Epiglottic Entrapment

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Introduction

Epiglottic entrapment is one of the causes of respiratory noise and exercise intolerance in the horse. In this condition, the aryepiglottic fold completely envelops the apex and lateral margins of the epiglottis.

The aetiology is unclear although epiglottic hypoplasia or deformity may sometimes be involved.

Entrapment may be intermittent but is usually a permanent condition.

Clinical Signs

Respiratory noise is variable. It can be inspiratory due to the turbulence created by the abnormal epiglottis in the laryngeal lumen, or expiratory due to the vibration of the entrapping mucosa.

Entrapment may also cause Dorsal Displacement of the Soft Palate, which causes an inspiratory and loud expiratory gurgle.

There is usually an impact on performance, although some cases have been incidental findings.

Less common signs include a cough, nasal discharge and head shaking.

Diagnosis

Endoscopic examination is the best way to diagnose the condition. Usually it is seen at rest, but some intermittent cases might need treadmill endoscopy for diagnosis.

This might also reveal Dorsal Displacement of the Soft Palate.

Treatment

Treatment involves resection of the entrapping mucosa. Transection of the aryepiglottic fold can be performed via a laryngotomy incision under general anaesthesia.

Another option is to insert instruments such as a hook knife, Nd:YAG laser or thermocautery equipment via the nose or mouth under endoscopic guidance. This is usually performed under standing sedation.

This is generally curative with a relapse rate of 5%. Some horses may require several months' convalescence.


Epiglottic Entrapment Learning Resources
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References

Kahn, C. (2005) Merck Veterinary Manual 9th Edition Merck & Co

McCann, J. (2000) Equine Practice: Differential diagnosis of abnormal respiratory noises in the exercising horse In Practice 22:370-381



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