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Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses

(2018) VETERINARY SURGERY. 47(7). p.942-950
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Abstract
Objective: To describe the anatomy of the entry to the equine esophagus (vestibulum esophagi) and to assess the risk of penetrating its adventitia and/or lumen during laryngoplasty. Study design: Ex vivo cadaveric study. Sample population: Five isolated equine larynges and 39 equine head and neck specimens. Methods: The anatomy of the vestibulum esophagi was studied by dissection of 5 cadaver specimens. Then, a bilateral laryngoplasty was performed, including 5 suture placements through the muscular processes, caudal, rostral, and sagittal, with straight and curved needles. Two of the 3 surgeons performing the implantations were unaware of the goals of the study. Suture positions and iatrogenic trauma to the lumen and/or adventitia of the vestibulum esophagi were identified during dissection of the specimens. Risk factors for penetrating the adventitia were evaluated with a multivariate regression model. Results: The vestibulum esophagi spans between both wings of the thyroid cartilage over the entire width of the larynx, covering the rostral spine (arcuate crest) of the arytenoid cartilages. It is covered by the thyropharyngeus and cricopharyngeus muscles. Masked surgeons were associated with a significantly higher number of adventitia penetrations (72%) compared to the nonmasked surgeon (9%). The lumen of the vestibulum esophagi was penetrated in 4.6% of suture placements and only by the 2 masked surgeons. Conclusion: Penetration of the adventitia was more common when surgeons were unaware of the anatomical extent of the vestibulum esophagi. Clinical significance: Anatomical knowledge of the extent of the vestibulum esophagi reduces the risk of penetrating its lumen or adventitia during suture placement on the muscular process of the arytenoid cartilage.
Keywords
RIMA GLOTTIDIS AREA, EQUINE ARYTENOID CARTILAGE, LARYNGEAL HEMIPLEGIA, TEMPOROMANDIBULAR-JOINT, MUSCULAR PROCESS, ABDUCTION, VENTRICULECTOMY, VENTRICULOCORDECTOMY, COMPLICATIONS, POSITION

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Chicago
Brandenberger, Olivier, Ann Martens, Céline Robert, Peter Wiemer, Hugo Pamela, Lieven Vlaminck, Katerina Barankova, et al. 2018. “Anatomy of the Vestibulum Esophagi and Surgical Implications During Prosthetic Laryngoplasty in Horses.” Veterinary Surgery 47 (7): 942–950.
APA
Brandenberger, O., Martens, A., Robert, C., Wiemer, P., Pamela, H., Vlaminck, L., Barankova, K., et al. (2018). Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses. VETERINARY SURGERY, 47(7), 942–950.
Vancouver
1.
Brandenberger O, Martens A, Robert C, Wiemer P, Pamela H, Vlaminck L, et al. Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses. VETERINARY SURGERY. 2018;47(7):942–50.
MLA
Brandenberger, Olivier, Ann Martens, Céline Robert, et al. “Anatomy of the Vestibulum Esophagi and Surgical Implications During Prosthetic Laryngoplasty in Horses.” VETERINARY SURGERY 47.7 (2018): 942–950. Print.
@article{8575317,
  abstract     = {Objective: To describe the anatomy of the entry to the equine esophagus (vestibulum esophagi) and to assess the risk of penetrating its adventitia and/or lumen during laryngoplasty. 
Study design: Ex vivo cadaveric study. 
Sample population: Five isolated equine larynges and 39 equine head and neck specimens. 
Methods: The anatomy of the vestibulum esophagi was studied by dissection of 5 cadaver specimens. Then, a bilateral laryngoplasty was performed, including 5 suture placements through the muscular processes, caudal, rostral, and sagittal, with straight and curved needles. Two of the 3 surgeons performing the implantations were unaware of the goals of the study. Suture positions and iatrogenic trauma to the lumen and/or adventitia of the vestibulum esophagi were identified during dissection of the specimens. Risk factors for penetrating the adventitia were evaluated with a multivariate regression model. 
Results: The vestibulum esophagi spans between both wings of the thyroid cartilage over the entire width of the larynx, covering the rostral spine (arcuate crest) of the arytenoid cartilages. It is covered by the thyropharyngeus and cricopharyngeus muscles. Masked surgeons were associated with a significantly higher number of adventitia penetrations (72\%) compared to the nonmasked surgeon (9\%). The lumen of the vestibulum esophagi was penetrated in 4.6\% of suture placements and only by the 2 masked surgeons. 
Conclusion: Penetration of the adventitia was more common when surgeons were unaware of the anatomical extent of the vestibulum esophagi. 
Clinical significance: Anatomical knowledge of the extent of the vestibulum esophagi reduces the risk of penetrating its lumen or adventitia during suture placement on the muscular process of the arytenoid cartilage.},
  author       = {Brandenberger, Olivier and Martens, Ann and Robert, C{\'e}line and Wiemer, Peter and Pamela, Hugo and Vlaminck, Lieven and Barankova, Katerina and Haspeslagh, Maarten and Perkins, Justin D and Ducharme, Norm and Rossignol, Fabrice},
  issn         = {0161-3499},
  journal      = {VETERINARY SURGERY},
  language     = {eng},
  number       = {7},
  pages        = {942--950},
  title        = {Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses},
  url          = {http://dx.doi.org/10.1111/vsu.12944},
  volume       = {47},
  year         = {2018},
}

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