Arytenoid Lateralization (Laryngeal Tie Back)
Arytenoid lateralization (tie-back) is a surgical procedure that involves creating a wider airway in the larynx by placing a suture between the cartilages of the larynx to hold the cartilages in an open position. A small skin incision is made over the side of the throat region to access the larynx and allow placement of the suture.
The primary indication for laryngeal tie-back surgery is laryngeal paralysis. Laryngeal paralysis is a condition in which the muscles that normally open the larynx during inspiration stop working. Without active muscles in the larynx, the cartilages tend to move inward as the patient tries to breathe, creating a narrower airway. Laryngeal paralysis typically affects older large breed dogs and typical signs include a loud raspy pant, decreased ability to exercise, and sometimes a change in the bark. Left untreated, laryngeal paralysis can lead to suffocation and or heat stroke and death. Other airway problems can mimic laryngeal paralysis, and a laryngeal exam under light anesthesia is required to confirm the diagnosis.
Pain medication is generally prescribed for the first few days. Tranquilizers may be used if the patient is overly excited. Antibiotics are generally not required in a routine case.
Exercise should be limited to short leash walks using a harness rather than collar. After 2-3 weeks, exercise can gradually be increased, but vigorous activities and overheating should be avoided indefinitely.
Please schedule an appointment for suture removal 10-14 days following surgery. If a persistent productive cough, fever, or extreme lethargy develop, the patient should be re-evaluated as soon as possible.
The prognosis for improved exercise tolerance and avoidance of acute life-threatening airway obstruction is good following a tieback procedure. Most patients still have a slightly louder pant and altered voice even after successful surgery. Although not frequent, the most serious potential postoperative complication is aspiration pneumonia. Aspiration is more likely in patients with a pre-existing vomiting or regurgitation problem or in patients that eat too rapidly.
Your pet’s recovery and well-being are our primary concerns, so please do not hesitate to call and speak with a surgical technician or surgeon if there are any questions regarding your pet’s recovery.
Figure 1: Laryngeal Paralysis. [Image]. Retrieved from https://vvma.org/resources/Conferences/2016%20VVC%20Notes/Broaddus-%20Laryngeal%20Paralysis%20[Compatibility%20Mode].pdf