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Partial laryngectomy is a surgical procedure that aims to widen the entrance to the larynx in order to help the dog breathe more easily. Another procedure, the laryngeal tie-back, is more commonly performed, as it is linked with fewer complications postoperatively.
The larynx is a complex structure which polices the entrance to the trachea or windpipe. Its job is to open wide when the dog breathes in, and narrow down when the dog breathes out. This is part of a mechanism that prevents food or liquid being inadvertently inhaled down into the lungs and causing inhalation pneumonia.
Partial laryngectomy may be undertaken in first opinion practice by a skilled surgeon, but intensive care nursing facilities should be available postoperatively. Alternatively, a skilled surgeon may preferentially perform a laryngeal tie-back procedure or refer the dog for this procedure.
A general anesthetic is essential, with a breathing tube placed in the dog's windpipe to maintain an open airway during surgery.
There are two approaches to this surgery. The most commonly used is intraoral, where the surgeon uses long instruments and accesses the larynx through the dog's open mouth. This is less invasive for the dog but there is little room for the surgeon to operate and complications such as hemorrhage can be difficult to deal with.
Alternatively, the patient lies on their back and the surgeon incises into the throat over the larynx. The surgeon surgically opens the larynx by cutting through the cartilaginous landmarks until the relevant anatomy is exposed.
Surgery involves trimming away part of the arytenoid and corniculate cartilage in order to enlarge the opening to the larynx. Hemorrhage is controlled by applying pressure with swabs or swabs soaked in epinephrine.
Complications occur in 40 to 50% of cases undergoing partial laryngectomy. This may be at the time of surgery, such as hemorrhage, or later in recovery. Long-term complications include making the larynx too wide, which means fluid is aspirated down into the lungs causing pneumonia. This is a potentially life-threatening condition.
Other problems include the formation of scar tissue across the larynx, which then narrows the opening back down, rendering the surgery ineffective.
Postoperative swelling of the throat is a major concern. Swelling of the larynx can completely occlude the entrance to the trachea, leading to suffocation. Thus, intensive nursing is required to observe the patient and take action accordingly.
This may mean administering anti-inflammatory drugs, or in extreme cases performing an emergency tracheotomy to ensure an open airway.
An oral approach partial laryngectomy may cost $1,000 to $2,000 depending on the experience of the surgeon. In contrast, a tie-back procedure costs approximately $1,500 to $4,000 depending on whether it is performed in first opinion practice or at a referral center.
Partial laryngectomy is one of several options to treat the symptoms of laryngeal paralysis.
Other options include a laryngeal tie back or placement of a permanent tracheotomy tube. Partial laryngectomy has largely fallen out of favor, because of the high risk of complications such as aspiration pneumonia. However, when successful the procedure can greatly improve quality of life for the patient.
Laryngeal paralysis can result from damage to the laryngeal nerve which runs along the neck. The commonest cause of injury is partial strangulation when a dog pulls hard on a collar. A combination of obedience training to teach the dog to walk and heel, and the use of a harness which spreads the force over the chest, can ensure prevention.
Owners should also be vigilant for signs of hypothyroidism, because when treated early the complication of laryngeal paralysis may be avoided. The symptoms include lethargy, weight gain, poor coat condition, and heavier-than-usual folds of skin on the face. Treatment is simple and requires a daily supplement of thyroid hormone in tablet form.
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