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CVJ / VOL 47 / OCTOBER 2006 1007
Case Report Rapport de cas
Case descriptions
Case 1
A
5-year-old, Thoroughbred gelding racehorse with a
1-week history of epiglottic entrapment causing poor
performance and upper respiratory noise was presented to
the Cornell University Equine Hospital for treatment. No
history of dysphagia was reported by the trainer; however,
the horse had coughed while exercising and eating for
approximately 3 wk.
On physical examination, no abnormalities of sig-
nificance were noted. An upper airway videoendoscopic
examination revealed focal swelling of the rostral third
of the epiglottis, ulceration on the dorsal surface of the
epiglottis, and loss of the scalloped edge of the epiglottic
cartilage with the appearance of a concomitant aryepiglot-
tic entrapment (Figure 1A). Indeed, loss of the scalloped
edge of epiglottic cartilage and a mucous membrane that
appeared to attach to the lateral aspect of the cornicu-
late process gave the false impression of an aryepiglot-
tic entrapment. However, a slightly more dorsal view
(Figure 1B) showed a rather inflamed and enlarged mucous
membrane of the epiglottic cartilage, not the aryepiglottic
membrane. Intermittent dorsal displacement of the soft pal-
ate (DDSP) was observed during the examination. Finally,
a white structure protruded for approximately 1 cm beyond
the dorsal surface of the epiglottic cartilage through an
ulcerated area of the epiglottis; this was presumed to be a
necrotic section of cartilage surrounded by abscessation.
A tentative diagnosis of septic chondritis of the epiglottic
cartilage was made.
The animal was sedated with detomidine hydrochlo-
ride (Dormosedan; Pfizer, Exton, Pennsylvania, USA),
0.012 mg/kg body weight (BW), IV, and butorphanol tar-
trate (Torbugesic; Fort Dodge Animal Health, Iowa, USA),
0.008 mg/kg BW, IV, to facilitate further investigation of
the epiglottic cartilage (1). Local anesthetic, 50 mL of
2% lidocaine hydrochloride solution (Lidocaine; Phoenix
Scientific, St Joseph, Missouri, USA) was applied to the
dorsal aspect of the epiglottic cartilage and nasopharynx
through the videoendoscope biopsy channel. Under video-
endoscopic visualization, approximately 1.25 3 0.75 cm of
necrotic epiglottic cartilage protruding through the ulcer-
ated area was removed with bronchoesophageal forceps
(Richard Wolfe Medical Instrument Corp., Vernon Hills,
Illinois, USA) inserted through the right nostril. The sam-
ple was submitted for histopathologic examination, culture,
and sensitivity testing. A cranial pedunculated tag of epi-
glottic mucosa, measuring approximately 1.25 3 1.0 cm,
was removed, using a diode laser and bronchoesophageal
forceps. The tag’s removal enhanced exposure to the ulcer-
ated area on the dorsal aspect of the epiglottic cartilage,
allowing better local debridement and removal of smaller
pieces of necrotic debris from the abscess with forceps.
Polyethylene (PE) tubing was passed through the videoen-
doscope biopsy channel into the epiglottic cartilage defect,
which was then lavaged with 250 mL of a solution of ster-
ile physiological saline solution containing 1g of sodium
ampicillin (Amicillin; American Pharmaceutical Partners,
Schaumburg, Illinois, USA) per liter. Histopathological
Septic epiglottic chondritis with abscessation in 2 young Thoroughbred
racehorses
Tomas Infernuso, Ashlee E. Watts, Norm G. Ducharme
Abstract — Septic epiglottic chondritis with abscessation diagnosed in 2 Thoroughbred racehorses.
Infected cartilage removed videoendoscopically followed by systemic antibiotics. The infectious process
was successfully controlled, but permanent dorsal displacement of the soft palate (DDSP) with a shortened,
deformed epiglottic cartilage developed. Surgery for the DDSP using bilateral partial sternothyroidectomy
or laryngeal tie-forward failed.
Résumé — Chondrite septique abcédée de l’épiglotte chez 2 jeunes chevaux de course Thoroughbred.
Une chondrite septique abcédée de l’épiglotte a été diagnostiquée chez 2 jeunes chevaux de course
Thoroughbred. Le cartilage infecté a été enlevé par vidéo-endoscopie puis une antibiothérapie systémique
a été instaurée. Le processus inflammatoire a été enrayé mais un déplacement dorsal permanent du palais
mou (DDPM) causé par un cartilage de l’épiglotte raccourci et déformé s’est développé. La chirurgie du
DDPM par sternothyroïdectomie partielle bilatérale ou avancement laryngée a échoué.
(Traduit par Docteur André Blouin)
Can Vet J 2006;47:1007–1010
Department of Clinical Sciences, College of Veterinary Medicine,
Cornell University, Ithaca, New York 14853, USA.
Address all correspondence to Norm G. Ducharme; e-mail:
ngd1@cornell.edu
Reprints will not be available from the authors.
1008 CVJ / VOL 47 / OCTOBER 2006
R AP P ORT DE CA S
Figure 1. Videoendoscopic view of a 5-year-old Thoroughbred horse with chondritis and abscessation of the epiglottic cartilage.
A) Note focal swelling on the rostral third and loss of the scalloped edge of epiglottic cartilage, suggestive of epiglottic entrapment.
Necrotic epiglottic cartilage (arrow) is being extruded from the dorsal aspect of the epiglottic cartilage. B) Note the epiglottic cartilage
round edge is due to the presence of inflamed epiglottic mucosa, not aryepiglottic membrane.
A B
examination of the sample revealed sheets of degenerated
cartilage that had undergone ischemic necrosis. Colonies
of mixed bacterial rods and cocci covered and extended
into the chondroid lacunae. Streptococcus pneumoniae,
sensitive to ampicillin and enrofloxacin, was isolated from
the aerobic culture.
A diagnosis of septic chondritis of the epiglottic car-
tilage with abscessation was made and the following
treatment was instituted: nonsteroidal antiinflammatory
medication, phenylbutazone (Vedco; St Joseph, Missouri,
USA), 2.2 mg/kg BW, PO, q12h for 10 d postoperatively,
and enrofloxacin (Baytril; Bayer Animal Health, Shawnee,
Kansas, USA), 7.5 mg/kg BW, PO, q24h for 21 d. A 20-mL
“throat spray” consisting of 250 mL glycerin (Humco;
Texarkana, Texas, USA), 250 mL dimethyl sulfoxide 90%
(DMSO; Butler Company, Columbus, Ohio, USA), 500 mL
furacin (nitrofurazone powder USP; PCCA, Houston,
Texas, USA), 50 mL dexamethasone sodium phosphate
(25 mg/mL) (American Regent, Shirley, New York, USA),
and ticarcillin and clavulonate (Timentin; SmithKline
Beecham, Philadelphia, Pennsylvania, USA), 3 g, was
applied to the nasopharynx through a flexible, soft rubber,
10 French catheter via the ventral nasal meatus twice daily
for 14 d. The horse was confined to a stall with daily hand
walking as exercise until being reevaluated 2 mo later.
At the approximately 2-month postoperative, reevalu-
ation physical examination, all vital signs were within
normal limits. Videoendoscopy of the larynx revealed
that the soft palate was persistently positioned dorsal to
the epiglottic cartilage. After sedation and administra-
tion of local anesthetic, as described previously, further
examination with the aid of bronchoesophageal forceps
revealed a shortened and deformed epiglottic cartilage
and an aryepiglottic entrapment. The aryepiglottic folds
were edematous and thick, with prominent margins, and
they covered 1/3 of the short, edematous, misshapen, and
discolored epiglottis, which was approximately half its
normal length, presumably as a result of its previous infec-
tion. A grave prognosis for return to racing was given, and
the horse was prepared for surgery to correct the epiglottic
entrapment and DDSP.
Because of the very thick aryepiglottic folds and
deformed epiglottic cartilage, removing a section of ary-
epiglottic membrane by laryngotomy was judged to be less
likely to cause injury to the remaining deformed epiglottic
cartilage and to have less likelihood of recurrence of the
epiglottic entrapment than making a linear incision of the
membrane with a hook blade or laser. The DDSP treatment
planned was a partial Llewellyn procedure (2), because a
tie-forward procedure cannot be done at the same time
as a laryngotomy (3). The horse was placed in dorsal
recumbency, a 2-cm section of the sternothyroideus tendon
and associated muscle was removed bilaterally, and the
entrapping aryepiglottic membrane was resected through a
laryngotomy. Recovery from anesthesia was uneventful.
The colt also received nonsteroidal antiinflammatory
medication, phenylbutazone (Vedco), 2 mg/kg BW, PO,
q12h for 5 d, and the “throat spray” described above for
14 d. In addition, the following treatment was recom-
mended: trimethoprim/sulfamethoxazole (Tribissen; Teva
Pharmaceuticals, Sellersville, Pennsylvania, USA), 30 mg/kg
BW, PO, q12h for 10 d, and a period of rest with controlled
CVJ / VOL 47 / OCTOBER 2006 1009
CA S E R E P O R T
exercise/walking for 2 wk. Endoscopic examination 5 mo
later revealed a persistent DDPS. The horse returned
to racing, but he was unable to compete successfully in
2 starts and was retired from racing.
Case 2
A 3-year-old, male Thoroughbred racehorse was presented
to the Cornell University Equine Hospital for evaluation
and treatment of DDSP associated with epiglottic swell-
ing. The colt had performed poorly in his most recent race
(1 wk prior to presentation), made an abnormal respiratory
noise while exercising, and was referred after epiglottitis
and associated intermittent DDSP had been diagnosed by
endoscopic examination. A few weeks prior to his poor
performances, the colt had coughed intermittently.
Results from a complete physical and visual examina-
tion, palpation of the colt’s head and neck, and auscultation
of the upper and lower respiratory tract and cardiovascular
system were within normal limits. The horse was comfort-
able and no abnormal upper respiratory noise could be
heard at rest. Videoendoscopic examination of the upper
respiratory tract, performed with the use of a lip chain for
restraint, showed that the dorsal aspect of the epiglottis
was swollen and ulcerated (Figure 2). In addition, the soft
palate was noted to displace frequently during the exami-
nation, and multiple swallowing episodes were needed
to replace it to its correct anatomical position. The scal-
loped edge of the epiglottic cartilage could still be seen.
A lateral radiograph of the laryngeal area with the horse
standing revealed a thick epiglottis, a blunted rostral third
of the epiglottic cartilage, and the caudal free edge of the
soft palate in the normal subepiglottic position. The horse
was restrained in stocks, sedated, and had local anesthetic
applied to the nasopharyngeal structures, as described for
Case 1. The ulcer on the dorsal aspect of the epiglottic
cartilage was explored with bronchoesophageal forceps.
Purulent exudate found deep within the ulcer was submit-
ted for bacterial culture. Further exploration revealed that
the tip of the epiglottic cartilage was loose from the main
cartilage; it was removed with the bronchoesophageal
forceps. The remaining purulent exudate was lavaged, as
described in Case 1. A diagnosis of septic chondritis of
the epiglottic cartilage with abscessation was made. It
was expected that shortening of the epiglottic cartilage as
a result of the chondritis would lead to persistent DDSP.
Therefore, surgical advancement of the larynx (laryngeal
tie-forward) with partial sternothyroideus muscle tenec-
tomy was performed under general anesthesia (2,3). The
animal recovered uneventfully from anesthesia.
Aerobic bacterial culture of the epiglottic cartilage
revealed a moderate number of Actinobacillus spp.
In response to the results from culturing and sensitiv-
ity testing, the colt was treated initially with ampicil-
lin (Ampicillin Na; American Pharmaceutical Partners),
15 mg/kg BW, IV, q8h, and gentamicin sulfate (GentaVed,
Vedco), 6.6 mg/kg BW, IV, q24h for 10 d, followed by oral
enrofloxacin (Baytril; Bayer Animal Health), 7.5 mg/kg
BW, PO, q24h for 10 d. Postoperative treatment also
included “throat spray” and phenylbutazone, as described
in Case 1.
The horse was kept in a box stall with daily hand walk-
ing for 3 mo postsurgery. Endoscopic evaluation at 3 and
6 mo revealed an almost persistent DDPS without dyspha-
gia. The epiglottic cartilage was observed to be blunt and
reduced in size by approximately 50%. The horse made
3 unsuccessful starts 6 mo after presentation.
Discussion
Septic chondritis of the laryngeal cartilages usually affects
1 or both arytenoid cartilages. The cause of arytenoid
chondritis is not well understood; however, inhalation of
debris and concussion of the paired arytenoid cartilages,
resulting in mucosal damage and subsequent infection,
have been suggested as causes (4,5). The condition is com-
monly overrepresented in Thoroughbred and standardbred
racehorses, and it may be related to their level of athletic
activity (4–6). An ulcerated mucosal lesion is presumed
to lead to secondary bacterial invasion and destruction of
the affected arytenoid cartilage (4–6). The mucosal ulcer-
ation is usually seen in horses at the rostral margin of the
vocal process of the arytenoid cartilage. In 1 study, the
ulceration progressed until it resulted in chondritis of the
arytenoid cartilage in 5% to 10% of yearling Thoroughbred
racehorses (6).
Septic chondritis of the epiglottic cartilage is a less com-
mon and understood process. We hypothesize that second-
ary bacterial invasion of the epiglottic cartilage followed
either epiglottitis, an epiglottic abscess, or epiglottic muco-
sal ulceration. We feel that it is important to differentiate
these 3 conditions from septic chondritis of the epiglottic
cartilage with abscessation or to identify any concomitant
disease present to achieve appropriate management and an
accurate prognosis. Classically, epiglottitis is recognized
endoscopically by signs of edema, reddening, and thick-
ening of the epiglottis and aryepiglottic membranes and,
occasionally, exposed cartilage at the tip of the epiglottis
(7,8). No causal organism has been reported, but cultures
Figure 2. Videoendoscopic view of a 3-year-old Thoroughbred
horse with chondritis and abscessation of the epiglottic cartilage.
Note subepiglottic granulation tissue and thickening combined
with an ulcer on the dorsal aspect of the epiglottic cartilage.
The scalloped edge of the epiglottic cartilage was still present.
1010 CVJ / VOL 47 / OCTOBER 2006
R AP P ORT DE CA S
are generally not attempted (7). Epiglottitis is a disease
that requires local and systemic medical treatment (7,8).
Following resolution of epiglottitis, various degrees of
epiglottic deformity can be seen, as reported in 5 out of
16 horses with epiglottitis (7). These epiglottic deformities
are usually mild, and a reasonable prognosis is expected
(7,8). Epiglottic abscessation without chondritis has been
reported to have the endoscopic feature of smooth round
swelling at the dorsal surface of the epiglottic cartilage.
Surgical drainage of the abscess appears to be important
(1). In the absence of cartilage involvement, epiglottic
abscessation does not lead to epiglottic deformation, and
a good prognosis is expected (1). Presumably, epiglottic
ulceration, like an arytenoid ulceration, has the potential
to lead to epiglottic chondritis and, at least, should be
monitored closely (6).
The differentiating endoscopic features in these 2 cases
of septic chondritis of the epiglottic cartilage included
an ulcer on the dorsal surface of the epiglottic cartilage
(not ventrally or at the tip of the epiglottis). In addition, a
white necrotic cartilage was protruding at the ulcer site.
The optimal treatment cannot be identified in this report,
as debridement and local and systemic antimicrobials suc-
cessfully eliminated the infectious process, but the disease
reduced the length of the epiglottic cartilage by approxi-
mately 50%. In this condition, the potential for severe
shortening of the epiglottic cartilage exists, which could
result in permanent DDSP. At this time, a poor prognosis
appears to be indicated if significant epiglottic cartilage
loss occurs. CVJ
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ment of dorsal displacement of the soft palate. Proc Am Assoc Equine
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3. Woodie JB, Ducharme NG, Kanter P, Hackett RP, Erb HN. Surgical
mobilization of the larynx (laryngeal tie-forward) as a treatment for
dorsal displacement of the soft palate: A prospective study 2001–2003.
Equine Vet J 2005;37:425–429.
4. Haynes PF, Snider TG, McClure JR, McClure JJ. Chronic chondritis
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6. Kelly G, Lumsden JM, Dunkerly G, Williams T, Hutchins DR.
Idiopathic mucosal lesions of the arytenoid cartilages of 21 Thorough-
bred yearlings: 1997–2001. Equine Vet J 2003;35:276–281.
7. Hawkins JF, Tulleners EP. Epiglottitis in horses: 20 cases (1988–1993).
J Am Vet Med Assoc 1994;205:1577–1580.
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Fertility and Obstetrics in the Horse,
3rd ed.
England GCW. Blackwell Publishing Professional, Ames, Iowa,
USA, 2005, ISBN 1-4051-2095-9. US$64.99.
E
quine theriogenology has realized much advancement in
recent years with the clinical application of new reproduc-
tive technologies. This soft-covered book is an excellent, quick
reference for student and graduate veterinarians who already
possess a substantial academic and clinical background. The
book is written in point form so topics are covered quickly,
but superficially. It will be necessary for the reader to reference
other material if a more thorough understanding of the details
of a topic is required.
The book is 300 pages, contains 30 chapters, and covers
both the mare and stallion. Topics include a broad spectrum of
subjects including the basic areas of anatomy and endocrinol-
ogy, clinical examination procedures and techniques, reproduc-
tive diseases, normal and abnormal pregnancy, obstetrics and
reproductive management. The stallion section is relatively
short but covers anatomy, endocrinology, clinical conditions,
and surgery.
This 3rd ed. is written in a style similar to the 2nd ed., with
both the mare and the stallion sections being updated and
expanded with new information. The text has been extensively
revised. It is well illustrated with line drawings, graphs, and
black and white photographs. The strength of the text is a
rapid reference for diagnosis and practical treatment of many
conditions of equine theriogenology; however, other reference
material will be required to access a more detailed description
of procedures.
The Codes of Practice included in the appendix apply more
directly to Britain than North America, but the information
remains accurate and extremely useful.
This reference text is a useful addition to the library of an
equine theriogenologist.
Reviewed by Walter Johnson DVM, MVSc, DipACT, Professor,
Theriogenologist, Department of Population Medicine, Ontario
Veterinary College, University of Guelph, Guelph, Ontario
N1G 2W1.
Book Review
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