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Equine Tie-Back System - Step by Step

Nylon Suture Secured with a Precision Crimping Device
Celia L Goodall

The prosthetic laryngoplasty was first described by Marks et al in 1970. Since that time surgeons have performed the technique, which involves placing a prosthetic suture between the cricoid cartilage and muscular process of the arytenoid cartilage, using sutures of different size and material. The nylon suture secured with a precision crimping device is easy to place and is a system which allows precise adjustments to be made to the degree of abduction of the arytenoid cartilage intra-operatively. It has also been demonstrated to maintain abduction of the arytenoid cartilage long-term.

The placement of the prosthesis is identical to that described by Marks. We recommend placing 1 or 2 80 lb nylon sutures with a swaged on small needle. The suture is passed dorsally through the cricoid cartilage, under the cricopharyngeus muscle and through the muscular process of the arytenoid cartilage. The caudal free end of the nylon is then passed under the cricopharyngeus muscle and the nylon secured as the nylon exits the muscular process of the arytenoid cartilage. Both ends of the nylon are passed through 2 crimps. Tension is applied to each of the free ends of the nylon and Kelly forceps positioned on each end of the nylon close to the crimps. A right angled retractor is recommended to retract the cricopharyngeus muscle caudally. The tension device is positioned between the 2 Kelly forceps and tension applied to each end of the nylon either side of the crimps. Intra-operative endoscopy is used to determine the optimal degree of arytenoid abduction. Once the optimal degree of arytenoid abduction is achieved the tension device is locked in position and the clamps are crimped twice with the precision crimping device. The free ends of the nylon are transected and the incision closed routinely. If using 2 sutures, securing the dorsal suture first is recommended.