Importância da ecografia no diagnóstico e escolha da técnica cirúrgica para o tratamento da Neuropatia Laríngea Recorrente
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2022-03-31
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Alguns dos grandes desafios que a Neuropatia Laríngea Recorrente (NLR) tem apresentado aos Médicos Veterinários nos últimos 50 anos são melhorar e antecipar o diagnóstico e aperfeiçoar ou criar novas técnicas cirúrgicas no tratamento. A ecografia laríngea não é uma prática extremamente comum e poucos trabalhos têm sido apresentados sobre o tema. A ecografia pode assumir um papel fundamental na escolha da técnica cirúrgica a implementar, tanto pela facilidade de acesso a este método de diagnóstico, como pela sua rapidez e simplicidade. O facto de permitir a melhor avaliação muscular, torna a ecografia uma técnica com potencialidades subaproveitadas no estadiamento desta doença. Nos casos em que se consegue um diagnóstico precoce, pode recorrer-se a técnicas mais fisiológicas, como a reinervação e a neuroprótese dinâmica, para restabelecer a função muscular antes da ocorrência de uma atrofia extensiva e fibrose, o que representa a situação ideal do ponto de vista médicoveterinário. Recentemente, a importância da ecografia tem vindo a aumentar, uma vez que é essencial conhecer o estado de atrofia do músculo cricoaritenoideu dorsal (mCAD) para a escolha da técnica cirúrgica mais adequada. O principal objetivo deste estudo é avaliar a importância da ecografia como meio de diagnóstico complementar na NLR e o seu papel na seleção do tratamento cirúrgico mais adequado. Este trabalho consiste num estudo retrospetivo de 76 cavalos referenciados com NLR à Clinique Veterinaire de Grosbois. Foram recolhidas informações como idade, sexo, raça, aptidão e sinais clínicos prévios à cirurgia. Os animais em estudo foram avaliados por endoscopia e ecografia ao mCAD e classificados em cada uma das referidas técnicas. Seguidamente foram intervencionados cirurgicamente pelas técnicas de reinervação laríngea (RL), laringoplastia (LP) ou neuroprótese dinâmica (NPD) em função das referidas classificações. Foram realizadas avaliações pós cirúrgicas na maioria dos cavalos através de endoscopia em estação e dinâmica. Foi ainda realizado um questionário de satisfação aos detentores dos animais pós cirurgia. Neste estudo, 33% dos animais apresentou uma atrofia significativa do mCAD, 26% atrofia severa, 26% atrofia moderada e 14% atrofia ligeira. Dos 26 cavalos submetidos a laringoplastia, 71% apresentava atrofia severa, 25% atrofia significativa e 4% atrofia moderada. Dos 31 cavalos submetidos a NPD, 59% apresentava atrofia significativa, 31% atrofia moderada e 10% atrofia ligeira. Dos 19 cavalos submetidos a RL, 10% apresentava atrofia severa, 11% atrofia significativa, 42% atrofia moderada e 37% atrofia ligeira. Considera-se, através deste estudo, que as complicações pós cirúrgicas da NPD são semelhantes às da LP e RL. A ecografia mostrou-se, assim, como um método de diagnóstico complementar essencial para optar pelas técnicas cirúrgicas de RL e NPD, permitindo assim a recuperação muscular e manutenção do funcionamento fisiológico da cartilagem aritenoide.
Some of the major challenges that Recurrent Laryngeal Neuropathy has presented to Doctors of Veterinary Medicine over the past 50 years are to improve and anticipate diagnosis, improve case selection and improve or create new surgical techniques. Laryngeal ultrasound is not an extremely common practice, and few papers have been presented on the topic. Ultrasound can play a fundamental role in the choice of the surgical technique to be implemented, both because of the ease of access to this diagnostic method, as well as its speed and simplicity. The fact that it allows the best muscular evaluation, as well as movement, makes ultrasound a technique with under-utilized potentialities in the staging of this disease. In cases where early diagnosis is achieved, more physiological techniques, such as reinnervation and dynamic neuroprosthesis, can be used to restore muscle function before extensive atrophy and fibrosis occurs, which represents the ideal situation from a veterinary medical point of view. Recently, the importance of ultrasound has been increasing, since it is essential to know the state of atrophy of the dorsal cricoarytenoid muscle (mCAD) for choosing the most appropriate surgical technique. The main purpose of this study is to evaluate the importance of ultrasound as a complementary diagnostic tool in Recurrent Laryngeal Neuropathy and its role in the selection of the most appropriate surgical treatment. This work consists of a retrospective study of 76 horses referred with suspected Recurrent Laryngeal Neuropathy to the Clinique Veterinaire de Grosbois. Information such as age, sex, breed, aptitude and clinical signs prior to surgery were collected. The studied animals were evaluated and classified by endoscopy and ultrasound of the dorsal cricoarytenoid muscle, and were then submitted to surgery using laryngeal reinnervation, laryngoplasty or dynamic neuroprosthesis technics. Postsurgical evaluations were performed on most horses by standing and dynamic endoscopy. The animal owners were also contacted to answer a brief post-surgery questionnaire. In this study, 33% of the animals presented significant mCAD amyotrophy, 26% severe amyotrophy, 26% moderate amyotrophy, and 14% mild amyotrophy. From the 26 horses submitted to laryngoplasty, 71% presented severe amyotrophy, 25% significant amyotrophy, and 4% moderate amyotrophy. From the 31 horses submitted to NPD, 59% had significant amyotrophy, 31% moderate amyotrophy, and 10% mild amyotrophy. From the 19 horses undergoing LR, 10% presented severe amyotrophy, 11% significant amyotrophy, 42% moderate amyotrophy, and 37% mild amyotrophy. It is considered, through this study, that the post-surgical complications of NPD are similar to those of LP and RL. Ultrasound was thus shown to be an essential complementary diagnostic method for choosing the surgical techniques for LR and NPD, allowing muscle recovery and maintaining the physiological functioning of the arytenoid cartilage.
Some of the major challenges that Recurrent Laryngeal Neuropathy has presented to Doctors of Veterinary Medicine over the past 50 years are to improve and anticipate diagnosis, improve case selection and improve or create new surgical techniques. Laryngeal ultrasound is not an extremely common practice, and few papers have been presented on the topic. Ultrasound can play a fundamental role in the choice of the surgical technique to be implemented, both because of the ease of access to this diagnostic method, as well as its speed and simplicity. The fact that it allows the best muscular evaluation, as well as movement, makes ultrasound a technique with under-utilized potentialities in the staging of this disease. In cases where early diagnosis is achieved, more physiological techniques, such as reinnervation and dynamic neuroprosthesis, can be used to restore muscle function before extensive atrophy and fibrosis occurs, which represents the ideal situation from a veterinary medical point of view. Recently, the importance of ultrasound has been increasing, since it is essential to know the state of atrophy of the dorsal cricoarytenoid muscle (mCAD) for choosing the most appropriate surgical technique. The main purpose of this study is to evaluate the importance of ultrasound as a complementary diagnostic tool in Recurrent Laryngeal Neuropathy and its role in the selection of the most appropriate surgical treatment. This work consists of a retrospective study of 76 horses referred with suspected Recurrent Laryngeal Neuropathy to the Clinique Veterinaire de Grosbois. Information such as age, sex, breed, aptitude and clinical signs prior to surgery were collected. The studied animals were evaluated and classified by endoscopy and ultrasound of the dorsal cricoarytenoid muscle, and were then submitted to surgery using laryngeal reinnervation, laryngoplasty or dynamic neuroprosthesis technics. Postsurgical evaluations were performed on most horses by standing and dynamic endoscopy. The animal owners were also contacted to answer a brief post-surgery questionnaire. In this study, 33% of the animals presented significant mCAD amyotrophy, 26% severe amyotrophy, 26% moderate amyotrophy, and 14% mild amyotrophy. From the 26 horses submitted to laryngoplasty, 71% presented severe amyotrophy, 25% significant amyotrophy, and 4% moderate amyotrophy. From the 31 horses submitted to NPD, 59% had significant amyotrophy, 31% moderate amyotrophy, and 10% mild amyotrophy. From the 19 horses undergoing LR, 10% presented severe amyotrophy, 11% significant amyotrophy, 42% moderate amyotrophy, and 37% mild amyotrophy. It is considered, through this study, that the post-surgical complications of NPD are similar to those of LP and RL. Ultrasound was thus shown to be an essential complementary diagnostic method for choosing the surgical techniques for LR and NPD, allowing muscle recovery and maintaining the physiological functioning of the arytenoid cartilage.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
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Equinos , Neuropatia Laríngea Recorrente