Proceedings of a Workshop on - The Havemeyer Foundation

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Havemeyer Foundation Monograph Series No. 11 Allergic and Immune Mediated Processes Infectious Agents - Viruses - Bacteria - Fungi Respiratory Irritants - Ammonia - Feed and barn dust Intrinsic Trauma - Vocalisation - Coughing - Throat clearing - Endoscopy Arytenoid Mucosal Inflammation and Oedema + Pressure over immobile epithelium/mucosa Extrinsic Trauma - Naso/orotracheal intubation - Course feed stuffs Mucosal Ulceration Uncommon • Deep infection in submucosa and perichondrium • Cartilage infection and proliferative granulation tissue production Cartilage swelling and distortion Common • Superficial mucosal/submucosal infection • Minimal granulation tissue production • Cartilage not affected Arytenoid Mucosal Injury Laser • Perilaryngeal tissues affected • Cricoarytenoid joint affected • Incomplete abduction Arytenoid Chondritis Arytenoidectomy Topical and/or systemic antibiotics and antiinflammatories Wound Healing 7-21 d Focal Curettage Fig 1: Suggested pathogenesis and outcome <strong>of</strong> arytenoid mucosal injury. occurs by epithelialisation, mild fibroplasia (granulation tissue production) and some contraction. Typically, the underlying arytenoid cartilage is not affected. The potential for such injuries to progress to the more serious arytenoid chondritis (discussed below) is thought to be low (Smith 2000; Kelly et al. 2003; B.H. Anderson, unpublished data) but happens occasionally. Kelly et al. (2003) reported idiopathic mucosal lesions <strong>of</strong> the arytenoids cartilages in 21 Thoroughbred yearlings (0.63% <strong>of</strong> 3,312 horses having post sale upper respiratory tract examinations over a 5 year period). In 2 horses (10%) granulomas developed at the site <strong>of</strong> ulceration and in one horse (5%) chondropathy developed. Strictly defined, arytenoid chondritis means inflammation <strong>of</strong> the arytenoid cartilage. However, the condition usually referred to as arytenoid chondritis is an inflammatory swelling involving the arytenoid cartilage, peri-arytenoid tissue, 53
Equine Recurrent Laryngeal Neuropathy laryngeal mucosal surface and dorsal muscular structures. Endoscopically this condition is recognised as a medially displaced, swollen, misshapen, arytenoid cartilage. In most cases the cartilage is reddened or hyperaemic. There may be reduced or absent cartilage movement in more severe cases. Discharging pus-filled lesions on the medial border <strong>of</strong> the arytenoid cartilage may be present as well as ulcers or epithelial swellings (‘kissing lesions’) on either cartilage. Intraluminal projections <strong>of</strong> granulation tissue may also be present. It is not clear what factors or conditions are important in determining if infection becomes established within the arytenoid cartilage rather than remaining in superficial tissues. What has become difficult in the sales environment is determining if infection or inflammation is confined only to the mucosa or if cartilage is involved. Differentiating generalised mucosal oedema from cartilage enlargement, and determining if luminal projections <strong>of</strong> granulation tissue involve the underlying cartilage or not is not always easy. Experience gained from surgical treatment has revealed that if luminal projections <strong>of</strong> granulation tissue are marked, invariably the underlying cartilage is affected. However, each case is considered ‘on the day’ and a decision on the absence or presence <strong>of</strong> chondritis is aided by careful examination <strong>of</strong> video-endoscopic pictures. REFERENCES Anderson, B.H. (2000) Post sale endoscopic examination <strong>of</strong> horses in New Zealand. Proc.Equine Seminar, Wairakei, 71-76. Kelly, G., Lumsden, J.M., Dunkerly, G. (2003) Idiopathic mucosal lesions <strong>of</strong> the arytenoid cartilages <strong>of</strong> 21 Thoroughbred yearlings: 1997- 2001. Equine vet. J. 35 (3), 276-281. Smith, R.L. (2000) Arytenoid Chondritis in Horses and Other Species. Thesis, Massey University, Palmerston North, New Zealand. 54
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