Unilateral Cricoarytenoid Lateralization
(Tie Back)
The goal of the tie-back surgery is to permanently open the airway enough to allow for easier breathing and to reduce the risk of life-threatening respiratory distress episodes. The muscle normally responsible for opening the airway when breathing is called the cricoarytenoideus dorsalis (CAD) muscle. The CAD muscle is named this way because it attaches to two cartilage structures in the larynx, the “cricoid” cartilage and the “arytenoid” process. When the CAD muscle tightens, it pulls these two cartilage structures closer together and this causes the airway to open. In dogs with laryngeal paralysis, this muscle is non-functional and cannot open the airway normally.
How will the surgeon complete the Tie Back procedure?
The cricoarytenoid lateralization or “tie-back” procedure involves tightening a strong, non-absorbable suture material between the cricoid cartilage and arytenoid process to mimic what the CAD muscle would normally do.
What are some of the benefits, risks or challenges of a Tie Back procedure?
This surgery will only hold the airway in a permanent open position. This is why after surgery, dogs are at a greater risk for food or fluid going “down the wrong tube” when swallowing and developing aspiration pneumonia. For this reason, the suture is tightened enough to increase the airway opening and improve breathing, but not so much that food or fluid will always go into the airway. Regardless, aspiration pneumonia is reported in up to 10-20% of dogs after undergoing tie-back surgery. Response to surgery is immediate and dramatic. Although there is a risk of aspiration pneumonia after surgery, generally the prognosis is excellent and 90% of patients show improvement of respiratory distress and return to a normal level of activity. Dogs typically go from loud and labored breathing to more normally and having an improved activity level. We make specific recommendations below to reduce the risk of aspiration pneumonia after surgery.
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Since laryngeal paralysis is often part of a larger progressive neurologic syndrome, GOLPP (Geriatric Onset Laryngeal Paralysis and Polyneuropathy), dogs will typically begin to develop additional neurologic deficits over time such as hindlimb weakness, ataxia (drunken gait), and scuffing of his hind paws. Thankfully, these signs are often mild and still allow for a good quality of life.
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For more information about GOLPP, please visit here.
POST OPERATIVE CARE PLANNING
FOR A TIE-BACK PROCEDURE:
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Dogs are typically discharged as soon as recovered from surgery to reduce patient stress
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No e-collar is necessary as the incision is on the neck. If your pet scratches as the incision, a sock or bootie can be placed on the offending paw to prevent their nails from damaging the closure
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Exercise restriction for 2 weeks: no off-leash activity allowed, no play, no jumping on/off furniture
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Try to avoid excessive barking and vocalization for 2 weeks while scar tissue develops around the suture
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Pain is typically minimal post-operatively, but a light pain medication is sent home.
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Avoid feeding your dog things that break apart and create dust and crumbs (eg. dry food, dry treats, crackers) as these can be inhaled into the open airway and cause coughing fits, or pneumonia
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We recommend feeding your pet wet food for the remainder of their life.
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For the first 2 weeks after surgery, we suggest making the wet food into formed “meatballs” that are hand fed to make it easier to swallow as they learn to protect their airway again.
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For a few days after surgery, it is common for dogs to cough when drinking water, especially if they drink too fast. This typically improves over time as they adjust to the changes in their airway.
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Swimming is not allowed after tie-back surgery, because if the head becomes submerged for even a moment, the open airway can take on water and cause drowning.
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If your pet vomits or regurgitates at any time after surgery, watch them closely for signs of aspiration pneumonia (coughing, sneezing, lethargy, fever). If concerned, please seek veterinary attention. Chest x-rays can be performed to evaluate for pneumonia and treat with antibiotics if indicated.