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Ground-breaking nerve transplantation at the RVC
Amodified first or second cervical nerve transplantation technique developed in conjunction with Dr Justin Perkins, Lecturer in Equine Surgery at the RVC and RVC Alumnus (1998), has shown promising results as a method of re-innervation of the larynx for horses with recurrent laryngeal neuropathy.
In the procedure, direct implantation of the first or second cervical nerve into the cricoarytenoid dorsalis (CAD) muscle is performed.
The aim of this technique is reinnervation of the muscle, thereby restoring the ability to achieve and maintain abduction of the left arytenoid cartilage. The first
or second cervical nerves innervate the
accessory muscles of respiration and are activated during forced inspiration (during canter and gallop work).
The procedure is typically performed under general anaesthesia. However,
a technique was recently developed
for the standing horse. The surgical approach is similar to that for a prosthetic laryngoplasty, where an incision is made adjacent to the linguofacial vein. Careful dissection is continued until the branch of the first or second cervical nerve is found as it enters the omohyoideus muscle.
The identification of the nerve is confirmed using a nerve stimulator
tool, which induces contraction of the omohyoideus muscle. Once identified, this nerve and its branches are dissected
to allow for transplantation into the
CAD muscle. They are then tunnelled into the CAD muscle and sutured in place. Routine closure of the incision is performed and the horses are discharged from hospital 48 to 72 hours later.
Postoperative management consists
of box rest for two weeks followed by two weeks of walking. Training resumes as early as six weeks following surgery and canter work is introduced early in the rehabilitation period to activate the accessory respiratory muscles and thus the C1 nerve.
You can read more about the technique in Clinical Connections. The article appears in the summer 2019 issue. www.rvc.ac.uk/clinical-connections
CLINICAL SERVICES
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