Paralisia de laringe em cão Dogue Alemão - tratamento com unilateralização da cartilagem aritenoide / Laryngeal paralysis in a Great Dane dog - treatment by unilateralization of the arytenoid cartilage

Background: Laryngeal paralysis is a disorder that affects the movement of the arytenoid cartilages, creating an obstacle to the passage of air during inspiration. The disease is progressive and clinical signs are associated with upper airway obstruction. Diagnosis occurs through observation of laryngeal movements, and it is important to rule out concomitant diseases. In severely affected animals, surgery is recommended to alleviate clinical signs and improve quality of life. The aim of this report is to report a case of idiopathic laryngeal paralysis in a dog submitted to arytenoid unilateralization to clear the upper airways and evaluate the effectiveness of the technique. Case: A 5-year-old male Great Dane dog was referred to the Hospital de Clínicas Veterinárias (HCV) of the Federal University of Rio Grande do Sul (UFRGS) with severe respiratory distress and respiratory stridor. The animal was taken directly to the emergency room, where it was promptly submitted to oxygen therapy with the aid of a mask, was medicated with nalbuphine hydrochloride 0.3 mg/kg intramuscularly and venous access was performed. After stabilization, complete blood count, biochemical profile, blood gas analysis and chest X-ray were requested. In the anamnesis, the tutor reported that the dog showed signs of fatigue with exercise intolerance, coughing similar to choking, breathing difficulties and noisy breathing, especially on hotter days and in situations of exertion, stress or euphoria. He mentioned that the signs were progressive, having started 2 months ago and that they were more frequent and lasting. The patient was diagnosed with laryngeal paralysis through transoral laryngoscopy and referred to surgery. The improvement in the breathing pattern and the absence of post-surgical complications resulted in the patient being discharged 6 days after hospitalization. Discussion: When the origin of laryngeal paralysis (LP) is undefined, the acquired form may be a consequence of generalized polyneuropathy, polymyopathy, neoplasia, endocrinopathy, iatrogenic or idiopathic injury. The patient under study did not present clinical signs or history of disease, therefore, the case was classified as idiopathic in origin. Laryngeal paralysis of unknown cause is the most common and affects mainly middle-aged to elderly males, large or giant breeds. The disease is often described in Labrador Retriever dogs, but it can affect other breeds such as Great Dane. This information corroborates the profile of the patient in this study. Although oral laryngoscopy is the recommended method for confirming the diagnosis in dogs with characteristic signs of LP, the diagnosis can also be obtained by transnasal laryngoscopy or echolaryngography, however, previous studies have shown that the sensitivity and specificity of diagnosis through echoaryngography is inferior to transnasal laryngoscopy, suggesting that direct visualization of the larynx is better to indirect visualization. Dogs with signs of moderate to severe respiratory distress or whose quality of life is affected as a result of LP are candidates for surgical treatment, as in this case, in which the patient had exercise intolerance and severe respiratory distress. The arytenoid unilateralization procedure proved to be effective in improving the quality of life of the patient under study, achieving excellent postoperative results and approval by the tutor. In this case, transoral laryngoscopy was essential to determine the diagnosis and establish the treatment. Although the goal of improving quality of life has been achieved without major complications, the animal must receive long-term follow-up due to a possible correlation with generalized polyneuropathy and long-term complications.

Brachycephalic syndrome in dogs - endoscopic findings in the airways

Background: Brachycephalic dogs have several abnormalities in the airways, which generate clinical manifestations that impair the quality of life of these animals. Primary alterations promote airflow obstruction and increase intraluminal negative pressure, causing secondary alterations due to a cycle of inflammation with consequent obstruction. With the onset of inflammation and other alterations in the airways, clinical manifestations can be observed, such as snoring, reverse sneezing, coughing, dyspnea, cyanosis, syncope, and vomiting. Endoscopic examination of the airways allows visualization and diagnosis of morphological changes in these animals. This study aimed to evaluate the endoscopic findings of the airways and determine the quantitative and qualitative assessment of the severity of clinical manifestations in 14 dogs with brachycephalic syndrome (BS). Materials, Methods & Results: Historical and anamnesis data and clinical, respiratory, and digestive manifestations were collected from the owners' reports. The clinical manifestations were classified as mild, moderate, or severe. All animals were subjected to endoscopy of the airways, and image findings were grouped according to the anatomical site where they were observed, then the abnormalities were correlated with the severity of the clinical manifestations. When comparing the frequency of endoscopic abnormalities with the severity of clinical manifestations, it is interesting to observe that animals with severe disease more frequently presented the following alterations: prolongation and thickening of the soft palate, laryngeal changes, presence of hyperemia, lymphoid hyperplasia and polyps in the nasopharynx, hypoplasia and presence of tracheal secretion and thickening of the dorsal tracheal muscle; bronchial collapse, hypoplasia of the main bronchi and bronchial hyperemia and the presence of aberrant nasal turbinates. Comparison between the means of nonparametric variables was performed using the Mann-Whitney test, with a 5% significance level. Discussion: A higher frequency of French Bulldog dogs included in the study was observed, probably due to their greater popularity, although any brachycephalic dog may be affected by BS. Considering that nostril stenosis is a congenital alteration, which is usually diagnosed early, and since the animals included in the study were dogs referred for the rhinoplasty procedure the higher frequency of young dogs in the study was not surprising. The results revealed a significant difference in the endoscopic findings with the severity of the clinical manifestations in different variables, such as prolongation and thickening of the soft palate, eversion of the laryngeal saccules, presence of laryngeal inflammation and collapse, presence of polyps or lymphoid hyperplasia in the nasopharynx, thickening of the dorsal muscle of the trachea, polyps in the trachea and hypoplasia in addition to bronchial hyperemia. The larynx was the most affected anatomical site, with alterations present in 92.8% of the evaluated dogs. Based on these findings, it can be concluded that airway obstruction caused by primary alterations can cause secondary alterations, with consequent clinical manifestations in brachycephalic dogs it is possible to suggest that dogs with this syndrome may present severe manifestations of the disease, regardless of age. Furthermore, it can be concluded that in this study, dogs with BS had frequent laryngeal alterations and that alterations in the main bronchi were present in all animals with severe manifestations of the disease.

Manejo da via aérea difícil em um gato com tonsilite / Management of difficult airway in a cat with tonsillitis

Background: Tracheal intubation is performed in an anesthetized patient in order to optimize oxygenation and to allow the administration of volatile anesthetics. Some patients have characteristics that make intubation a challenge. Therefore, an adequate pre-anesthetic evaluation enables the anesthesiologist to define the best management. There are reports of the impossibility of performing conventional intubation attributed to the lack of pre-anesthetic consultation in Medicine, which motivates and justifies the discussion of these aspects in Veterinary Medicine. Therefore, this study aims to report a case of difficult airway management in a feline with tonsillitis. Case: A 3-year-old male NDB cat weighing 3.5 kg was admitted to the Veterinary Hospital, Federal University of Pampa (UNIPAMPA) - Uruguaiana, for consultation. After physical examination, total tooth extraction and tonsillectomy was recommended. On the day of the procedure, a physical evaluation of the patient was performed, and he was classified as ASA II. Zolazepam and tiletamine [Zoletil® - 5 mg/kg, i.m] associated with morphine [Dimorf® - 0.3 mg/kg, i.m] was given as premedication. Given the difficulty of intubation in a previous procedure reported by the tutor, a thoughtful conduct was planned for the intubation of the patient, considering the possibility of tracheostomy. The patient was pre-oxygenated, and subsequently, propofol [Propovan® - 4 mg/kg, i.v] was administered to promote anesthetic induction. The first attempt at intubation was done by laryngoscopy, but despite the use of a 6 cm blade, it was too large in relation to the hyperplastic tissue; then swabs and a flashlight were subsequently used. With the help of 2 people, the experienced anesthesiologist was able to position the endotracheal tube correctly approximately 25 min after the first attempt, requiring supplemental doses of propofol [Propovan® to the effect, i.v] and oxygenation between the attempts. Anesthetic maintenance was achieved with isoflurane [Isoforine® vaporized in 100% oxygen] in a system without gas rebreathing. Locoregional block of the maxillary nerve and inferior branch of the mandibular nerve was performed with lidocaine 2% [0.1 mL/kg]. During the transoperative, the vital parameters remained stable and there was no need for analgesic rescue. After the end of the procedure and extubation, the patient received oxygen therapy via facemask until he regained consciousness and had no complications. Discussion: The mortality of dogs and cats related to anesthetic procedures is substantially higher when compared to humans. Studies have shown that most anesthetic-related complications in humans are predictable. The lack of adequate pre-anesthetic evaluation or anesthetic consultation are factors that can cause losses in the transoperative period. Therefore, sharing information that can mitigate these situations is critical. The scarcity of reports on pre-anesthetic evaluation in veterinary medicine allows the identification of a gap on the role of the anesthesiologist in this important stage of anesthesia, and how it is performed in the hospital routine or in veterinary clinics. The success in managing the difficult airway in the case reported here can be attributed to the procedures adopted in all stages of the procedure, especially the planning based on information obtained during the pre-anesthetic period. It is worth mentioning that the owner was a veterinarian and we believe this also contributed to the outcome, since he informed the anesthesiologist about the difficulties encountered during the previous procedure. This case motivated the implementation of a pre-anesthetic consultation service in the hospital in question. In addition to the physical examination, a complete anamnesis carried out with the owner may reveal relevant details for determining the most appropriate and safe anesthetic conduct for the patient.

Palatoplastia em envelope para tratamento de prolongamento de palato mole em cão da raça pastor belga malinois: relato de caso

Prolongamento de palato é uma afecção primária em cães de raças braquicefálicas, entretanto encontra-se presente em outras raças. Promove dispneia e podem ocorrer quadros de cianose e síncope. O diagnóstico se dá por laringoscopia e o tratamento é estritamente cirúrgico, sendo a estafilectomia a técnica mais usual. Outras técnicas, como a palatoplastia em envelope, foram desenvolvidas para tratamento dessa afecção. O objetivo do estudo é relatar um caso de palatoplastia em envelope modificada para tratamento de prolongamento de palato em um cão da raça Pastor Belga Malinois, assim como sua boa recuperação pós-operatória.(AU)

Elongated soft palate is a primary affection in brachicephalic dogs, however is found to be presente in other breeds. Promotes dyspnea and may occur episodes of cianosis and syncope. Diagnosis is obtained through laryngoscopy and the treatment of this affection is strictly cirurgical, and staphylectomy is an usual technique commonly used. Other procedures, such folded flap palatoplasty, have been developed to the correction of this disease,. This study aims to report a case of a modified folded flap palatoplasty to correct a elongated soft palate in a Belgian Malinois dog, as well as its good posoperative evolution.(AU)

Palatoplastia em envelope para tratamento de prolongamento de palato mole em cão da raça pastor belga malinois: relato de caso

Prolongamento de palato é uma afecção primária em cães de raças braquicefálicas, entretanto encontra-se presente em outras raças. Promove dispneia e podem ocorrer quadros de cianose e síncope. O diagnóstico se dá por laringoscopia e o tratamento é estritamente cirúrgico, sendo a estafilectomia a técnica mais usual. Outras técnicas, como a palatoplastia em envelope, foram desenvolvidas para tratamento dessa afecção. O objetivo do estudo é relatar um caso de palatoplastia em envelope modificada para tratamento de prolongamento de palato em um cão da raça Pastor Belga Malinois, assim como sua boa recuperação pós-operatória.

Elongated soft palate is a primary affection in brachicephalic dogs, however is found to be presente in other breeds. Promotes dyspnea and may occur episodes of cianosis and syncope. Diagnosis is obtained through laryngoscopy and the treatment of this affection is strictly cirurgical, and staphylectomy is an usual technique commonly used. Other procedures, such folded flap palatoplasty, have been developed to the correction of this disease,. This study aims to report a case of a modified folded flap palatoplasty to correct a elongated soft palate in a Belgian Malinois dog, as well as its good posoperative evolution.

Paralisia de laringe em cão: relato de caso / Laryngal paralysis in dog: case report

A paralisia de laringe consiste na perda da capacidade de abdução das cartilagens aritenóides durante a inspiração. Pode ser congênita ou adquirida, secundária a trauma, neoplasia, polineuropatia ou endocrinopatia. O diagnóstico tem como base os sinais clínicos e exame de imagem da laringe. Uma cadela, de 9 anos de idade, da raça Labrador Retriever foi atendida no hospital veterinário com quadro de dispnéia inspiratória, intolerância ao exercício, sobrepeso, inquietação e taquicardia. Após oxigenoterapia, foram solicitados hemograma, perfil bioquímico, hemogasometria e exame radiográfico do tórax, porém, o diagnóstico definitivo de paralisia de laringe foi obtido por meio da ultrassonografia da região cervical ventral e laringoscopia. Nestes exames foram observados movimentos assimétricos das cartilagens aritenóides durante a inspiração. Desta forma, foi instituído o tratamento emergencial de traqueostomia. Após quatro dias foi realizada a técnica de lateralização aritenóide unilateral. Ao longo de 14 dias de internação, o padrão respiratório da paciente foi restaurado, resultando na alta do animal.

Laryngeal paralysis consists of the loss of the capacity of abduction of arytenoid cartilages during inspiration. The etiology may be congenital or acquired, secondary to trauma, neoplasia, polyneuropathy or endocrinopathy. The diagnosis is based on clinical signs and on the examination of the larynx. A 9-year-old Labrador Retriever was treated at the veterinary hospital, with symptoms of inspiratory dyspnea, exercise intolerance, overweight, restlessness and tachycardia. After oxygen therapy, complete blood count, biochemicals, hemogasometry and chest radiography were requested. The definitive diagnosis of laryngeal paralysis was obtained by ultrasonography of the ventral cervical region and laryngoscopy. Asymmetric movements of the arytenoid cartilages were observed during inspiration. Therefore, emergency tracheostomy treatment was instituted. After the assessment of the operative risks, it was chosen to perform the unilateral laryngeal lateralization procedure. Throughout 14 days of hospitalization, the patient's respiratory pattern was restored, resulting in the discharge of the animal.

Paralisia de laringe em cão: relato de caso / Laryngal paralysis in dog: case report

A paralisia de laringe consiste na perda da capacidade de abdução das cartilagens aritenóides durante a inspiração. Pode ser congênita ou adquirida, secundária a trauma, neoplasia, polineuropatia ou endocrinopatia. O diagnóstico tem como base os sinais clínicos e exame de imagem da laringe. Uma cadela, de 9 anos de idade, da raça Labrador Retriever foi atendida no hospital veterinário com quadro de dispnéia inspiratória, intolerância ao exercício, sobrepeso, inquietação e taquicardia. Após oxigenoterapia, foram solicitados hemograma, perfil bioquímico, hemogasometria e exame radiográfico do tórax, porém, o diagnóstico definitivo de paralisia de laringe foi obtido por meio da ultrassonografia da região cervical ventral e laringoscopia. Nestes exames foram observados movimentos assimétricos das cartilagens aritenóides durante a inspiração. Desta forma, foi instituído o tratamento emergencial de traqueostomia. Após quatro dias foi realizada a técnica de lateralização aritenóide unilateral. Ao longo de 14 dias de internação, o padrão respiratório da paciente foi restaurado, resultando na alta do animal.(AU)

Laryngeal paralysis consists of the loss of the capacity of abduction of arytenoid cartilages during inspiration. The etiology may be congenital or acquired, secondary to trauma, neoplasia, polyneuropathy or endocrinopathy. The diagnosis is based on clinical signs and on the examination of the larynx. A 9-year-old Labrador Retriever was treated at the veterinary hospital, with symptoms of inspiratory dyspnea, exercise intolerance, overweight, restlessness and tachycardia. After oxygen therapy, complete blood count, biochemicals, hemogasometry and chest radiography were requested. The definitive diagnosis of laryngeal paralysis was obtained by ultrasonography of the ventral cervical region and laryngoscopy. Asymmetric movements of the arytenoid cartilages were observed during inspiration. Therefore, emergency tracheostomy treatment was instituted. After the assessment of the operative risks, it was chosen to perform the unilateral laryngeal lateralization procedure. Throughout 14 days of hospitalization, the patient's respiratory pattern was restored, resulting in the discharge of the animal.(AU)

ENDOSCOPIA DAS VIAS AÉREAS SUPERIORES EM CADÁVERES DE CÃES PREPARADOS COM SOLUÇÕES DE ÁLCOOL ETÍLICO GLICERINADO E SAIS DE CURA

A solução de álcool etílico glicerinado e sais de cura usada em cadáveres minimiza a proliferação microbiológica e instalação de alterações post-mortem. Esse estudo objetivou por meio de exames endoscópicos seriados (laringoscopia, faringoscopia e rinoscopias direita e esquerda) avaliar as vias aéreas superiores de cadáveres caninos quimicamente preparados com solução de álcool etílico glicerinado e sais de cura, mantidos sob refrigeração de 4-6°C. Foram selecionados 10 cadáveres caninos mesocefálicos, sem afecções de trato respiratório, congelados a -18°C e descongelados 18 horas antes do experimento. Esses exames foram realizados imediatamente após descongelamento (M0) e sete, 15, 30, 60, 90 e 120 dias (M7- 120) após injeção da solução de preservação. Cada sítio anatômico foi avaliado com relação ao estado de conservação, visibilidade; coloração de mucosa; aspecto de superfície mucosa e presença de artefatos. Pontuado por escore de 0 a 3 (0: normal/excelente; 1: discretamente alterado; 2: moderadamente alterado; 3: estado ruim/avaliação inviável). Do total de 110 análises, menos de 5% delas apresentaram diferença significativa entre ao menos dois momentos. As principais alterações encontradas foram mudanças na coloração da mucosa da epiglote (p=0.0075), do palato mole (p=0.0234 e p=0.0022) e nasofaringe (p=0.0475), além de artefatos no meato ventral direito (p=0.0280) e septo nasal (p=0.0399). A partir das avaliações endoscópicas seriadas, conclui-se que a manutenção de cadáveres caninos descongelados sob refrigeração, após preparo com solução de fixação de álcool etílico glicerinado e sais de cura, por período de até 120 dias, proporciona conservação das vias aéreas superiores com poucas alterações nas avaliações.

Glycerinated ethyl alcohol and curing salts solution used in cadavers minimize microbiological proliferation and postmortem changes. This study aims to evaluate the upper respiratory tract of dogs cadavers preserved in glycerinated ethyl alcohol and curing salts solution, refrigerated at 4-6°C through a series of endoscopic exams (laryngoscopy, pharyngoscopy, right and left rhinoscopy). Ten mesocephalic canine dogs, without a history of respiratory sickness, frozen at -18°C were defrost 18 hours before the experiment. The exams were performed immediately after defrosting (M0) and seven, 15, 30, 60, 90, and 120 days (M7-120) after injection of the preservation solution. Each anatomic site visualized in the exams was evaluated regarding conservation state, visibility, mucous membrane color, mucous membrane surface, and artifact presence. These received a score from 0 to 3 (0: normal/great; 1: slightly modified; 2: mildly modified; 3: poor preservation/impossible to evaluate). From a total of 110 analyses, less than 5% exhibit a significant difference in at least two moments. Mucous membrane color change in epiglottis (p=0.0075), soft palate (p=0.0234 and p=0.0022) and nasopharynx (p=0.0475), artefacts in right ventral meatus (p=0.0280) and nasal septum (p=0.0399) were the main changes found. Through a series of endoscopic exams, it is concluded that maintaining canine cadavers under refrigeration, after injection of glycerinated ethyl alcohol and curing salts solution, for a period of 120 days, preserved the upper airways with little changes visualized.

Laryngeal and voice disorders in patients with gastroesophageal symptoms. Correlation with pH-monitoring / Alterações laríngeas e vocais em pacientes com sintomas de refluxo gastroesofágico. Correlação com exame de phmetria

PURPOSE: To investigate laryngeal and voice disorders in patients with gastroesophageal symptoms and their correlation with pH-monitoring. METHODS: A prospective study was carried out in patients attended at the Voice Disorder Outpatient Clinics of Botucatu Medical School in a five-year period and had vocal and gastroesophagic symptoms. Patients underwent videolaryngoscopy, auditory-perceptual vocal analyses, computerized acoustic vocal analysis and dual probe pH-monitoring for 24 hours. RESULTS: Fifty-seven patients were included (aged between 21 and 65 years; 45 women and 12 men), 18 had normal (31.6%) and 39 had abnormal pH-monitoring results (68.4%). Videolaryngoscopy recorded several laryngeal lesions for both patients with normal and abnormal pH-monitoring, but mostly for the latter group, highlighting posterior pachyderma. Auditory-perceptual vocal assessments identified vocal changes of several intensities for both groups but especially for patients with abnormal pH-monitoring results. All acoustic parameters, except f0, were abnormal for both groups, compared to the control population. CONCLUSION: Acoustic and perceptual vocal changes and laryngeal lesions were recorded for both patients with normal pH-monitoring results and patients with abnormal pH-monitoring results, evidencing the importance of clinical history and videolaryngoscopic findings for diagnosing acid laryngitis.(AU)

OBJETIVO: Investigar as alterações laríngeas e vocais em pacientes com sintomas de refluxo gastroesofágico e correlacioná-las com o exame de phmetria. MÉTODOS: Estudo prospectivo que incluiu os pacientes atendidos nos ambulatórios de Distúrbios da Voz da Faculdade de Medicina de Botucatu no período de cinco anos com sintomas vocais e gastroesofágicos. Os pacientes foram submetidos à videolaringoscopia, às análises vocais perceptivo-auditivas, a analise vocal acústica computadorizada e ao exame de pHmetria de dois canais com monitorização durante 24 horas. RESULTADOS: Foram incluídos 57 pacientes (entre 21 a 65 anos; 45 mulheres e 12 homens). Desses, 18 apresentavam pHmetria normal (31,6%) e 39 alterada (68,4%). As videolaringoscopias registraram diversas lesões laríngeas tanto nos pacientes com pHmetria normal como alterada, sendo mais relevantes neste último grupo, destacando-se a paquidermia posterior. As avaliações vocais perceptivo-auditivas identificaram alterações vocais de diversas intensidades em ambos os grupos, mais importantes nos pacientes com pHmetria alterada. Todos os parâmetros acústicos, exceto Fo, mostraram-se alterados em ambos os grupos, quando comparados aos controles. CONCLUSÕES: Alterações vocais perceptivas e acústicas, e lesões laríngeas foram registradas tanto nos pacientes com phmetria normal como alterada, sinalizando para a importância da historia clínica e dos achados videolaringoscópicos no diagnóstico das laringites ácidas.(AU)

Paralisia de laringe congênita em um cão: relato de caso / Congenital laryngeal paralysis in a dog: a case report

A paralisia de laringe (PL) é causada pela perda total ou parcial da inervação dos músculos laríngeos, que promovem adução e abdução das cartilagens aritenóides (CA) e das cordas vocais. Os sinais clínicos correlacionam-se com o grau de paralisia das CA e podem incluir dispnéia inspiratória, estridorlaríngeo, angústia respiratória, intolerância ao exercício, disfonia ou mudança no latido. Uma polineuropatia pode acompanhar a doença respiratória, caracterizando-se por megaesôfago e neuropatias apendiculares. O objetivo deste trabalho é relatar um caso de PL congênita em um cão labrador, fêmea, de dois meses de idade, com grave dispnéia inspiratória, sibilos audíveis, constante posição ortopnéica e aumento dos sons broncovesiculares associado à moderada disfonia. A consecução diagnóstica foi realizada por laringoscopia com sedação superficial, onde se constatou edema das cartilagens laríngeas e paralisia bilateral das CA com difícil visualização do lúmen traqueal. A lateralização cirúrgica das CA como tratamento foi proposto, no entanto a paciente apresentou evolução desfavorável no período pré-operatório e evoluiu negativamente a óbito(AU)

The congenital laryngeal paralysis is caused by total or partial disruption of the laryngeal muscles innervation that promotes abduction and adduction of the arytenoids cartilages and vocal folds. The clinical signs correlate with the degree of paralysis of the arytenoid cartilages and are presented with inspiratory dyspneia, laryngeal stridor, respiratory distress, dysphonia or change in bark. A polyneuropathy associated to respiratory disease can be observed, characterized by megaesophagus and peripheral neuropathies. The aim of this paper is toreport a case of congenital laryngeal paralysisin a female Labrador Retriever dog, two months old, presented with inspiratory dyspneia, audible wheezing, orthopnea, increased lung sounds and change in bark. The diagnosis was made by laryngoscopy with superfitial sedation. Laryngeal edema, paralysis of the arytenoid cartilages and difficult visualization of the trachea was observed. The surgical lateralization of the arytenoid cartilages was proposed, but the patient presented complications at preoperative period and evolved negatively todeath(AU)

Paralisia de laringe congênita em um cão: relato de caso / Congenital laryngeal paralysis in a dog: a case report

A paralisia de laringe (PL) é causada pela perda total ou parcial da inervação dos músculos laríngeos, que promovem adução e abdução das cartilagens aritenóides (CA) e das cordas vocais. Os sinais clínicos correlacionam-se com o grau de paralisia das CA e podem incluir dispnéia inspiratória, estridorlaríngeo, angústia respiratória, intolerância ao exercício, disfonia ou mudança no latido. Uma polineuropatia pode acompanhar a doença respiratória, caracterizando-se por megaesôfago e neuropatias apendiculares. O objetivo deste trabalho é relatar um caso de PL congênita em um cão labrador, fêmea, de dois meses de idade, com grave dispnéia inspiratória, sibilos audíveis, constante posição ortopnéica e aumento dos sons broncovesiculares associado à moderada disfonia. A consecução diagnóstica foi realizada por laringoscopia com sedação superficial, onde se constatou edema das cartilagens laríngeas e paralisia bilateral das CA com difícil visualização do lúmen traqueal. A lateralização cirúrgica das CA como tratamento foi proposto, no entanto a paciente apresentou evolução desfavorável no período pré-operatório e evoluiu negativamente a óbito

The congenital laryngeal paralysis is caused by total or partial disruption of the laryngeal muscles innervation that promotes abduction and adduction of the arytenoids cartilages and vocal folds. The clinical signs correlate with the degree of paralysis of the arytenoid cartilages and are presented with inspiratory dyspneia, laryngeal stridor, respiratory distress, dysphonia or change in bark. A polyneuropathy associated to respiratory disease can be observed, characterized by megaesophagus and peripheral neuropathies. The aim of this paper is toreport a case of congenital laryngeal paralysisin a female Labrador Retriever dog, two months old, presented with inspiratory dyspneia, audible wheezing, orthopnea, increased lung sounds and change in bark. The diagnosis was made by laryngoscopy with superfitial sedation. Laryngeal edema, paralysis of the arytenoid cartilages and difficult visualization of the trachea was observed. The surgical lateralization of the arytenoid cartilages was proposed, but the patient presented complications at preoperative period and evolved negatively todeath

Uso do grampeador para o fechamento da faringe após laringectomia total

PURPOSE: To evaluate total laryngectomy for the surgical salvage after a unsuccessful chemoradiation therapy treatment for advanced laryngeal squamous cell carcinoma. METHODS: Twelve total laryngectomies were performed from March, 2001 to December, 2002 for recurrence salvage using the linear stapler for pharyngeal closure. The organ preservation protocol for advanced laryngeal cancer consists in weekly cysplatin concomitant to the radiation therapy. The age ranged from 42 to 64 and 11 patients were men. A new clinical stage analysis was performed with telelaryngoscopy, suspension laryngoscopy under general anesthesia and computed tomography. The recurrences should be restricted to the endolarynx. The linear stapler was applied longitudinally in the vallecula between the pharynx and larynx as close as possible to the thyroid cartilage alae. The primary placement of the phonatory prosthesis was performed in 11 patients after the pharyngeal closure. All the patients were discharged from the 4th to the 10th postoperative day and the oral intake was started in the 10th postoperative day. The pharyngeal and esophageal contrasted radiography was performed from the 21th to the30th postoperative day in order to evaluate the pharyngeal pouch. RESULTS: The stapler placement delayed no more than five minutes. There was no report of infection, pharyngocutaneous fistulae, dysphagia complaint and pharyngoesophageal narrowing on the radiographic examination. The phonatory prosthesis was succfully used for the speech rehabilitation. CONCLUSION: The use of the stapler is technically easy to perform and it does not increase the rate of fistulae and dysphagia in patients underwent salvage laryngectomy after radiation therapy. The surgical time is reduced and the primary phonatory rehabilitation with tracheoesophageal prosthesis is feasible.

OBJETIVO: Avaliar a laringectomia total para resgate de recidiva após tratamento por radioterapia e quimioterapia concomitante por carcinoma epidermóide avançado de laringe. MÉTODOS: Entre março de 2001 e dezembro de 2002, foram realizadas 12 laringectomias totais de resgate de recidiva com uso do grampeador linear. O protocolo de preservação de órgão para casos de câncer avançado de laringe consiste no uso de cisplatina semanal concomitante à radioterapia. A idade variou de 42 a 64 anos e onze pacientes eram do sexo masculino. Realizou-se novo estadiamento por telelaringoscopia, laringoscopia de suspensão e tomografia computadorizada. Os tumores recidivados eram restritos à endolaringe. O grampeador linear foi aplicado longitudinalmente na região da valécula, entre a faringe e a laringe, o mais próximo possível da asa da cartilagem tireóidea. A colocação primária de prótese fonatória foi realizada em 11 pacientes após o fechamento da faringe. Todos os pacientes obtiveram alta hospitalar entre o 4º e o 7º dia de pós-operatório e a dieta oral foi iniciada no 10º dia. Realizou-se radiografia contrastada de faringe e esôfago entre o 21º e o 30º dia para avaliar a bolsa faríngea. RESULTADOS: A aplicação do grampeador durou menos que cinco minutos. Não houve infecção, fístula faringo-cutânea, queixa de disfagia nem estreitamento ao estudo radiográfico. Os pacientes obtiveram sucesso na reabilitação fonatória a prótese. CONCLUSÃO: O uso do grampeador é tecnicamente fácil e não aumenta a incidência de fístula ou de disfagia em pacientes submetidos a laringectomia de resgate pós-radioterapia. O tempo cirúrgico é reduzido e não há prejuízo na reabilitação fonatória primária com uso de prótese traqueo-esofágica.

Uso do grampeador para o fechamento da faringe após laringectomia total

PURPOSE: To evaluate total laryngectomy for the surgical salvage after a unsuccessful chemoradiation therapy treatment for advanced laryngeal squamous cell carcinoma. METHODS: Twelve total laryngectomies were performed from March, 2001 to December, 2002 for recurrence salvage using the linear stapler for pharyngeal closure. The organ preservation protocol for advanced laryngeal cancer consists in weekly cysplatin concomitant to the radiation therapy. The age ranged from 42 to 64 and 11 patients were men. A new clinical stage analysis was performed with telelaryngoscopy, suspension laryngoscopy under general anesthesia and computed tomography. The recurrences should be restricted to the endolarynx. The linear stapler was applied longitudinally in the vallecula between the pharynx and larynx as close as possible to the thyroid cartilage alae. The primary placement of the phonatory prosthesis was performed in 11 patients after the pharyngeal closure. All the patients were discharged from the 4th to the 10th postoperative day and the oral intake was started in the 10th postoperative day. The pharyngeal and esophageal contrasted radiography was performed from the 21th to the30th postoperative day in order to evaluate the pharyngeal pouch. RESULTS: The stapler placement delayed no more than five minutes. There was no report of infection, pharyngocutaneous fistulae, dysphagia complaint and pharyngoesophageal narrowing on the radiographic examination. The phonatory prosthesis was succfully used for the speech rehabilitation. CONCLUSION: The use of the stapler is technically easy to perform and it does not increase the rate of fistulae and dysphagia in patients underwent salvage laryngectomy after radiation therapy. The surgical time is reduced and the primary phonatory rehabilitation with tracheoesophageal prosthesis is feasible.

OBJETIVO: Avaliar a laringectomia total para resgate de recidiva após tratamento por radioterapia e quimioterapia concomitante por carcinoma epidermóide avançado de laringe. MÉTODOS: Entre março de 2001 e dezembro de 2002, foram realizadas 12 laringectomias totais de resgate de recidiva com uso do grampeador linear. O protocolo de preservação de órgão para casos de câncer avançado de laringe consiste no uso de cisplatina semanal concomitante à radioterapia. A idade variou de 42 a 64 anos e onze pacientes eram do sexo masculino. Realizou-se novo estadiamento por telelaringoscopia, laringoscopia de suspensão e tomografia computadorizada. Os tumores recidivados eram restritos à endolaringe. O grampeador linear foi aplicado longitudinalmente na região da valécula, entre a faringe e a laringe, o mais próximo possível da asa da cartilagem tireóidea. A colocação primária de prótese fonatória foi realizada em 11 pacientes após o fechamento da faringe. Todos os pacientes obtiveram alta hospitalar entre o 4º e o 7º dia de pós-operatório e a dieta oral foi iniciada no 10º dia. Realizou-se radiografia contrastada de faringe e esôfago entre o 21º e o 30º dia para avaliar a bolsa faríngea. RESULTADOS: A aplicação do grampeador durou menos que cinco minutos. Não houve infecção, fístula faringo-cutânea, queixa de disfagia nem estreitamento ao estudo radiográfico. Os pacientes obtiveram sucesso na reabilitação fonatória a prótese. CONCLUSÃO: O uso do grampeador é tecnicamente fácil e não aumenta a incidência de fístula ou de disfagia em pacientes submetidos a laringectomia de resgate pós-radioterapia. O tempo cirúrgico é reduzido e não há prejuízo na reabilitação fonatória primária com uso de prótese traqueo-esofágica.