Justin D. Perkins

Two- and three-dimensional computed tomographic anatomy of the enamel, infundibulae and pulp of 126 equine cheek teeth. Part 1: Findings in teeth without macroscopic occlusal or computed tomographic lesions.

REASONS FOR PERFORMING STUDY Dental disorders are of major clinical importance in equine practice; however, the knowledge of normal dental anatomy, especially that of the pulp remains incomplete. Computed tomography (CT) is being used increasingly in the diagnosis of dental disease, although the normal 2- (2D) and 3-dimensional (3D) CT anatomy has not yet been fully described. OBJECTIVE To describe the 2D and 3D CT appearance of the enamel, infundibulae and pulp of normal equine cheek teeth. METHODS One-hundred-and-twenty-six cadaveric cheek teeth with eruption ages of 0.5-19 years were evaluated; CT scans of each tooth were performed after occlusal surface examination with a dental probe. Three-dimensional reconstructions of the enamel, infundibulae and pulp were created from the CT scans using greyscale thresholding and subsequent polynomial meshing. Each tooth was sectioned coronally or axially into serial slices using a band saw and the sections compared to the corresponding CT images. RESULTS The CT reconstructions enabled the systematic description of the pulpar anatomy of the mandibular and maxillary cheek teeth in 3D, which has not been described in detail previously. The number of interpulpar communications between pulp horns and the pulpar volume of each tooth was shown to decrease with increasing age. The interpulpar communications of the maxillary cheek teeth were found to be of greater complexity and variety in comparison to their mandibular counterparts. Mandibular and maxillary cheek teeth showed different, but consistent patterns in their pulpar and enamel morphology. CONCLUSIONS AND POTENTIAL RELEVANCE The detailed description of the normal 2D and 3D CT appearance of equine cheek teeth provides a reference basis for the diagnosis of dental disease with CT. Additionally, in depth knowledge of the pulpar anatomy of the equine cheek teeth is an essential prerequisite if endodontic therapy is to develop further in the future.

Effect of left-sided valvular regurgitation on mortality and causes of death among a population of middle-aged and older horses.

The effect of left-sided valvular regurgitation (LSVR) on the mortality of middle-aged and older horses was investigated in a prospective cohort study involving 19 yards and 1153 horses. The horses were examined to determine whether they had a cardiac murmur and its type, and their age, sex, breed type and occupation were recorded. They were followed up at intervals of two years by postal questionnaire, and after four years information on 773 horses was available. There was no significant difference in the mortality of the horses with and without LSVR, but small horses had a significantly higher risk of having LSVR than small ponies (odds ratio [OR] 2·33), and older horses were slightly more likely to have LSVR than young horses (OR 1·07). Twenty-nine per cent of the deaths reported by the owners were due to orthopaedic problems, 23·3 per cent to gastrointestinal problems, and only 7·9 per cent to cardiovascular problems. Orthopaedic problems were the main cause of death in the horses, and gastrointestinal problems were the main cause of death in the ponies.

Caudal anaesthesia of the infraorbital nerve for diagnosis of idiopathic headshaking and caudal compression of the infraorbital nerve for its treatment, in 58 horses

REASONS FOR PERFORMING STUDY Idiopathic headshaking is often a facial pain syndrome, but a diagnostic protocol has not been described. In a previous study, caudal compression of the infraorbital nerve for treatment offered a fair success rate, but low case numbers and short follow-up time were limitations. OBJECTIVES To describe a diagnostic protocol for headshaking, examining the role of bilateral local analgesia of the posterior ethmoidal nerve (PET block). To report longer-term follow-up after surgery of the original cases and further cases and to determine whether changes to the technique influence success rates and complications. METHODS Records of horses that had undergone PET block and caudal compression surgery at 3 hospitals were reviewed. Modifications to the surgical technique included placing additional coils into the infraorbital canal and/or performing concurrent laser cautery of the nerve. Follow-up information was obtained by telephone contact with owners. RESULTS The PET block was performed in 27 horses, with a positive result in 23 of 27 (85%). Surgery was performed in 58 horses. A successful outcome was initially achieved in 35 of 57 (63%) horses, but recurrence occurred between 9 and 30 months later in 9 (26%). Surgery was repeated in 10 of 31 (32%) horses. Final success rate, considering only response to the last performed surgery, was 28 of 57 (49%) horses with median follow-up time of 18 months (range 2-66 months). Nose-rubbing was reported post operatively in 30 of 48 (63%) horses. This resolved in all but 4 horses, which were subjected to euthanasia. Response to PET block or change in surgical technique did not appear to influence outcome or complications. CONCLUSIONS AND POTENTIAL RELEVANCE The diagnostic protocol described is recommended for the investigation of headshakers. Caudal compression offers the best prognosis for a successful outcome compared with other treatments, for horses in which the only alternative is euthanasia. Surgical treatment of the disorder requires refinement, and the pathogenesis of the disorder requires investigation.

Histopathology and computed tomography of age‐associated degeneration of the equine temporohyoid joint

REASONS FOR PERFORMING STUDY The aetiology of temporohyoid osteoarthropathy (THO) is unknown; both primary infectious and degenerative causes have been suggested. HYPOTHESIS There is a significant association between increasing age and severity of temporohyoid joint degeneration. To examine the histopathology of the temporohyoid articulation in aged horses and to compare the appearance of the joint with computed tomography (CT) and peripheral quantitative CT (pQCT). METHODS pQCT scans of the temporohyoid articulations were obtained bilaterally from 31 horses (range age 1-44 years) post mortem and images were graded by 2 blinded observers on 2 occasions for the presence of osteophytes, irregularity of the joint surface and mineralisation. Eight heads had been examined previously by CT, with the images similarly graded for the shape and density of the proximal stylohyoid bones, bone proliferation surrounding the joint, mineralisation of the tympanohyoid cartilage and the relationship of the petrous temporal bone to the stylohyoid bone. Sixteen temporohyoid joints were then evaluated histologically. RESULTS There was significant association between the mean pQCT degeneration score and age (rho = 0.75; P<0.0001), between the pQCT and CT score (rho = 0.63; P = 0.01) and between the degenerative changes identified within each temporohyoid joint within each horse (rho = 0.81; P<0.0001). Age-associated changes included the development of a club shape by the proximal stylohyoid bone, rounding of the synostosis with the petrous temporal bone and extension of osteophytes from the petrous temporal bone to envelope the stylohyoid head and bridge the joint. In no horse was there any evidence of osteomyelitis within the petrous temporal bone, stylohyoid bone or tympanohyoid cartilage. CONCLUSIONS This study provides evidence that age is associated with increasing severity of degenerative changes in the equine temporohyoid joint and that similar changes are commonly found bilaterally. POTENTIAL RELEVANCE The changes identified appear similar, albeit milder to the changes reported in horses with THO, suggesting that degenerative, rather than infectious causes may underlie the aetiology of THO. Future work should be directed at examining the histopathology of clinical THO cases.

Demonstration of regional differences in equine ventricular myocardial velocity in normal 2-year-old thoroughbreds with Doppler tissue imaging

REASONS FOR PERFORMING STUDY Doppler tissue imaging (DTI) is a novel noninvasive method by which myocardial velocity can be assessed directly and it allows regional, rather than global, cardiac function to be evaluated. HYPOTHESIS That regional differences in myocardial velocities exist within the equine ventricle. OBJECTIVES To develop a repeatable examination technique for DTI in horses, describe DTI findings in various regions of the normal equine ventricle, compare colour (CDTI) and spectral (SDTI) techniques of DTI, and document regional differences in myocardial velocity. METHODS Five regions of the ventricles (right ventricular wall, interventricular septum and left, right and caudal regions of the left ventricle) were evaluated using SDTI and CDTI in 20 clinically normal Thoroughbreds age 2 years. Individual repeatability of the method was determined by examination of one 6-year-old Thoroughbred on 6 occasions. RESULTS Three major movements were observed in the ventricular walls in systole, early diastole and late diastole. The interventricular septum had a complex pattern of movement. The left region of the left ventricle and interventricular septum had the most rapid movement. The individual repeatability of CDTI was poor, while in systole and early diastole, but not late diastole, SDTI produced repeatable estimates of maximal myocardial velocity. The different velocity estimates obtained with SDTI and CDTI are not interchangeable. Regional differences in the peak mean and maximal myocardial velocities were found in systole and early diastole (P<0.05), but were not identified in late diastole. CONCLUSIONS The SDTI modality appears to produce the most repeatable data. There are regional differences in myocardial velocity within the equine ventricles for systole and early diastole. POTENTIAL RELEVANCE DTI shows potential as a tool for studying regional myocardial movement both in clinical cases suspected of having myocardial dysfunction and in a research setting. In particular, SDTI offers potential as a direct and noninvasive means to study early diastolic function of the equine ventricles.

Rater Agreement on Gait Assessment during Neurologic Examination of Horses

Background Reproducible and accurate recognition of presence and severity of ataxia in horses with neurologic disease is important when establishing a diagnosis, assessing response to treatment, and making recommendations that might influence rider safety or a decision for euthanasia. Objectives To determine the reproducibility and validity of the gait assessment component in the neurologic examination of horses. Animals Twenty‐five horses referred to the Royal Veterinary College Equine Referral Hospital for neurological assessment (n = 15), purchased (without a history of gait abnormalities) for an unrelated study (n = 5), or donated because of perceived ataxia (n = 5). Methods Utilizing a prospective study design; a group of board‐certified medicine (n = 2) and surgery (n = 2) clinicians and residents (n = 2) assessed components of the equine neurologic examination (live and video recorded) and assigned individual and overall neurologic gait deficit grades (0–4). Inter‐rater agreement and assessment‐reassessment reliability were quantified using intraclass correlation coefficients (ICC). Results The ICCs of the selected components of the neurologic examination ranged from 0 to 0.69. “Backing up” and “recognition of mistakes over obstacle” were the only components with an ICC > 0.6. Assessment‐reassessment agreement was poor to fair. The agreement on gait grading was good overall (ICC = 0.74), but poor for grades ≤ 1 (ICC = 0.08) and fair for ataxia grades ≥ 2 (ICC = 0.43). Clinicians with prior knowledge of a possible gait abnormality were more likely to assign a grade higher than the median grade. Conclusion and Clinical Importance Clinicians should be aware of poor agreement even between skilled observers of equine gait abnormalities, especially when the clinical signs are subtle.

Investigation of the incidence and type of injuries associated with high-speed treadmill exercise testing

REASONS FOR PERFORMING STUDY During the past 20 years, treadmill exercise testing has played an important role in both the study of equine exercise physiology and the investigation of poor athletic performance. However, it has been suggested that some trainers and veterinarians may be reluctant to refer horses for treadmill exercise testing because of fears that horses may be at increased risk of musculoskeletal injury during treadmill exercise. OBJECTIVE To investigate the incidence and types of injuries sustained by horses undergoing treadmill exercise. METHODS Data were collated from 9 centres in the UK, France and Belgium, and the prevalence and types of injury were established. RESULTS A total of 2305 records were reviewed, with 2258 horses performing treadmill exercise. There was an overall injury rate of 5.4%. However, the majority of injuries sustained were minor in nature (4.7%). Only 13 horses (0.6%) sustained major injuries in association with treadmill exercise. These included 5 cases of severe exercise-induced myopathy, 4 fractures (of which 1 was catastrophic), 2 tendon injuries, 1 case with undiagnosed severe lameness and 1 with marked exacerbation of a previously diagnosed lameness. Two other major incidents were reported but were not directly associated with treadmill exercise (one had iliac thrombosis and one collapsed and died as a result of a pulmonary embolism). CONCLUSIONS This study confirms that the majority of horses undergo treadmill exercise without incident. The majority of injuries that did occur were minor in nature and the incidence of major injuries was similar to that reported during competition elsewhere. POTENTIAL RELEVANCE Treadmill exercise is a safe procedure and does not appear to pose an increased risk of injury in comparison with overground exercise.

In Vitro Effect of Ventriculocordectomy Before Laryngoplasty on Abduction of the Equine Arytenoid Cartilage

OBJECTIVE To determine whether ventriculocordectomy (VCE) performed before prosthetic laryngoplasty (PL) results in increased rima glottidis size compared with PL alone. STUDY DESIGN Experimental study. ANIMALS Equine cadaver larynges (n=13). METHODS Right arytenoid cartilages were maximally abducted using a standard PL technique. Standard PLs were then performed on the left side and the force required to maximally abduct the left arytenoid cartilage recorded (F(max) ). Photographs were taken of the rima glottidis at zero force and at five equal levels of force up to F(max) . The force applied was released, left VCE performed, and photographs repeated. Arytenoid left:right angle quotients (LRQ) and glottic cross-sectional area ratios (CSAR) were calculated at each force level in each condition (PL and VCE-PL). RESULTS Mean LRQ and CSAR for both PL and VCE-PL increased with increasing force, initially rapidly before plateauing at ~50% of F(max) . LRQ and CSAR were significantly greater for VCE-PL than for PL (P<.001). When VCE was performed before PL, 12% less force was required to achieve an LRQ of 0.8, and 45% less for a CSAR of 0.8. CONCLUSIONS In vitro, VCE performed before PL enables the arytenoid cartilage to be abducted to a greater degree for a given PL suture force.Objective: To determine whether ventriculocordectomy (VCE) performed before prosthetic laryngoplasty (PL) results in increased rima glottidis size compared with PL alone. Study Design: Experimental study. Animals: Equine cadaver larynges (n=13). Methods: Right arytenoid cartilages were maximally abducted using a standard PL technique. Standard PLs were then performed on the left side and the force required to maximally abduct the left arytenoid cartilage recorded (Fmax). Photographs were taken of the rima glottidis at zero force and at five equal levels of force up to Fmax. The force applied was released, left VCE performed, and photographs repeated. Arytenoid left:right angle quotients (LRQ) and glottic cross-sectional area ratios (CSAR) were calculated at each force level in each condition (PL and VCE-PL). Results: Mean LRQ and CSAR for both PL and VCE-PL increased with increasing force, initially rapidly before plateauing at ∼50% of Fmax. LRQ and CSAR were significantly greater for VCE-PL than for PL (P<.001). When VCE was performed before PL, 12% less force was required to achieve an LRQ of 0.8, and 45% less for a CSAR of 0.8. Conclusions: In vitro, VCE performed before PL enables the arytenoid cartilage to be abducted to a greater degree for a given PL suture force.

Multiple immunofluorescence labelling enables simultaneous identification of all mature fibre types in a single equine skeletal muscle cryosection

Skeletal muscle is composed of a heterogeneous mixture of several fibre types, each with specific physiological properties. In equine muscle, identification of these individual fibres (fibre typing) is important for both exercise physiology and pathological studies. Traditionally, fibre typing has been achieved by adenosine triphosphatase (ATPase) histochemistry or by immunoperoxidase labelling with antibodies directed at myosin heavy chain isoforms. ATPase histochemistry can be temperamental and lacks specificity, and both techniques require staining of serial cryosections to reveal the entire fibre type compliment of a single sample, which is time consuming and prone to inaccuracy. Here we describe an immunofluorescence labelling technique that enables rapid, accurate and specific identification of the 3 mature equine muscle fibre types in a single cryosection.

Effects of Functional Electrical Stimulation on Denervated Laryngeal Muscle in a Large Animal Model.

Bilateral vocal fold paralysis (BVCP) is a life-threatening condition that follows injury to the Recurrent Laryngeal nerve (RLn) and denervation of the intrinsic laryngeal musculature. Functional electrical stimulation (FES) enables restoration and control of a wide variety of motor functions impaired by lower motor neuron lesions. Here we evaluate the effects of FES on the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle in a large animal model of RLn injury. Ten horses were instrumented with two quadripolar intramuscular electrodes in the left PCA muscle. Following a 12-week denervation period, the PCA was stimulated using a once-daily training session for 8 weeks in seven animals. Three animals were used as unstimulated controls. Denervation produced a significant increase in rheobase (P < 0.001). Electrical stimulation produced a 30% increase in fiber diameter in comparison with the unstimulated control group (33.9 ± 2.6 µm FES+, 23.6 ± 4.2 µm FES-, P = 0.04). A trend toward a decrease in the proportion of type 1 (slow) fibers and an increase in type 2a (fast) fibers was also observed. Despite these changes, improvement in PCA function at rest was not observed. These data suggest that electrical stimulation using a relatively conservative set of stimulation parameters can reverse the muscle fiber atrophy produced by complete denervation while avoiding a shift to a slow (type 1) fiber type.