A Modified Viborg's Triangle Approach for Surgical Drainage of Guttural Pouches Empyema Through Placement of a Fenestrated Tube in a Mare

A 7-year-old mare was brought to the clinic with a history of falling 1 month earlier and bilateral mucosanguinous nasal discharge, respiratory distress, and bilateral swelling caudal to the posterior margin of vertical rami of mandibles for 3 weeks. Lateral radiography of the neck region revealed gas-filled soft tissue density caudal to the mandibles. Empyema of the guttural pouches was diagnosed and surgical drainage was planned by placement of a fenestrated tube. A skin incision was made at the dependent part of the swelling in Viborg's triangle on both sides; guttural pouches were exposed and mucosanguinous contents drained by lancing the pouches. Fenestrated tubes, prepared from the tubing of a urine collection bag, were fixed into the guttural pouches by anchoring to the wall of the pouches and skin. Postoperatively, 5 g of streptomycin plus 4 million IU of penicillin and 75 mg of meloxicam were administered intramuscularly for 7 days and 5 days, respectively. Guttural pouches were lavaged daily with 0.1% potassium permanganate solution (KMnO4) and 5% topical povidone iodine diluted with normal saline solution to 1%. Tubes from both sides were removed on the 14th postoperative day, and wounds healed by second intention. The animal recovered uneventfully.