"A procedure to correct a paralyzed larynx has fewer risks if it’s performed in a standing, sedated horse with the aid of local anesthesia." -Dr. Kleider
Equine surgeons typically perform laryngoplasty, a surgery that reinforces paralyzed vocal folds and repositions paralyzed laryngeal cartilage, in anesthetized horses lying on their side. But new studies show that the same operation—also called “tie-back” surgery—can be performed on standing horses using local anesthesia and sedation with better outcomes. Anatomically, everything falls into its correct position when the horse is standing erect. Not only are all the throat’s anatomical structures in their correct positions, but surgeons can also operate on a horse with normal throat movements.
Further, horses waking from general anesthesia often have intense breathing and swallowing during recovery, which can add to complications such as sutures tearing through. Additionally, horses in dorsal or lateral recumbancy have their heads and throats level to or below their hearts, meaning more blood flow to the surgical site. There is much less blood loss during the surgery in standing horses.
The standing procedure is more precise, but it also requires significantly more experience and skill.
In the larynx, a small pair of pyramid-shaped cartilage structures and the vocal folds open and close to allow for breathing, swallowing, and vocalization. Sometimes, one of these cartilages may become paralyzed. Affected horses often have noisy breathing—also called “roaring”—and reduced performance. Laryngoplasty is a surgical option that pulls the arytenoid cartilage open into an intermediate abduct position so the horse can breathe more easily. This is done in conjunction with laser surgery of the vocal fold.