The effect of head position on the radiographic assessment of the laryngeal tie-forward procedure

Objective—To assess the effect of head position on relative position of the larynx and hyoid apparatus in horses with palatal dysfunction, and to define a standard position for radiographic assessment of laryngeal tie-forward. Study Design—Prospective clinical study. Animals—Adult horses (n¼9) with palatal dysfunction. Methods—Left lateral radiographs of the larynx were obtained pre and postoperatively for 3 different head positions (flexed¼901; neutral¼1001; extended¼1151). Distance between thyrohyoid bone and thyroid cartilage was measured. Data were analyzed to investigate differences between head positions, and to compare differences between pre- and postoperative measurements. Results—Head position had a significant effect on relative position of the larynx and hyoid apparatus preoperatively. There was no significant difference in postoperative measurements of the 3 head positions. A significant difference between pre- and postoperative measurements was found with the head in the neutral or extended position whereas there were no significant differences between pre- and postoperative measurements using the flexed position. Conclusions—Head position affects the relationship between the hyoid apparatus and larynx preoperatively, with greatest distance occurring when the head is extended. In a flexed position, it is not possible to ascertain whether laryngeal position has changed postoperatively. Clinical Relevance—A standardized head position is necessary when assessing the laryngeal tieforward procedure radiographically. An extended head position is most useful for this assessment.