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Thursday, December 6, 2012

Displaced Soft Palate!!

Figure 1
The image above is an endoscopic pic of a middle-aged gelding that presented for a history of exercise intolerance. Apparently, during low level, forced exercise, the gelding would begin to make loud "gurgling" noises and become short of breath! In addition, the gelding would cough on a regular basis, especially when eating in the stall. 

Figure 2

 The image above is that from a normal horse. The yellow arrow is pointing to the epiglottis which is not visible in Figure 1 and Figure 3 due to the dorsal displacement of the soft palate. Normally, horses breathe through their nasal passages. The epiglottis helps keep the soft palate in position thus keeping the oral pharynx separate  from the nasal pharynx. However, when the soft palate becomes displaced and covers the epiglottis, the nasal pharynx and oral pharynx communicate directly. When this occurs, the horse suddenly begins to breath through its oral cavity which results in a gurgling sound and exercise intolerance.

Figure 3
The cause of the chronic dorsal displacement of the soft palate in this case is in part due to chronic inflammation of the soft palate (yellow arrow) and potentially an abnormal epiglottis (blue star). The epiglottis was not visualized in this exam and may require an oral endoscopy and skull radiographs to better determine if  there is a structural problem with the epiglottis. Management of this condition involves treating with systemic anti-inflammatory medications and medicated throat wash. If the soft palate remains displaced, surgical consultation is recommended. Yet another example of the benefit of an endoscopic exam for a horses that suffer from coughing, exercise intolerance, or nasal discharge.

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