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Update on Treatment of Soft Palate Disease
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The treatment of dorsal displacement of the soft palate (DDSP) must be tailored to the cause. The intrinsic causes of DDSP can be neuromuscular, i.e., decreased tone in the palatinus and palatopharyngeus muscle (Holcombe et al., 1998) or structural, i.e., sub-epiglottic and palatal masses/cysts and severe epiglottic deformation. Extrinsic causes are related to the respective position of the larynx, basihyoid and soft palate (Ducharme et al., 2003; Chalemrs et al., 2009). However when no structural anomaly of the larynx is found it is clearly more difficult to identify the cause of the DDSP. The following summarizes the approach taken at the author’s university hospital.
Initial management
Any horse’s guttural pouch infection should be treated first. For example, treatment of guttural pouch infection with a physiological and sterile balanced electrolyte solution accompanied by non-irritant anti-microbial and systemic antibiotics must precede any surgical treatment for DDSP. Horses with nasopharyngeal inflammation are treated with systemic and topical anti-inflammatory agents. Two different anti-inflammatory protocols are used for the average 450kg horse in treatment: 1) dexamethasone (30 mg PO or IV SID for 3 days, 20 mg PO or IV SID for 3 days, 10 mg PO or IV SID for 3 days, and 10 mg PO or IV EOD for 3 treatments) and 2) prednisolone (300 mg PO BID for 2 weeks, 300 mg PO SID for 2 weeks, and 300 mg PO EOD for 2 weeks). The dexamethasone protocol is more potent.
Horses with structural abnormality of the larynx and nasopharynx such as sub-epiglottic cyst, subepiglottic granuloma and ulcers, palatal cyst, epiglottitis and ary-epiglottic entrapment have good reason to experience DDSP. These primary lesions must be addressed first. Cysts, which are mainly congenital malformations, should be excised using a laryngotomy or endoscopically through the oropharynx or nasopharynx with the aid of endoscopic laser. Chronic inflammatory disease, such as granulomas and epiglottitis are more difficult to address. However if there is not a prolonged history of medical treatment, the latter should be done first; the standard treatment for horses with acute or subacute epiglottitis is 10-21 days of antimicrobials (usually trimethoprim- sulfadiazine 15 mg/kg PO, BID or enrofloxacin 7.5mg/kg PO and nonsteroidal anti-inflammatory medications (phenylbutazone 2.2 mg/kg PO, BID for 5-7 days, then SID for 3-5 days). Although controversial, topical nasopharyngeal anti-inflammatory preparations are frequently used in our practice. The preparation we use is a throat spray at 20 cc BID (made up of 250 ml glycerin, 250 ml DMSO 90%, 500 ml nitrofurazone, and 50 ml of dexamethasone (2 mg/ml)), and a steroid inhaler (Beclomethasone) has been used by others (D. Archer, personal conversation Liverpool). [...]
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