Post operative complications and implications of laryngeal surgery

Laryngoplasty (LP)

Acute and chronic post operative coughing and dysphagia with accompanying nasal discharge have been reported in a number of studies [1–12], with reduced airway protection and excessive surgical abduction implicated as the cause [8,13]. Post operative tracheitis and/or mild pneumonia may also be involved [8]. Chronic coughing can be severe enough to limit performance [12]. A late onset cough, up to several months post surgery, has also anecdotally been reported [12]. Acute post operative loss of arytenoid abduction has commonly been reported in the first few days [8,10,14,15], while chronic loss can occur between one and 6 weeks following surgery [14,16]. A recent study has shown that further loss of arytenoid abduction is less likely after this time [16]. Arytenoid instability has been reported in a number of studies, and may be implicated in continued poor performance and respiratory noise post operatively [10,16–19]. Other forms of dynamic airway collapse have been seen post LP. These were identified in horses returned for investigation of continued poor performance and/or respiratory noise [10,20]; and in a recent study investigating perceived clinically asymptomatic horses [11]. In the latter study, more than three-quarters of horses were found to have a form of upper airway collapse at exercise, including axial deviation of the aryepiglottic folds and vocal cord collapse. Perhaps of more concern was that more than half of the horses showed signs of palatal dysfunction, with both palatal instability and, most commonly, dorsal displacement of the soft palate (DDSP) seen at exercise. This was shown in a further study to present differently to other reported forms of DDSP [21]. Pharyngeal lymphoid hyperplasia (PLH) was common in this group of horses, and was significantly associated with the grade of abduction. It is unclear at present if these findings are a direct consequence of the surgical procedure, a result of the altered upper airway dynamics, or if they were present but undiagnosed prior to the LP surgery. Excessive granulation tissue and arytenoid chondritis has also been reported post LP [4,8,10,11,16], which may be directly related to the LP procedure, or possibly to concurrently performed ventriculocordectomy procedures [12]. […]