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Endoscopic examination of the upper airway and standardized grading systems

Endoscopic examination of the upper airway and standardized grading systems. 2016 CBA Educational Symposium. Modified Cornell System (1991) A standardized classification system based on description of arytenoid function.

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Endoscopic examination of the upper airway and standardized grading systems

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  1. Endoscopic examination of the upper airway and standardized grading systems 2016 CBA Educational Symposium

  2. Modified Cornell System (1991)A standardized classification system based on description of arytenoid function • Numbers are interchangeable with words, so it is a descriptive system, and relatively objective • Grades 1-4 • Recognized as the standard grading system by the AAEP

  3. Grade 1 function • The number “1” is synonymous with the word “symmetric” • A Grade 1 function means that the arytenoids open symmetrically, fully abduct (open), and hold their position

  4. Grade 2 function • The number “2” is synonymous with the word “asymmetric” • Grade 2 function means that the arytenoids open asymmetrically, fully abduct (open), and hold their position • Broken down into (2) categories: • 2A means mild asymmetry • 2B means moderate asymmetry

  5. Grades 1, 2A & 2B are all variations of normal throat function • Statistically, there is no difference in the racing performance of horses with Grade 1, Grade 2A and Grade 2B function

  6. Grade 3 function • Arytenoid may achieve full abduction transiently and cannot hold OR may not fully abduct

  7. Grade 4 function • Arytenoid does not move

  8. Grades 3 & 4 function are not normal • Grade 3 and Grade 4 throats do not meet Conditions of Sale at all four of the Thoroughbred sales companies in the US

  9. Grading of epiglottis • Epiglottis is evaluated separately from arytenoid function • Graded as normal, mildly flaccid, moderately flaccid, severely flaccid • Also noted is length: normal or short • Epiglottis can change, even within the same endoscopic exam

  10. Another grading system currently used by some at the sales • Three grades: A+, A and A- • Subjective, and only has meaning to the veterinarian who scoped the horse • Combines all findings into a subjective grade, ie. a horse with a Grade 1 function and a moderately flaccid epiglottis could be graded the same as a horse with Grade 2B function and a normal epiglottis • This system is not recognized by the AAEP

  11. Upper airway conditions of sale • Additionally, there is a group of upper airway endoscopic findings that are considered to adversely affect airway function and are covered by Conditions of Sale at the four major US sales companies • Post-sale endoscopic examination is sufficient to protect the buyer in these cases.

  12. Videoendoscopic examination at sales: several issues to consider • Time interval between videoendoscopic exam and selling session • Method of identification of horse to ensure integrity • Uniformity of video equipment used so that the quality of the videos is excellent • Criteria acceptable to veterinarians (ie. length of video, methodology, etc.) to encourage usage during the pre-sale assessment process • Possible necessity of the addition of a condition of sale to assure that the pre-sale video of upper airway approximates the throat function post-sale?

  13. Repository Radiographic Reports • Problems arise when the report leaves the hands of the person for whom it was generated and is circulated to interested parties who have no relationship to either the veterinarian or the seller

  14. Repository Radiographic Reports • The basis of the problem is that these reports are by nature subjective, and as such only have meaning in the context of a vet / client relationship where level of risk and intended use is clearly communicated and understood • Not like a CARFAX

  15. Repository Radiographic Reports • The current usage of the reports at the sales creates significant legal exposure for the consignor / owner, veterinarian and sales company

  16. Repository Radiographic Reports • The notation “No Significant Findings” is problematic because the word “significant” means significant in the mind of the person reviewing the radiographs • Different veterinarians may interpret the same finding differently, rendering each opinion subjective

  17. Repository Radiographic Reports • In a strict legal sense, the true significance of any finding lies in whether that finding is significant in the mind of the buyer • It is impossible for any veterinarian or consignor to know in advance of the sale what is significant to a person that they have no relationship with

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