Bilateral Arytenoid Lateralization in Dogs

Bilateral arytenoid lateralization in dogs is a surgical procedure used to permanently pull the wall of the airway open on one side of the larynx. Veterinary surgeons used this surgical technique to treat dogs with congenital or acquired laryngeal paralysis. The larynx works to prevent the inhalation of food, producing sound or voice, and regulating airflow. If the muscles and/or nerves of the larynx are affected, it cannot properly carry out its routine functions and the dog suffers from breathing complications. 

The canine will be given a pre-sedative injection to allow the veterinary team to induce a gas anesthetic. In order to deliver gas anesthetic and oxygen to the canine throughout the surgical procedure, a tracheal tube must be placed. Once this specialized breathing tube is in position, the veterinary anesthetist will calculate the appropriate concentration of anesthetic to be delivered via gas. 

1. The dog will be positioned in lateral recumbency.
2. A skin incision will be made over the larynx, just ventral to the jugular groove.
3. The sternohyoid muscle is retracted ventrally in order to expose the lateral aspect of the thyroid and cricoid cartilages. 
4. The larynx will then be rotated to expose the thyropharyngeal muscle, which is then transected. 
5. The wing of the dog’s thyroid will be retracted laterally and the cricothyriod junction is incised. 
6. The cricoarytenoideus dorsalis muscle or fibrous tissue will be dissected and transected. 
7. Using Metzenbaum scissors, the cricoarytenoid articulation will be detached from caudal to cranial. 
8. The arytenoid cartilage is sutured to the caudal-dorsal aspect of the cricoid cartilage. 
9. One 2-0 nonabsorbable suture is placed in a simple interrupted stitch pattern from the muscular process of the arytenoid cartilage to the cricoid cartilage’s caudal-dorsal edge. 
10. The sutures are then tightened to maintain arytenoid position. 
11. The thyropharyngeal muscle is then sutured and the surgical opening is closed bringing together the subcutaneous layers of tissue. 

Bilateral arytenoid lateralization is a successful procedure to treat canines with laryngeal paralysis. Arytenoid lateralization can be performed bilaterally or unilaterally, with unilaterally resulting in less surgical complications. Talk to your veterinarian about the best choice for your dog’s laryngeal condition, as in some instances, the surgical results outweigh the risks.

Following a bilateral arytenoid lateralization surgery, patients will not be allowed to eat or drink for 24 hours unless otherwise directed by the veterinarian. Sedatives and heavy analgesics will be administered on a routine basis in order to maintain the dog’s swallowing reflex without pain. Hand feeding the canine small amounts of soft food will be carried out by the dog owner at home and continue for up to two weeks after surgery. Dogs should not use neck collars. Physical activities will be limited as the dog rests and recovers for the next four to six weeks. 

The average cost to have a bilateral arytenoid lateralization surgery performed on a dog is roughly $200 to $3,000. The cost of the surgery depends on the severity of the dog’s condition and aftercare. 

A number of intraoperative, postoperative and long-term complications can develop in a canine that has undergone bilateral arytenoid lateralization surgery. During the operation, a dog could experience hemorrhage, arytenoid cartilage fragmentation, and failure to achieve an adequate rima glottidis opening. After the operation complications include, aspiration pneumonia, seroma or oedema development, hematoma and rima glottidis over-abduction. In the long term, a dog could develop issues with contralateral arytenoid collapse, arytenoid suture pull-through, aspiration pneumonia and surgical failure.

Laryngeal paralysis can either be an acquired or idiopathic condition in dogs. Acquired laryngeal paralysis can be the result of hypothyroidism, polyneuropathies, neoplasia or trauma. The veterinarian may try a medical management approach using steroids, sedatives and oxygen therapy to avoid the need for a bilateral arytenoid lateralization surgery.