Ex vivo study of vagal branches at risk for iatrogenic injury during laryngoplasty in horses

Objective To localize vagal branches within the surgical field of laryngoplasty and identify potentially hazardous surgical steps. Study design Observational cadaveric study. Sample population Five equine head–neck specimens and four entire equine cadavers. Methods Dissection of the pharyngeal regio...

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Bibliographic Details
Published in:Veterinary surgery 2021-02, Vol.50 (2), p.425-434
Main Authors: Pisano, Simone R. R., Stoffel, Michael H., Bodó, Gábor
Format: Article
Language:English
Subjects:
Animals
Cadaver
Cadavers
Constrictors
Dissection
Dissection - veterinary
Esophagus
Female
Health risks
Horses
Horses - injuries
Horses - surgery
Iatrogenesis
Laryngoplasty - veterinary
Male
Muscles
Nerves
Pharynx
Population studies
Risk
Septum
Sheaths
Skull
Vagus nerve
Vagus Nerve - surgery
Vagus Nerve Injuries - surgery
Vagus Nerve Injuries - veterinary
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Summary:Objective To localize vagal branches within the surgical field of laryngoplasty and identify potentially hazardous surgical steps. Study design Observational cadaveric study. Sample population Five equine head–neck specimens and four entire equine cadavers. Methods Dissection of the pharyngeal region from a surgical perspective. Neuronal structures were considered at risk if touched or if the distance to instruments was less than 5 mm. Results The branches of the pharyngeal plexus (PP) supplying the cricopharyngeal muscle (PPcr), the thyropharyngeal muscle (PPth), and the esophagus (PPes) were identified in the surgical field in nine of nine, five of nine, and one of nine specimens, respectively. The internal branch of the cranial laryngeal nerve (ibCLN) was identified within the carotid sheath in six of nine specimens. The external branch of the cranial laryngeal nerve (ebCLN) was identified close to the septum of the caudal constrictors in nine of nine specimens. The blade of the tissue retractor compressed the ibCLN in six of six, the ebCLN in four of six, the PPcr in six of six, the PPth in two of three, and the PPes in two of two specimens in which the respective nerves were identified after further dissection. Surgical exploration of the dorsolateral aspect of the pharynx and the incision of the septum of the caudal constrictors harmed the ebCLN in nine of nine, PPcr in seven of nine, and PPth in four of eight specimens. Conclusion Several vagal branches were located in the surgical field and must be considered at risk because of their location. Clinical significance Use of the tissue retractor, dissection over the pharynx, and dissection of the septum of the caudal constrictors involve a risk to damage vagal branches.
ISSN:0161-3499
1532-950X
DOI:10.1111/vsu.13548