TIE-BACK COMPLICATION - ALL IN THE APPROACH?

摘要

Idiopathic laryngeal paralysis is an extremely common disorder in large breed dogs that can result in a life threatening inability to breathe. This disorder is often treated by unilateral surgical fixation (a "tie back procedure") of the arytenoid cartilage in an abducted (open) position. Approximately 10-30% of surgically treated dogs will develop aspiration pneumonia following this procedure.1"4 Although permanently opening the glottis is likely the largest contributor to the development of aspiration pneumonia post-tie back, surgical access to the larynx may contribute to this complication. The standard surgical approach involves transecting muscles which contribute to the upper esophageal sphincter and thus play a critical role in the act of swallowing and in preventing esophageal reflux. When surgically approaching a joint, a basic principle is to avoid transecting muscle fibers whenever possible - it is likely that this principle should also be applied to the cricoarytenoid articulation. Thestandard tie-back, also involves transecting the cricoarytenoideus dorsalis muscle which likely increases the risk of damaging intrinsic nerves that innervate nearly all other ipsilateral laryngeal/pharyngeal muscles as well as the mucosa of the larynx/pharynx. A muscle sparing laryngoplasty technique thus has the potential to decrease the risk of potentially life-threatening aspiration in the post-operative period.