Upper Airway Surgery – Tie Back
Tie back surgery has remained the major way of treating laryngeal hemiparalysis (“roaring”) since the 1970’s.
The most common cause of this condition is unknown (idiopathic) and it happens most often in large sized thoroughbred and warmbloods. However, other breeds and smaller horses can be affected. It is usually a left sided condition but can occur on the right side as well. When it does, it is either caused by an irritating injection next to the vein affecting nerve function or part of a more complex birth defect (fourth branchial arch defect).
While the surgery does not render the patient with a physiological “normal” airway, it creates the best compromise allowing for normal function at rest (swallowing) as well as near maximal performance ability at exercise.
The only recent change to the procedure other than minor modifications and improvements has been the transition from general anesthesia to a standing position in the past years.
Depending on the patient’s demeanor and attitude, we offer this procedure standing or under general anesthesia. We are happy to advise you what may be best in your individual horse.
Often, a unilateral ventriculocordectomy (VCE) is performed with the tie back surgery. This improves airflow even further and in some breeds, such as draft horses, it has shown to improve the airway condition majorly by itself. With the advent of standing tie backs, we usually recommend both procedures to be combined for maximum effect even in these breeds.
The VCE can be done through an open approach but in most cases we recommend the minimal invasive route using the transendoscopic laser, which is performed through the nasal cavity in the standing, sedated horse.