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Castellated laryngofissure refers to a rare surgical procedure in the cat. The technique may be considered in cats with laryngeal paralysis whereby the entrance to the trachea (windpipe) is severely narrowed. The surgery would be undertaken at a specialist referral center with intensive care facilities, as postoperative bleeding and breathing complications are to be expected.
The procedure itself involves cutting into the thyroid cartilage and remodelling it so that when sutured back together it has a wider diameter than previously, the aim being to open up the airway. However, other techniques such as a laryngeal tie-back are better established and linked to fewer complications, which largely makes a castellated laryngofissure a second choice option.
The cat is given preemptive pain relief and a pre med, and then general anesthesia induced. The fur of the ventral neck is clipped and the entire area aseptically prepared. The surgeon first performs a tracheotomy and places a tracheotomy tube. This is because post operative swelling is so severe that the upper airway is occluded for the first three to four days after surgery.
The surgeon then takes a ventral approach to expose the larynx. The thyroid cartilage is identified and divided into three equal parts lengthwise. The middle portion is to form the square flap for which the 'castellation' is named. An incision is made following the castellation. The thyroid is realigned with the central flap alongside the opposite cranial third. The thyroid cartilage is then sutured, using non-absorbable suture, in this new position. The wound is repaired, the patient woken and taken to intensive care for observation.
Studies have been done that compare and contrast the efficacy of two related procedures: The laryngeal tie-back and the castellated laryngofissure. The former (tie-back) seems superior in most aspects. Both resulting increase in the width of the rima glottis (entrance to the trachea) and the lesser surgical post-op complication make the tie-back a preferred option to the laryngofissure.
However, in the long term in cases where a tie-back is not appropriate (perhaps because of failed earlier surgery) the castellated laryngofissure does have benefits and should be considered to improve quality of life.
The patient is likely to experience bleeding and swelling that mean a temporary tracheostomy tube is required. The cat may need to spend two to four days in intensive care in order to monitor blood loss and ensure they are able to breathe.
Once stable, the patient can go home, either with or without the tracheotomy tube in place depending on their progress. The skin sutures are removed at the 10 to 14-day point, at which point the tracheotomy tube is also removed (if still in place.)
Expect a consultation with a specialist surgeon to be $200 upwards. The surgery itself is around $2,000 to $4,000. The cost of intensive care also needs to be considered at an average of $600 per night.
Castellated laryngofissure is a challenging procedure associated with severe post op complications. When an alternative procedure that is marginally more effective and safer is available, it is preferable to take that option.
However, there may be circumstances where a tie-back is not a viable option, such as trauma to the larynx where the anatomy of the arytenoids is disrupted, or where previous failed surgery has disrupted identifiable landmarks. This could then offer a viable option to improve the cat's quality of life.
Many of the problems linked to laryngeal paralysis are not preventable. This condition is rarer in the cat than in the dog. This is because dogs pulling on their collar is common (causing trauma to the laryngeal nerve) and a genetic predisposition is more common in the dog than the cat.
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