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Departmental Papers (Vet) School of Veterinary Medicine

7-1976

Diseases of the Guttural Pouch

Charles W. Raker

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Part of the Large or Food Animal and Equine Medicine Commons

Recommended Citation Raker, C. W. (1976). Diseases of the Guttural Pouch. Modern Veterinary Practice, 57 (7), 549-552. Retrieved from https://repository.upenn.edu/vet_papers/65

This paper is posted at ScholarlyCommons. https://repository.upenn.edu/vet_papers/65 For more information, please contact [email protected]. Diseases of the Guttural Pouch

Disciplines Large or Food Animal and Equine Medicine | Medicine and Health Sciences | Veterinary Medicine

This journal article is available at ScholarlyCommons: https://repository.upenn.edu/vet_papers/65 The Equine Practitioner DISEASE S OF THE GUTTURAL POUCH

c. W. Raker, VMD Si gns of upper airway obstr uction Yal") University of Pennsylvania New Bolton Center in intensity with the degree of distention of Kennett Square, Pennsylvania 19348 the GP. The anomaly is said to be unilat­ eral ,2 but I have see ll 2 cases wi th bilateral TlIe pai red g uttural pouches (G P) in tbe involvement. The nature of the defect i· lj()r~ e rep r e ~ e lll ventral dive nicula of the not known, but it appear, to ill volve rh ellsla t.hiall tubes, although theif true func­ pharyngea l orifice of the eustachi an tube, liull is unknown. T hey Dlay fUIlctio n as a allowing ail to el1l er the GP, where it is teJi d valve mechani, m ~i n c e Lhey fill with trapped. :t\ur,ing fo als are susceptible to lit Juring expira tion and empty during in­ aspira tion (milk) pneumonia- a serious CCl m­ ' pir:llion. pharynx through a slit­ defect are avai lable. and in the absence of lik e openiJl g. pneumonia the prugnosis is favorable_ He­ h e~c opellings can bc scen with an en­ fo re surgery, deculOpression should be per­ do1copc. bUI they are normally collapsed formed to determine whethel the c1e[cn i~ (exce!)t during furceful eXl-'i ratioll and sw al­ unilatr::i1 or bila teraL U n ila teral tympan­ lowing) and the inside of the pouch is not ites may ca use distelltion on both sides 01 \J ~ i ble unless the endosc0pe i ~ introduced the neck, but the signs should disappear 0 11 di recll y into the GP. T he medial ~ i d e of the unilateral decompressiun. If bilateraL signs opening consists of a fold o[ fibrocartilag would still be evident following unilateral (O \'cred with mucous membrane. decompression. The GP may be involved in i1 11 infec tions The foal is placed under general clll es­ the respiratory tract. but the incidence of or thesia in la teral recumbency wi th the af­ primary GP disea, e is low. fected GP up. The skin O V(I- Viborg's tri ­ Tymplmiles angle is prepared fo r surgery. and a 3-4" T ympani tcs (emphysema) of the GP is ski n incision is made in the triangle. T it seen occa sionally in suc kl i ng~ and wean­ wall of the distended GP lie, directly under Ji ugs. Some reports sugges t th at this i, a the skin and is ex p o ~e d by careful b lum co ugenital defect which may not be In :1 ni ­ dissection. It is ca refull y incised, causing it les tcd until the horse is 1 year of age] The to collapse. If the defect is unila teral. a peninel1l clinical signs are dislention of one l -c m ~ or larger window is made through tit OJ both GP in the region of Viborg's tr i­ med ian walls of the left and ri ght GP. T lli, allgl e. Percussion reveals an air-fill ed cavity, communica tion betwee n the 2 GPs all o w ~ Jnd fi rm digilal pressure may res ul t in ex­ trapped air lO e.,ca pe through the opposite pulsion of air wi th collapse of th e GP. normal pharyngeal orifi ce. %C)u ld this procedure fa il, decompress ion If th e defect is bililteJ-al, in addition to ran b<.: achieved by im ening a needle into establishing a communica ting window, a 9" tll e distended GP. ­ Allis t i ~s ue or sponge forceps is passecl cra l1i­

Ju ly, 1976 549 a lly thro ugh u:J e eu, t3 clii;1I1 t u he lo lhe (HOlne] 's syndrom e). l nvolvem en t o ( ve::. ­ If' vel or i t ~ p h hal'\' l1 gea I o rifi ce is securely m i ttent nasal exudate. a nd pain . .~ra~pcd in th e forceps. A section or tissue is .EIl d o ~c o p y of the GP is so m ewhat dif­ CII l fro m the orifice with a p air of Ion?; fi c ult. Sp ecial an gled tips for standard Ale tzcnl;aum sc i ~~o r ~ . T hi s p lO ce dure pre­ Lril iglI t endoscop es nre available, and a long ve n ts tIl(! trap ping of a ir a nd cor rect '> the curved l a thetcl (Guen th el' or N eib on) Ol catheter, vi e wing the deve lo ped cleclroca u tel y is i n troduced into entrance to the G P through the e ndosrope lil e GP, and with endoscop ic visualiza tion m ay h elp. C ultu res o f the G P m ay he ob­ a l,1" i nd ow is cut hetwecn th e r igh t a nd left t;li nccl ill a similar manner, using ster ile Gr . T h e G P G ill also be ap proached by the n asop h ar yngeal swab s. Similarly, irriga tion m ore classica l ro ute i n tbe regio n uf th e a nd washil lg o [ the p ou ch . wi th collection wing' l ) L the a tla~. ~ u f the fluid [or cytology a nd culture, can be A f l' er m mpletion o f tli e corrective sur­ perfor m ed. gery. l Ilt' wa ll of the G P a nd tl H! skin m ay If daily jrrjg~l tion and m ed icatio n of the Fig 1. The most charac l)c ~ Ill u re d , or I he wound m ::l) be left o p cn G P is d esira hle, a self-r ("' tain ing plastic in guttural pouch is the, the throat latch poster I f) ll eal hy gran ulat iun. Except Ior foreig n Ixa uterine cath eler is in ser ted . T he p ortion uod y p nclI mon ia, complications 'I re r3 1' (, of the tub e p ro tr uding from the ex ternal problem, calling a Il d prug-n osis is J;. \ ora b Je_ Proph yl;u I ic tel­ n arc's j ~ securely sutured i nsirle the noslril and the possibilit 3 11 m anlit oxin a n d anLibio tics 1'01 5 days to p reve n t the horse from tearing it Ollt b} be reported to tht are givel1. rubbing. T his p roced u re obvia tes dai ly p as· treatment is avail Di,,/tlherifl (My('o.~i .~ ) sage uf tubes for irr iga lion a n d medication. disease is undergo Fatal t p j ~ t axis h a~ becn att ribll ted to a Surgic;d cl rain aRe a n d loul m edica tion ,.viLl I E {(I 'Hliiio n termed d iph thel ia of the gll ttural vari o l!;; LII ugs has failed to a ller the my­ Empyema of th l pOUd l . A d iph th eritic J e~ i on was found j n­ cu Li( infe cti o n . ~ Surgical lemov::t l of Ihe secondary chroni "olving mO!o1 h eqllen il y tile d orsa l w ~tl l of m }l(o tic le~ j o ll m ay result in fa tal cxpislaxis. m o re generalized the m e rl ial comprll tlIl c n l of tlle GP III the IVfywsis/epistaxi 'i has b een dfectively lion. R adiographs reg-i on 01 t he petrom temp Ol al bo ne, th e L!'ca ted lJY insti ll a tio n of a 1:4 d iluliO!, of filled GP. or the I cervica l sympa th etic n erve. an d th e g loss,,­ p uvidon e iodine (Betad in e) solutjo n. :-; T he come in spissated plt:lryngeal and va l c:t t;\lTl l, hea e! brall e. /\ b te l' ca" p o f chronic empyema , 11 yn es 'i, abnormal r espi ra tor) n oise, swe;H­ o [ th e CP trea ted ill a sim iJ:ll manner fa il ed ing a nd shivering, H orner 's sy n drome

SSO MODERN VETERINARY PRACTI CE July, 1976 vemelll of ve:.­ of accumulated exudate may be observed ion of the G P periodically when the horse lowers his head ,1I11 cti on, inler­ to the ground. \IVith unilateral infection pJi n most of the exudate may flow from the nos­ tnewhat dif­ tril on the affected side. The exudate is fOI standard usually nonodorous. somewhat mucoid, ahle, ;lod a long slightly milky, and opaque. '")" Nei lson) or a Exudate from the lungs may appear sim· i ~ swtable fOI ilar to that from the GP and may also be J[ difficulty is discharged intermittently; therefore, this tcr. yjewillg Ih . sign is not pathognomonic. The affected GP 1 the en dos(()pe may be distended, the head may be held P nM)' he ob· stiff, and pressure over the area of the GP 'r. using ~terile may elicit pain. T he diagnosis can be con­ Jarly. irngation fi rmed by endoscopic examination of the wit li coll ection GP. I cu lture . can be Treatment consists of daily irrigation through a Neilson or Guenther catheter or edic:ltioll o( til Fig I. The most characteristic feature of tympanites of the guttural pouch is the air·filled distention in the region of i nin ~ plas ti c i n­ the th roat latch posterior to the ramus of the mandible. ed. The pOI·tion problem, calling for a guarded prognosis, ) m the external lSide the nostril and tb e possibility of fatal ep istaxis should (, Jring I t Ollt b be reported to the owner. No truly effective )vi :l le<; dai lY pas­ treatment is available at this time, but the and medication. disease is u ndergoing extensive study. meJication with Empyema Fmpyema of the GP usually represents a (I alter the 1lly­ removal or th econdary chronic infection following a more gelleralized upper respiratory i nfec­ 1 b ta] ex pi st;l).is. been en'ccti V('] y ti Oll. Radiographs may demonstrate a fluid­ fdled GP, or the purulent exudate may be­ I I :'t di lu tion of .) .,Ol ll ti on r. 1 he come inspissated and form radiopaque masses. A relatively voluminous discharge 7-JO da y~ or un­ ev idence or a il"l react ion \Ipon he IJ1U CO ll ~ mem­ Fig 3. Diagnosis of empyema of the guttural pouch can fre­ !nonic C111 pyem internal carotid artery may result in lresenls a serious fatal epistaxis. affected side of the head in the region of

RINARY PRACTICE July, 1976 551 Vi borg's triangle and the parotid gland up to the base of the ear is prepared for sur­ gery. A 4" skin incision is made approxi­ rna tely )" in front of and parallel to the anterior border of the wing of the atlas. The heavy fascia is carefully incised. bringing the parotid salivary gland in view. Careful dissection is begun at the poste­ rior border of the parotid gland and con­ tinued until the gland is completely freed from its tiss ue bed sufficiently to allow it to be retracted an teriorly. The auricular nerve should be isolated and retracted caudally. T he plane of dissection is continued bluntly with the fingers to the posterior border of the occipito-mandibularis muscle. at which poi n t the carotid artery will come into view. Careful exploration of the area will identify the thin wall of the GP. If the horse has not been intubated but has been given an in­ travenous anesthetic, the GP will distend with air d uring expiration. T he GP is grasped with a pair of rat­ tooth forceps or Allis tissue forceps and in­ cised with scissors. After tbe opening is en­ larged wi th the fingers to admi t the hand. the GP is inspected and palpated. and any impissaled material is removed. Following co pious irrigation, a suitable d rain is in­ serted, if indicated, with the distal end brought out through Viborg's triangle and sutured to the skin. If more efficient drainage is deemed ad­ visable, a curved metal probe is placed through the incision into the GP and di­ rected distad so that its tip lies in Viborg's triangle. \Vith the application of pressure the tip is palpable. The skin, underlying ti~ sue s and G P are careful Iy incised over the ftACHEL.i! point of the catheter to establish effective AQUACHEI" 4ouACHn-100 IIQECfIO" venlral drainage. To prevent the opening 'ltdEcT'OII from closing, a seton or suitable drain may

I\Iltll1..,I I" be inserted. The incision along the wing of the atlas may be partially closed, leaving room for further irrigation and medication. The prognosis followi ng surgical drain­ age is favorable. T etanus antitoxin and a course of antibiotics are indicated. 0 References l. jAVMA 140:453·454,1962. 2. Vet Uec 79: 1-7, 1966. Rachelle 3. Frank : Veterinar y Surgery} Burgess, r..1inneapolis, )964 . For further 4. Yel Rec 83:336-345; 422-428, 1968. information: 700 Henry Ford Ave., Long Beach, California 90801 5. H ammel. Raker &: !lo les: Unpublished data. Based on a presen tation at the Annual Gun tHat )'Our vewrlnu)' dl_trlbl1(.or rr A subsidiary of International Rectifier Corp. h."" a qu".Uon about tho u." or Conference for Veterinarians, Cornell F or additional technical inlormal University, Janu ary) 976. Robert L. Miller, D. V. M.. Director M.odlcaJ St!rYires. A. H. Robins R~s~Ar

Labonu..ories t 1.211 Shorw(l(ld A "Clltle. 552 MODERN VETERINARY PRACTICE Richmond. Virginia 2;1220 ."