American journal of veterinary research · 2019
Ex vivo evaluation of arytenoid corniculectomy, compared with three other airway interventions, performed on cadaveric equine larynges with simulated recurrent laryngeal neuropathy.
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Tucker Michelle L, Sumner David, Reinink Shawn K, Wilson David G, Carmalt James L
Аннотация
OBJECTIVE: To compare laryngeal impedance, in terms of air flow and pressure, following arytenoid corniculectomy (COR) versus 3 other airway interventions (left-sided laryngoplasty with ipsilateral ventriculocordectomy [LLP], LLP combined with COR [LLPCOR], and partial arytenoidectomy [PA]) performed on cadaveric equine larynges with simulated left recurrent laryngeal neuropathy (RLN) and to determine whether relative laryngeal collapse correlated with the interventions performed.
SAMPLE: 28 cadaveric equine larynges.
PROCEDURES: Each larynx in states of simulated left RLN alone and with airway interventions in the order LLP, LLPCOR, COR, and PA was evaluated in a box model construct that replicated upper airway flow mechanics consistent with peak exercise in horses. Results for impedance, calculated from airflow and pressure changes, were compared between states for each larynx. Multivariable mixed-effects analysis controlling for repeated measures within larynx was performed to calculate the predicted mean impedance for each state.
RESULTS: Results indicated that tracheal adapter diameter, individual larynx properties, airway intervention, and relative laryngeal collapse affected laryngeal impedance. The LLP and LLPCOR interventions had the lowest impedance, whereas the COR and PA interventions did not differ substantially from the simulated left RLN state. Residual intraclass correlation of the model was 27.6 %.
CONCLUSIONS AND CLINICAL RELEVANCE: Although impedance was higher for the simulated left RLN with the COR intervention state than with the LLP intervention state, given the clinical success of PA for treating RLN in horses and the similar results for the COR and PA intervention states in the present study, the use of COR warrants further investigation. The residual interclass correlation suggested that individual laryngeal variation affected impedance and may have a clinical effect.
SAMPLE: 28 cadaveric equine larynges.
PROCEDURES: Each larynx in states of simulated left RLN alone and with airway interventions in the order LLP, LLPCOR, COR, and PA was evaluated in a box model construct that replicated upper airway flow mechanics consistent with peak exercise in horses. Results for impedance, calculated from airflow and pressure changes, were compared between states for each larynx. Multivariable mixed-effects analysis controlling for repeated measures within larynx was performed to calculate the predicted mean impedance for each state.
RESULTS: Results indicated that tracheal adapter diameter, individual larynx properties, airway intervention, and relative laryngeal collapse affected laryngeal impedance. The LLP and LLPCOR interventions had the lowest impedance, whereas the COR and PA interventions did not differ substantially from the simulated left RLN state. Residual intraclass correlation of the model was 27.6 %.
CONCLUSIONS AND CLINICAL RELEVANCE: Although impedance was higher for the simulated left RLN with the COR intervention state than with the LLP intervention state, given the clinical success of PA for treating RLN in horses and the similar results for the COR and PA intervention states in the present study, the use of COR warrants further investigation. The residual interclass correlation suggested that individual laryngeal variation affected impedance and may have a clinical effect.