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The larynx is a complex structure that polices the entrance to the trachea (windpipe). It has a number of functions including protecting the airway from aspiration of food and liquid, plus the vocal cords are located on the larynx.
Laryngectomy refers to the complete removal of the larynx, of which the main indication is cancer affecting the area. However, without a functional larynx the dog is not able to breathe, and so a permanent tracheotomy is an essential part of the procedure. The tracheotomy tube provides a permanent opening directly into the windpipe through which to breathe.
Laryngectomy is a rare procedure, only undertaken at referral centers or university teaching facilities. Most of the veterinary knowledge about laryngectomy has been transferred from human medicine, where it may be undertaken when patients with laryngeal cancer do not respond to radiotherapy.
Expert surgeons, including cooperation from human surgeons experienced in this field, are required. Prior to the laryngeal procedure, a gastrostomy feeding tube is placed in the dog's stomach. This is to facilitate feeding in the postoperative period when swallowing may be difficult.
The patient is given a general anesthetic, and the head and neck area clipped and aseptically prepared. The surgeon first places a tracheotomy tube. This allows ventilation of the patient during surgery, whilst the laryngeal procedure is underway.
Then the skin overlying the larynx is incised, and the soft tissue structures dissected away to expose the area. Removal of the larynx is an intricate procedure which can take two experienced surgeons three hours to perform.
On recovery the dog is carefully monitored for pain and breathing difficulties.
Laryngectomy is a radical but effective way to remove a tumor of the larynx. However, the patient should be carefully screened prior to surgery to eliminate the chance of secondary spread (metastasis) already having occurred. The latter would limit the life expectancy of the dog and mean that such major surgery was unethical.
In human medicine, radiotherapy is the treatment of choice for laryngeal tumors, with laryngectomy being reserved for non responsive cases. The cases of laryngeal cancer in the dog are few and far between so alternative management methods depend on the experience of specialist experts within traveling distance of the owner.
Once the dog has adjusted to breathing through the tracheotomy tube, an immediate improvement in demeanour should be evident. The patient should rest for 10 to 14 days post-surgery, in order to recover.
The tracheostomy tube requires careful management and daily checks to make sure it is clean and patent. The owner must learn how to maintain and clean the tracheotomy stoma, and seek veterinary attention whenever a problem is suspected.
The dog must wear a harness rather than a collar for exercise. Certain lifestyle adjustments are necessary, such as never allowing the dog to swim (as water will enter via the tracheotomy and drown the dog).
The costs involved are unchartered and liable to represent $10,000 or more at a conservative estimate.
The initial work up at the first opinion vet may include consultations, blood work, radiographs, and endoscopic examination of the larynx. This represents costs of around $500 to $1,000.
When a laryngeal tumor is suspected, the dog will have both breathing and swallowing difficulties and be at risk of aspiration pneumonia. Whilst a tracheotomy without laryngectomy will aid breathing, it will not stop the progression of the cancer. Therefore removal of the laryngeal tumor is the procedure most likely to extend life.
It may be difficult to find a surgeon with the necessary experience to perform a laryngectomy. It might be the procedure is most likely undertaken at a teaching hospital as part of a wider learning experience for all involved.
Cancers of the larynx are rare in dogs. When they do occur it tends to be in younger dogs, which suggests a genetic tendency to disease. Affected dogs should not be bred from. However, hereditary disorders aside there is no identifiable cause for laryngeal cancer in dogs, and therefore prevention is impossible.
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