Total laryngectomy for management of chronic aspiration pneumonia in a myopathic dog

Abstract

A 5-month-old female pit bull terrier dog evaluated for ataxia, progressive regurgitation, and recurrent aspiration pneumonia had markedly elevated creatine kinase activity, non-inflammatory generalized myopathy, and severe esophageal dysmotility. A narrow-field total laryngectomy was performed. The dog is doing well 30 months after surgery, and no longer has episodes of aspiration pneumonia, despite intermittent regurgitation. This case represents the first application of total laryngectomy for the prevention of chronic recurrent aspiration pneumonia in the dog.

Figure 1

Cryosections from the adductor, diaphragm, cranial tibial, and pharyngeal muscles stained with hematoxylin and eosin (H&E). Excessive variability in myofiber size is evident in the adductor, diaphragm, and pharyngeal muscles with marked endomysial fibrosis separating individual muscle fibers in the adductor and diaphragm muscles consistent with a severe degenerative myopathy. The cranial tibial muscle is relatively spared. Bar = 50 μm for all images.

Figure 2

A, B, C — Videofluoroscopic swallow study with liquid barium documenting evidence of aspiration characterized by barium coating the trachea and severe esophageal dysmotility with retrograde movement of the bolus in the proximal esophagus prior to movement of the bolus in an aborad direction. D — Videofluoroscopic swallow study with barium-soaked kibble documenting displacement of the cardia cranially to the diaphragmatic crus (sliding hiatal hernia) with gastroesophageal reflux.

Figure 3

A — Fully healed uncovered tracheostoma following laryngectomy in a pit bull terrier. B — The tracheostoma is kept patent with a soft, flexible silicon tracheostoma vent (Bivona; Smiths Medical ASD, Gary, Indiana, USA) that is secured in place with a foam tracheal tie (Posey Company, Arcadia, California, USA).