Radnor Hunt Star Ballet Boy Receives Endoscopy at New Bolton Center
“If you don’t look for it, you won’t find it.” Dr. Eric Parente remembers well this advice from his time as a veterinary student. And it is counsel that has served him well in his career as a surgeon with a particular interest in the upper airways of the horse.
Looking for the unexpected is also something for which Ballet Boy, a well-muscled, deep bay gelding, might thank Dr. Parente.
Bred in Ireland as a steeplechase racer, the horse developed a persistent cough and his performance began to 
decline. Though Ballet Boy had been through the appropriate testing for such a condition, nothing had been revealed, and the cause of his chronic respiratory issues was a mystery yet to be solved when he first came to the Widener Hospital for Large Animals at New Bolton Center in the spring of 2010. He was seven years old.
Performing an endoscopy of the upper airways, in which a tiny video camera is gently introduced into the horse’s throat, a clear picture of the interior tissues projects onto a video monitor and Dr. Parente is able to confirm what earlier examinations have concluded -- there was nothing was out of the ordinary. But an endoscopy typically looks at the upper portion of the epiglottis and Dr. Parente had a suspicion that there was something going on out of sight, under the epiglottis.
“It’s not a part of the anatomy that we usually look at,” said Dr. Parente, a Penn Vet faculty member and board-certified surgeon with a strong interest in issues of the upper airway. In order to examine the elusive tissue, the nerves of the throat had to be anesthetized. Once sedated, a surgical instrument was placed into the throat to elevate the epiglottis so the surface underneath could be seen.
And there it was: Ballet Boy was suffering from severe ulceration under the epiglottis that had become infected.
Surgery was performed the following day with Ballet Boy under general anesthesia. Using an endoscope to precisely guide him, Dr. Parente removed the abnormal tissue with a laser. In a pre-emptive attempt to prevent future displacement of the soft palate, he also performed a standard tie-forward procedure, improving the position of the epiglottis over the palate.
The procedure required a long period of healing. Because endoscopic examination of the area under the epiglottis is something that cannot be accomplished in the field, Ballet Boy returned to New Bolton Center three times between July and November for rechecks. For every recheck, blocking the nerves of the throat was required.
While the resection was anything but a standard procedure, Dr. Parente insists on sharing the credit for its success with the horse’s trainer, Tom Voss. Without his patience throughout the recovery process, Dr. Parente is sure the outcome would not have been as positive.
“He was great about giving the horse the time he needed, and making sure he was right before the horse went back to work. It was a smart decision,” said Dr. Parente.
The time, more than 10 months in all, paid off. On May 19th, his first time back on the turf since his surgery, Ballet Boy was the star of the Radnor Hunt Races, finishing first in the $50,000 National Hunt Cup. He completed the 2-3/8 mile race, over hurdles, in little over four-and-a-half minutes.
Now Dr. Parente finds himself examining beneath the epiglottis more and more frequently. Older horses in particular, he has observed, tend to develop sub-epiglottic lesions that may lead to persistent, undiagnosed cough. Ballet Boy is a perfect example: if you don’t look for it, you won’t find it.