Guttural Pouch Mycosis: A Three-Step Therapeutic Approach

Simple Summary Clinical signs of guttural pouch mycosis in equids tend to be nonspecific but can include epistaxis, cranial nerve disorders, uni- or bilateral mucoid nasal discharge or a combination of these symptoms. On the basis of these warning symptoms, the equine practitioner will confirm the diagnosis through an endoscopy and must be prepared, sometimes in an emergency, to propose the most appropriate therapeutic approach, depending on the clinical situation. A three-step therapeutic approach to this condition is described, including temporary common carotid artery ligature at the barn, the trans-arterial coil embolization procedure in a specialized equine surgery center to stop or prevent epistaxis, and topical oxygen therapy to improve local defences in the respiratory mucosa of the guttural pouches while reducing the development of the mycotic organism.Abstract The temporary ligation of the common carotid artery is performed as an emergency aid in cases of guttural pouch mycosis. Its usefulness is put into perspective after an anatomical summary of arterial vascularization involving a guttural pouch. It helps to better understand the need for the cranial (cerebral) and caudal (cardiac) occlusion of an arterial rupture by embolization in order to achieve maximum success in preventing and treating an hemorrhage. Topical oxygen therapy used alone or in a multimodal approach with embolization surgery is performed to promote healing of the inflammatory and mycotic lesions observed when an individual is affected. In conclusion, this three-step therapeutic approach should enable the equine practitioner to better orient their decision tree when faced with this condition which, while rare, can be potentially fatal if poorly treated.