- Empyema of the guttural pouches is a condition where pus collects in the guttural pouches of horses, usually due to infection spreading from the pharynx through the eustachian tube. - Symptoms include intermittent nasal discharge, difficulty swallowing and breathing, and swelling of lymph nodes. - Treatment involves early antibiotic therapy if possible, but once pus has formed, surgical drainage of the affected pouch is needed, which can be done through the incising along the atlas bone or through the viborg's triangle approach in the neck.

1. Empyema of Gutteral pouches
• Only in equines
• GP – large mucous
sac which is ventral
deverticulum of the
eustachian tube and
situated on both sides
on dorsal surface of
the pharynx

2. • Eustachian tubes:
passage on each side,
from throat to the middle
ear and serve to maintain
even atmospheric
pressure upon the inner
surface of the ear drum
or tympanum. Open
widely in the act of
swallowing or yawning.

3. Empyema of Gutteral pouches
• Collection of pus in GP-
as a result of infection
from pharynx through the
Eustachian tube .
• Sequelae of influenza/
strangles.
• Pus may be partly
inspissated (Chondroids)
• Persists for want of
complete drainage

4. Empyema of Gutteral pouches
• Symptoms:
• Intermittent nasal
discharge – head is
lowered during
feeding or drinking.
• From both nostrils
even if one gutteral
pouch is affected
• Thin and not foul
smelling

5. • Press the pouch with
hand – discharge is seen
• Difficulty in swallowing
and breathing because of
pressure on pharynx and
larynx
• Swelling of submaxillary
(mandibular) lymph
glands

6. • Holding of the head
towards the sound
side
• Rattling sound during
trotting – agitation of
the contents

7. • Pass a Gunther’s catheter into the pouch
• From nostril into pharynx and carefully directed
into the opening of the eustachian tube at the
pharynx to reach the GP of the affected side

8. Prognosis
• Favourable if complete drainage is
provided by surgical operation
• Death rarely occurs due to inflammation
and ulceration of mucus memberane

9. • Death may occur by severe hemorhage
• Inspiration pneumonia due to ingested
food materials entering lungs because of
dysphagia

10. Treatment
• Early stages:
antibiotic therapy may
be helpful
• Once pus is formed ,
drainage is to be
effected surgically
• Irrigate with mild AS
solutions after
passing catheter
• Chondroids cannot be
removed

11. Surgical
• 2 sites
• Incising along the
anterio- inferior
border of the wing of
atlas and doing
hyovertebrotomy
• Viborg’s triangle

12. • GA is prefferred
• Viborg’s can be done
under LA

13. • Technique:
• Area defined by
tendon of
sternomandibular
muscle, linguofacial
(external maxillary )
vein, and caudal
border of vertical
ramus of mandible
• 4-6 cm incision dorsal
and parallel with
linguofacial vein from
the border of
mandible caudad

14. • Separate the
subcutaneous tissue
• Reflect the base of
parotid gland- avoid
trauma to gland and duct,
lingofacial vein, branches
of the vagus nerve along
the floor of gutteral pouch
• Exposes the GP –
distended in pathologic
state

15. • Grasp the
memberane with
foreceps and incise
with scissors
• Wound is left open for
drainage or a drain is
inserted
• Granulation
(secondary intension)

16. Hyovertebrotomy Approach
• exposes the
Dorsolateral aspect of
GP
• More difficult
• More vessels and
nerves in surgical site
• 8-10 cm incision –
parallel and just
cranial to wing of
atlas

17. Hyovertebrotomy Approach
•
exposes the parotid
salivary gland and
overlying
parotidoauricularis
muscle
• Ventral part of muscle is
incised – incise the
parotid facia on its
caudal border
• Reflect the parotid
craniad
• Caudal auricular nerve
crosses obliquely in the
dorsal aspect of field
• Reflect it caudad

18. • Reflection of parotid
reveals
occipitohyoideus and
digastricus m
craniodorsally and
rectus capitis
caudodorsally
• One can see the
mandibular salivary
gland ventrally

19. • Blunt dissection
through areolar tissue
exposes the
dorsolateral wall of
GP
• Entry is made
between
glossopharyngeal
nerve rostrally and
vagus nerve caudally

20. • Avoid the internal
carotid art.
• Incise GP
• If necessary after
drainage fix a drain
• Close the incision, GP
memberane by simple
interrupted – synthetic
absorbable

21. • Close the facia
associated with
parotid gland
• Close the skin