laser-assisted ventriculocordectomy for treatment of recurrent laryngeal neuropathy in 78 Thoroughbred racehorses. Equine Vet J 47 (1), 60-64 PubMed. 
  • Mason B J, Riggs C M & Cogger N (2013) Cohort study examining long-term respiratory health, career duration and racing performance in racehorses that undergo left-sided prosthetic laryngoplasty and ventriculocordectomy surgery for treatment of left-sided laryngeal hemiplegia. Equine Vet J 45 (2), 229-234 PubMed.
  • Cramp P et al (2009) Effect of ventriculectomy versus ventriculocordectomy on upper airway noise in draught horses with recurrent laryngeal neuropathy. Equine Vet J 41 (8), 729-734 PubMed.
  • Witte T H, Mohammed H O, Radcliffe C H, Hackett R P & Ducharme N G (2009) Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 Thoroughbred racehorses competing at less than 2400m (1997-2007). Equine Vet J 41(1), 70-75 PubMed.
  • Robinson P et al (2006) Effects of unilateral laser-assisted ventriculocordectomy in horses with laryngeal hemiplegia. Equine Vet J 38 (6), 491-496 PubMed.
  • Taylor S E, Barakzai S Z & Dixon P (2006) Ventriculocordectomy as the sole treatment for recurrent laryngeal neuropathy: long-term results from ninety-two horses. Vet Surg 35 (7), 653-657 PubMed.
  • Brown J A, Derksen F J, Stick J A, Hartmann W M & Robinson N E (2003) Ventriculocordectomy reduces respiratory noise in horses with laryngeal hemiplegia. Equine Vet J 35 (6), 570-574 PubMed.

Other sources of information

  • Ducharme N G & Rossignol F (2019) Larynx. In: Equine Surgery. 5th edn. Eds: Auer J & Stick J. Saunders, USA. pp 734-769.