Published on September 25, 2011
Surgical Drainage from Guttural Pouch in Equine : Surgical Drainage from Guttural Pouch in Equine By TOUQEER AHMED Normal location of guttural pouch.: Normal location of guttural pouch. Indications: Indications Empyema of guttural pouch. Trauma. Guttural pouch tympany (fig). Endoscopic view of guttural pouch.: Endoscopic view of guttural pouch. Anaesthesia and Control : Anaesthesia and Control Depends on the site chosen. For hyovertebrotomy , General anaesthesia is required. Local analgesia may be adequate for opening the pouch at the Viborg’s triangle. The horse is cast and secured on the opposite side with head extended. Anatomy : Anatomy The guttural pouches are diverticula of the Eustachian tubes and present in the equine species. Relationship of guttural pouch: Dorsally : Base of cranium and atlas; Ventrally : Pharynx and oesophagus ; Contd…: Contd … Medially : Medially the two guttural pouches are in contact with each other with a little separation above due to the ventral straight muscles of the head. (Rectus capitis ventralis ). Dorso -medially : The Vagus , spinal accessory and Sympathetic nerves; the anterior cervical ganglion; the internal caroid artery, and the ventral cerebral vein. Contd…: Contd … Laterally: laterally it is overlapped by many important structures, viz. Pterygoid , Levator palate, Tensor palate, Stylohyoideus , Occipito-hyoideus , Occipito-mandibularis , and Digastricus muscles; the parotid and mandibular (sub-maxillary) salivary glands; the Glosso -pharyngeal, Hypoglossal and Anterior Laryngeal nerves; and the great cornu of the hyoid bone; Site : Site Over the anterior-inferior border of the wing of atlas called the DIETERCHI’s Method of Hyo-vertebrotomy . In the Viborg’s triangle, which is outlined by : The posterior border of the vertical ramus in front. Tendon of sternomaxillaris above. The sub-maxillary vein below. Technique : Technique Site No.1 : Make a 3 to 5 inches long skin incision along the anterior-inferior border of the wing of atlas. Reflect the parotid gland forward by freeing it from areolar attachments. Contd…: Contd … In a distended state the pale wall of the guttural pouch would become visible immediately. Normally it is under cover of the digastricus , stylo-maxillaris and occipito hyoideus muscles. A fold of the guttural pouch is held by tissue forceps and an opening is made into it. Contd…: Contd … A probe or a sound is then introduced into the pouch towards the Viborg’s triangle so that a counter opening can be made at that level to facilitate drainage and introduction of a seton , if required. Site No.2 : Thorugh the Vibrog’s triangle by a simple incision and blunt dissection. T H A N K S.: T H A N K S.