Clinical outcome after surgical correction of cleft palate by laryngeal tie-forward in 2 horses

Introduction: Cleft palate is a rare congenital defect in horses. Its description in literature is generally limited to cases of young foals referred for milk regurgitation from nostrils, coughing and dysphagia, with a guarded to poor prognosis if not treated. Surgical intervention consists mainly in palatoplasty that is considered a salvage procedure and complications are frequent. Only few cases of cleft palate in adult horses are described in literature. Laryngeal tie-forward, a surgical technique generally used to treat dorsal displacement of the soft palate, has been described only in one 4-year-old pony with cleft palate but clinical improvement after surgery was partial and temporary.
Objectives: To describe laryngeal tie-forward as a valid option for the treatment of cleft palate in two adult horses not suitable for palatoplasty.
Methods: Clinical records of two 8 y.o. jumping horses performing respectively at a low and intermediate intensity of exercise and competition. Both horses were referred for respiratory noise, exercise intolerance, cough and alimentary nasal discharge; they were diagnosed with a moderate soft palate defect and surgically treated by laryngeal tie-forward. A clinical examination and control endoscopy were realized at 4 months for one horse and at 3 years after surgery for the other.
Results: In both horses postoperative endoscopy showed a visible reduction of the gap between soft palate and the larynx so that the epiglottis was covering the soft palate defect. One horse was examined 4 months after surgery, a residual respiratory noise during exercise was still present but lighter than prior to intervention, its performances had remarkably improved. The second horse was controlled 3 years after surgery, some cough was still observed but limited to the onset of exercise, performances were satisfying and the horse was working at the same intensity level. Globally, in both horses, initial symptoms had disappeared or were significantly reduced after surgery and owners were satisfied. Reduction of the soft palate defect was still effective, even several months after surgery.
Conclusions: The description of these two clinical cases shows that some horses can grow up to adult age with moderate defects of the soft palate; they are likely to show clinical signs of variable severity. In such cases laryngeal tie-forward should be considered as an option if the defect is too large or asymmetrical to be corrected with palatoplasty.