Tie-Forward Surgery Successfully Treats Dorsal Displacement of the Soft Palate

The tie-forward surgical procedure for treating intermittent dorsal displacement of the soft palate (iDDSP) was deemed successful by veterinary surgeons, reportedly resolving the condition in 75% of treated horses.^*

The condition occurs when the soft palate deviates to an abnormal position above the level of the epiglottis, which impedes the flow of air through the upper airways to the trachea and lungs. Not surprisingly, this is a performance-limiting condition, frequently presenting in athletic horses as upper respiratory sounds during exercise often described as gurgling, fluttering, or vibrating.

“Veterinarians diagnose iDDSP using overground endoscopy. This involves fitting an endoscopic camera into the horse’s upper airway and fixing it in place on the halter. This camera captures video of the airways, including the soft palate, while the horse is performing its usual type and level of work,” described Catherine Whitehouse, M.S., a Kentucky Equine Research nutrition advisor.

One treatment for iDDSP is a surgery called a “tie-forward” procedure in which two permanent sutures (referred to as prostheses) are placed in the laryngeal region to replicate the function of the thyrohyoid muscles. The goal of this procedure is to prevent specific movements of the larynx and stop the soft palate from displacing dorsally and obstructing airflow.

“Previous studies report wide-ranging success rates from 12% to 80% based on a comparison of pre- and postoperative racing performance rather than using follow-up examinations via overground endoscopy,” Whitehouse explained.

To gather follow-up information, veterinary surgeons from Rossdales Equine Hospital in England provided re-examination with overground endoscopy to patients diagnosed with iDDSP using the same test and treated with a tie-forward. Follow-up overground endoscopic examinations were conducted approximately 138 days following surgery.

“Fifty-six horses were diagnosed with iDDSP and underwent a tie-forward. Of those, 75% had no evidence of iDDSP postsurgically, prompting the surgeons to consider the tie-forward a successful procedure,” Whitehouse said.

But 48% of the trainers reported continued upper respiratory tract noise and expressed concern regarding continued poor performance. In 44% of those cases, continuing iDDSP was diagnosed.

“Reports of suspected ongoing upper airway impairment postoperatively by the trainer or owner should alert the clinician to the possibility of ongoing palatal dysfunction and the need for repeat overground endoscopy,” wrote the surgeons.

Other airway abnormalities can occur in concert with iDDSP that may contribute to persistent noise and poor performance, including palatal instability, nasopharyngeal collapse, epiglottic retroversion, and medial deviation of the aryepiglottic folds.

“The co-occurrence of various upper respiratory tract abnormalities further supports the ‘one airway’ concept and a previous study that suggested lower airway issues such as inflammatory airway disease may contribute to iDDSP,” stated Whitehouse.

Inflammatory airway disease reportedly occurs in performance horses that appear clinically normal but may negatively affect performance.

“Experts recommend supplementing horses with omega-3 fatty acids, particularly DHA, for horses with inflammatory airway disease, due to its anti-inflammatory effects,” Whitehouse said.

 She added, “Fish oil is a rich source of EPA and DHA and these long-chain omega-3 fatty acids help mitigate inflammation. Supplementing horses with a high-quality fish oil in combination with a low-dust environment helps support respiratory health.”

^*Barnett, T.P., V.A. Colgate, N. Robinson, L.C.R. Smith, L. Palmer, and S.Z. Barakzai. 2025. Overground endoscopic examination following laryngeal tie-forward in horses with dorsal displacement of the soft palate. Veterinary Surgery:14245.