Virgin J E, Holcombe S J, Caron J P, Cheetham J, Kurtz K A, Roessner H A, Ducharme N G, Hauptman J G, Nelson N C
Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, USA.
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Equine Vet J. 2016 May;48(3):362-7. doi: 10.1111/evj.12430. Epub 2015 May 13.
Pharyngeal dysphagia is a debilitating, sometimes fatal condition in horses, with multiple aetiologies. The pathophysiology is complex and not fully understood. Treatment is largely supportive. Laryngeal advancement surgery may diminish symptoms of dysphagia and improve swallowing in affected horses.
Experimental design using 6 adult horses.
Two dysphagia models were produced by blocking IX, the pharyngeal branch of X and XII unilaterally (moderate model) and only the pharyngeal branch of X bilaterally (marked model) within the guttural pouches. Both models were performed on each horse before and after surgery in order to assess the effectiveness of the surgical procedure as a potential treatment for pharyngeal dysphagia. Dysphagia was scored by partly blinded observers on a scale of 0-12 based on observations of eating (nonblinded), endoscopic examinations and fluoroscopic swallowing (blinded), where 0 = normal swallow and 12 = severe dysphagia with tracheal aspiration. Data were analysed by 3-factor ANOVA, with significance taken as P<0.05.
Dysphagia models were reversible, and horses swallowed normally within 3 h of model induction. The marked dysphagia model impaired movement of feed from the base of the tongue to the oesophagus and caused severe airway contamination. The average dysphagia score (mean ± s.d.) for the marked dysphagia model was 10.6 ± 1.1 before surgery and 6.1 ± 4.3 after surgery (P = 0.007). Laryngeal advancement surgery did not significantly improve the dysphagia scores in the moderate model (P = 0.5).
Laryngeal advancement surgery may improve swallowing and reduce aspiration in horses affected with diseases that cause pharyngeal dysphagia.
咽吞咽困难是马匹中一种使人衰弱、有时甚至致命的疾病，病因多样。其病理生理学复杂，尚未完全明确。治疗主要是支持性的。喉前移手术可能会减轻受影响马匹的吞咽困难症状并改善吞咽功能。
1）通过对舌咽神经（IX）、迷走神经（X）和舌下神经（XII）分支进行区域麻醉来诱导可逆性的中度和重度咽吞咽困难；2）描述每种模型所产生的吞咽困难；3）确定喉前移手术是否能改善这些模型中的吞咽功能。
对6匹成年马采用实验设计。
通过在咽鼓管囊内单侧阻断IX、X的咽支和XII（中度模型）以及双侧仅阻断X的咽支（重度模型）来建立两种吞咽困难模型。在每匹马手术前后均进行这两种模型的操作，以评估该手术作为咽吞咽困难潜在治疗方法的有效性。由部分不知情的观察者根据进食观察（非盲法）、内镜检查和吞咽荧光透视检查（盲法），以0至12分的量表对吞咽困难进行评分，其中0分表示吞咽正常，12分表示伴有气管误吸的严重吞咽困难。数据采用三因素方差分析进行分析，以P<0.05为有统计学意义。
吞咽困难模型是可逆的，马匹在模型诱导后3小时内恢复正常吞咽。重度吞咽困难模型损害了饲料从舌根到食管的移动，并导致严重的气道污染。重度吞咽困难模型术前的平均吞咽困难评分为（均值±标准差）10.6±1.1，术后为6.1±4.3（P = 0.007）。喉前移手术在中度模型中未显著改善吞咽困难评分（P = 0.5）。
喉前移手术可能会改善患有导致咽吞咽困难疾病的马匹的吞咽功能并减少误吸。
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