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The Treatment of Dorsal Displacements of the Soft Palate by Thermal Cautery: A Review of 252 Cases
R.M. Ordidge
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Summary:
Thermal cautery (firing) of the oral surface of the soft palate (SP) was shown to be as successful as other surgical procedures for helping to prevent its dorsal displacement in racing Thoroughbred horses during strenuous exercise, proving to be clinically successful in 72.16% of cases.
Introduction:
Intermittent dorsal displacement of the soft palate (DDSP) is believed to be a common cause of respiratory distress and poor performance in racing Thoroughbred horses that occurs during strenuous exercise (1). The aetiology and pathophysiology of DDSP is not clear and it may be a primary or secondary disorder (2,3). It is a functional rather than a physical problem and is therefore impossible to diagnose with absolute certainty without the use of upper airway endoscopy performed during galloping to a level of fatigue on a high-speed treadmill. Without this facility the diagnosis is usually made on a history of a horse making a characteristic “gurgling” respiratory noise caused by vibration of the SP and/or suddenly fading during a race. Resting endoscopy of the upper respiratory tract (including the guttural pouches) is used to eliminate other possible upper respiratory tract abnormalities such as, laryngeal hemiparesis, epiglottic entrapment, dynamic nasopharyngeal collapse, cleft palate, subepiglottic cysts, pharyngitis or neoplasia etc. The trachea should also be endoscopically examined for the presence of discharges or haemorrhage that would indicate a lower airway problem. Absence of a characteristic “gurgling” noise during galloping does not rule out the possibility of DDSP. High-speed treadmill endoscopy has shown that 30% of cases of DDSP do not make a detectable noise (4). Non-surgical methods used to help prevent DDSP include attention to fitness, prevention of oral discomfort, the use of tongue straps, dropped nosebands and tongue depressing bits. There are also several surgical procedures credited with success in treating DDSP. These include resection of the caudal border of the soft palate (staphylectomy) (5), tenectomy of the sternothyroideus and sternohyoideus muscles (strap muscle myectomy) (6,7,8), epiglottic augmentation with Teflon ® (9), partial-thickness longitudinal resection of the mucosa of the oral surface of the SP (tension palatoplasty: Ahern Procedure) (10) and laser cautery of the soft palate performed under sedation in the standing horse (11). Each of these surgical procedures has the disadvantage of either being time-consuming, and therefore expensive, disfiguring, potentially detrimental to the well being of the horse or necessitating time out of training. Additionally, none of these techniques has been critically evaluated and proven to be a beneficial treatment for DDSP.
Thermal cautery of the oral surface of the SP is a simple and quick procedure which is performed under a short-acting general anaesthetic (GA), is not clinically detectable, does not require a period of post-operative rest, is repeatable and is overall a low-risk procedure. This study evaluated the clinical benefit of thermal cautery of the soft palate as a treatment for DDSP in Thoroughbred racehorses. [...]
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