Initial management of animals with laryngeal paralysis should include symptomatic therapy to enable normal ventilation. Most
animals with laryngeal paralysis are not dyspneic and may be managed conservatively by minimizing exposure to high temperature
and the stress of exercise, use of a harness rather than a neck leash, and avoidance of obesity. Hyperthermia is treated by
cooling the patient with wet towels or alcohol applied to the trunk and/or extremities. If the animal is dyspneic at presentation,
oxygen is administered by face mask, nasal oxygen catheter, or in an oxygen cage. Corticosteroids and tranquilizers may also
assist in preoperative stabilization of the patient. Rarely, temporary tracheostomy may be necessary to stabilize the animal
prior to clinical work-up and definitive surgery.
Although not ideal, some dogs can be managed conservatively by owners if they keep the dog quiet and cool. These are dogs
that are not overtly dyspneic on presentation. Dogs that are dypsneic need surgical intervention for relief of signs.
Surgery is the treatment of choice for dogs with laryngeal paralysis. Laryngoplasty techniques include partial arytenoidectomy
and vocal fold excision, castellated laryngofissure, and arytenoid lateralization or "tie-back" procedures. Although there
is no consensus as to which surgical procedure is best most surgeons prefer to perform an arytenoid lateralization ("Tieback")
technique. The goal of any surgical procedure is to widen the glottis enough to prevent dyspnea in normal semi-restricted
activity. Most animals have acceptable exercise tolerance following surgery however athletic performance should not be expected.
Most surgeons also agree that partial arytenoidectomy and vocal fold excision performed per os is NOT an acceptable surgical
procedure. This procedure can cause "webbing" and excessive granulation tissue formation necessitating permanent tracheostomy
for salvage. Castellated laryngofissure is more complicated surgical procedure that is successful in treatment of this disease.
Because of the more complex nature and the fact that tracheostomy is necessary during surgery this technique is rarely performed.
Unilateral arytenoid lateralization is performed by retracting the arytenoid cartilage laterally and attaching it to the cricoid
or thyroid cartilage cartilage. I prefer to suture the muscular process to the cricoid. Specifically, the muscular process
of the arytenoids is sutured to the caudodorsal border of the cricoid cartilage with non-absorbable suture. Tieback procedures
are performed unilaterally to decrease the incidence of aspiration pneumonia following surgery. A recent study of a large
number of tieback cases revealed that about 25% of animals develop aspiration pneumonia following surgery. This may occur
in the perioperative period or up to a year later. Overall success with the surgical procedure is reported to be 80-100%.
Aspiration pneumonia can potentially be a serious consequence of the disease or following surgery. This risk seems to be present
life-long with this disease.
Arytenoid Lateralization Procedure
1. Place the animal in right lateral recumbency if the surgeon is right-handed. A towel is placed ventral to the neck
to cause elevation of the cervical area.
2. A 10-12 cm skin incision is made from the angle of the mandible to the jugular furrow.
3. Subcutaneous tissue and superficial muscle is incised and the jugular vein retracted dorsally. Electrocautery is used
to coagulate small bleeders.
4. The wing of the thyroid cartilage is palpated and a "stay suture'" placed to allow lateral traction.
5. The thyropharyngeus muscle is incised to expose pharyngeal membrane which is also incised.
6. The cricoarytenoid articulation is palpated and separated.
7. The cricoid cartilage on the posterior larynx is palpated and a suture of 2-0 or 0 polypropylene placed around the
cricoid and then through the disarticulated muscular process.
8. The suture is tied snugly but NOT over tightened. Remember, the animal already has an endotracheal tube in place thus
the glottis is relatively open.
9. If desired, the tube may be removed and the glottis checked for appropriate opening.
10. The thryopharyngeus muscle and other soft tissues are closed routinely.
Postoperatively, we typically start the dog on ice-chips and then small meat balls of food to see how the animal tolerates