Safia Barakzai

Treatment of equine cheek teeth by mechanical widening of diastemata in 60 horses (2000–2006)

REASON FOR PERFORMING STUDY Cheek teeth (CT) diastemata are a significant cause of painful dental disease in horses and limited factual information is available on the treatment of this disorder. OBJECTIVE To assess the response to mechanical widening in the treatment of diastema. METHOD Details of the presenting signs and treatment of cases of CT diastema by widening were recorded and the response to treatment of these cases assessed by re-examinations and by obtaining follow-up information from owners. RESULTS Sixty horses of various breeds, median age 9 years, with clinically significant CT diastemata were classified as having primary (inadequate rostro-caudal CT compression: n = 29) and secondary (to other dental abnormalities: n = 31) diastemata. Quidding was present in 82% of cases, weight loss in 35%, halitosis in 17% and bitting disorders in 12%; 85% of the identified CT diastemata involved mandibular CT and 15% maxillary CT, with caudal CT more commonly affected. Of 273 identified diastemata in the 60 horses, 207 were deemed to have significantly associated periodontal food pocketing and were widened to 4.5-5.5 mm diameter on their occlusal surface using a mechanical burr. The 29 horses with primary diastemata received a median of 1.3 treatments each and at 10 months following their last treatment 72% showed complete remission of signs and 28% showed good improvement. The 31 horses with secondary diastemata received a median of 2.2 treatments each and, at mean 9 months following their last treatment, 48% showed full improvement, 42% good improvement, 6% slight improvement and 3% no improvement. Inappropriate areas of the clinical crown were removed from 4 CT without causing pulpar exposure; one case was reported to have a transient oral infection post treatment and another developed an apical infection in a treated tooth that was unrelated to the diastema widening. CONCLUSION Diastema widening is an effective treatment of periodontal pocketing in CT diastemata. POTENTIAL RELEVANCE The described treatment of CT diastema widening by trained personnel is an effective and safe treatment, but repeated treatments are often necessary, especially with secondary diastemata.

Equine paranasal sinus disease: A long-term study of 200 cases (1997–2009): Treatments and long-term results of treatments

REASONS FOR PERFORMING STUDY There is limited objective information available on the treatment and the long-term response to treatment of the different types of equine sinus disease. OBJECTIVES To document the treatments and long-term response to these treatments in 200 cases of equine sinus disease (1997-2009). METHODS The treatments of horses affected with subacute primary sinusitis (n = 52); chronic primary sinusitis (n = 37); dental sinusitis (n = 40); sinus cyst (n = 26); traumatic (n = 13); dental-related oromaxillary fistula (n = 8); sinus neoplasia (n = 10); mycotic sinus disease (n = 7); and intrasinus progressive ethmoid haematoma (n = 7) and the long-term response to these treatments were retrospectively reviewed. RESULTS Treatments evolved throughout the study and latterly were as conservative as possible, including sinoscopic lavage and standing sinusotomy, with a maxillary sinusotomy approach preferred for the mainly mature horses treated in this study. Removal of intrasinus inspissated pus, including transendoscopically (by sinusotomy and via existing sinonasal fistulae), was the main treatment for chronic primary sinusitis and sinonasal fistulation was seldom performed latterly. Attempted oral extraction of infected cheek teeth, even if unsuccessful, facilitated subsequent dental repulsion, resulting in few post operative problems. Sinus cyst removal carried an excellent prognosis. Except for cases of sinus neoplasia (only 22% cured), an excellent long-term response to treatment (91% fully cured, 7% partially cured) was obtained for all other types of sinus disease following a median of one treatment. CONCLUSIONS More conservative treatments, including removal of intrasinus inspissated pus by sinoscopy, pre-existing sinonasal fistula or sinusotomy, are effective for chronic primary sinus disease. Standing sinusotomy, mainly using a small maxillary site, was suitable for most cases of sinus disease in mature horses.

Correlation of resting and exercising endoscopic findings for horses with dynamic laryngeal collapse and palatal dysfunction

REASONS FOR PERFORMING STUDY To correlate resting and exercising endoscopic grades of laryngeal function in horses undergoing high-speed treadmill endoscopy (HSTE) using the Havemeyer grading system. To correlate dorsal displacement of the soft palate (DDSP) seen at rest with palatal function during exercise. METHODS Records of horses that underwent HSTE examination (1999-2009) were reviewed. Resting laryngeal function score and other abnormalities noted on resting endoscopy were recorded as were results of HSTE. Results of resting and exercising endoscopic findings were correlated. RESULTS 281 horses underwent HSTE. There was significant correlation between grade of laryngeal function at rest (grades 1-4) and exercise (ρ=0.53, P<0.001) and between resting subgrades 3.1, 3.2 and 3.3 and exercising grades of laryngeal function (ρ=0.43, P=0.0017). DDSP was observed at rest significantly more often in horses that developed DDSP during HSTE than those without DDSP during HSTE (RR=4.1, P<0.001). The sensitivity and specificity of DDSP seen during resting endoscopy as a test for DDSP occurring during exercise were 25.5 and 95.1% respectively (positive predictive value 0.57, negative predictive value 0.83). CONCLUSIONS AND POTENTIAL RELEVANCE The results of the current study support the use of the Havemeyer system for grading laryngeal function in the resting horse, and corroborate findings of previous studies correlating resting and exercising palatal abnormalities. Studies that use the presence of spontaneous DDSP during resting endoscopic examination as an inclusion criterion for investigating efficacy of treatments for DDSP are likely to have a low proportion of horses with false positive diagnoses.

Assessment of the efficacy of composite surgery for the treatment of dorsal displacement of the soft palate in a group of 53 racing Thoroughbreds (1990–1996)

REASONS FOR PERFORMING STUDY There has been no objectively assessed case-control study of the efficacy of surgery to correct dorsal displacement of the soft palate (DDSP) previously reported. HYPOTHESIS Composite surgery has a beneficial result on racing performance in horses affected with DDSP as compared to a matched control population. METHODS Race records were obtained for 53 racing Thoroughbreds which underwent composite staphylectomy, sternothyrohyoideus myectomy and ventriculectomy for correction of idiopathic DDSP at the University of Bristol between 1990 and 1996. Each surgical case was matched for age, sex and training yard with 2 control horses. The racing performance, based on prize money won, of surgical cases and control horses were compared for 3 races run before and after the date of surgery. RESULTS Ninety-two percent of the surgical cases returned to racing after surgery. There was a significant increase in earnings of the surgical group before and after surgery (P = 0.011), but there was no significant difference in earnings of the control group before and after the date of surgery (P = 0335). Sixty percent of the surgical group had higher earnings after surgery than before, compared to 40% of controls. When horses which underwent surgery were ranked relative to their 2 matched controls, surgical cases did not significantly change in rank (P = 033), whereas control horses significantly decreased in rank (P = 0.012). Additionally, horses within the surgical group were more likely (P < 0.01) to start in 3 post operative races than those in the control group. CONCLUSIONS AND POTENTIAL RELEVANCE Composite surgery had a beneficial effect on racing performance of horses afflicted with idiopathic DDSP, and further studies to evaluate objectively the usefulness of other surgical techniques are warranted.

Equine idiopathic cheek teeth fractures: part 3: a hospital-based survey of 68 referred horses (1999-2005)

REASONS FOR PERFORMING STUDY There is limited information available on the more serious sequellae of idiopathic cheek teeth (CT) fractures. OBJECTIVES To obtain information on clinical and ancillary diagnostic findings in referred horses with idiopathic CT fractures. METHODS Details of all horses suffering from idiopathic CT fractures referred to the Equine Hospital at the University of Edinburgh 1999-2005 were examined, and information concerning fracture patterns, clinical and ancillary diagnostic findings, treatments and long-term response to treatments were obtained and analysed. RESULTS A total of 60 maxillary and 17 mandibular idiopathic CT fractures were diagnosed in 68 horses. Fracture patterns included maxillary CT lateral slab fractures (45%), maxillary CT midline sagittal fractures (16%) and various other patterns of maxillary CT fractures (17%). In the mandibular CT, lateral slab fractures were found (12%) and various other CT fracture patterns were present in 10%. The more centrally positioned CT (maxillary and mandibular Triadan 08s and 09) were preferentially fractured. Clinical signs included quidding in 47% of cases; bitting and behavioural problems (28%); signs of apical infection, including bony swellings and nasal discharge (21%); anorexia/weight loss (15%); halitosis (13%); and buccal food impaction (12%). The treatment of all cases was conservative whenever possible and included corrective rasping of the remaining tooth (46% of cases); oral extraction of the smaller and loose dental fragment (32%) and extraction of the entire fractured tooth by oral extraction (28%) or by repulsion (13%). Prophylactic treatment of adjacent, nonfractured CT with carious infundibula was possibly of value in preventing further midline sagittal maxillary CT fractures. CONCLUSIONS Horses referred with idiopathic CT fractures frequently have clinical signs of apical infection of the fractured CT and these teeth require extraction, orally if possible. More conservative treatment of idiopathic CT fractures without signs of gross apical infection can resolve clinical signs in most cases. POTENTIAL RELEVANCE In the absence of apical infection, extraction of only the loose dental fragments of CT with idiopathic fractures is usually successful.

Postoperative Race Performance is Not Correlated with Degree of Surgical Abduction After Laryngoplasty in National Hunt Thoroughbred Racehorses

OBJECTIVES To (1) assess the degree of arytenoid cartilage abduction lost after laryngoplasty (LP) in Thoroughbred National Hunt racehorses and (2) to correlate postoperative racing performance with degree of arytenoid abduction after LP. STUDY DESIGN Case series. ANIMALS National Hunt Thoroughbred racehorses (n=68). METHODS Grade of postoperative arytenoid abduction for National Hunt racehorses that had LP with ventriculocordectomy was assessed at 1 day, 6 days, and 6 weeks after LP. Race records were analyzed to ascertain if there was correlation between the degree of arytenoid cartilage abduction and various measures of race performance (return to racing postoperatively, total earnings in 5 races immediately postoperatively, and lifetime number of starts postoperatively). RESULTS Median postoperative arytenoid abduction was grade 2 on day 1 but had decreased to grade 3 by 6 weeks. Horses with grades 1, 2, and 3 abduction 1 day after surgery had median losses of 1, 1, and 0.5 abduction grades, respectively, at 6 weeks. Horses with grade 1 abduction on day 1 were significantly more likely to lose abduction by day 6 after surgery than horses with grade 3 abduction on day 1. There was no statistically significant correlation between the postoperative grade of arytenoid abduction at any time point and earnings in 5 races after surgery, likelihood of racing postoperatively, or total number of lifetime race starts postoperatively. CONCLUSIONS Horses with maximal (grade 1) surgical arytenoid abduction are significantly more likely to suffer postoperative loss of abduction than those with grade 3 abduction. Postoperative grade of abduction does not appear significantly correlated with markers of racing performance in National Hunt racehorses; however, very few horses with poor (grade 4 or 5) abduction were included and thus conclusions regarding racing performance in such horses cannot be drawn from this study. CLINICAL RELEVANCE Seemingly, most horses with grade 3 laryngeal abduction can race successfully and perhaps surgeons should not be disillusioned by the appearance of only moderate (grade 3) abduction in the long term after LP in racehorses.

Sinoscopic Treatment of Rostral Maxillary and Ventral Conchal Sinusitis in 60 Horses

OBJECTIVE To evaluate the use of sinoscopy for detection and treatment of ventral conchal sinus (VCS) and/or rostral maxillary sinus (RMS) disease in horses. STUDY DESIGN Case series ANIMALS Horses (n=60) with suspected paranasal sinus disease. METHODS Horses were evaluated by sinoscopy through a conchofrontal sinus (CFS) portal with ventral conchal bulla (VCB) fenestration. Other endoscopic sinus approaches and adjunctive diagnostic tests; oral examination, computed tomography, radiography, scintigraphy and endoscopic examination of the upper portion of the respiratory tract were used in some horses. RESULTS The CFS approach permitted adequate observation of the RMS and VCS in 53 horses (88%). Hemorrhage caused by VCB fenestration prevented examination of the RMS and/or VCS in 12 horses (21%). Observation of lesions was possible in all horses diagnosed with neoplasia, sinus cysts, and progressive ethmoidal hematomas. Endoscopy of the paranasal sinuses was useful diagnostically in 82% of horses with primary sinusitis. Other diagnostic modalities were usually required to confirm a diagnosis of dental sinusitis. CONCLUSIONS Trephination into the CFS with VCB fenestration is a minimally invasive technique that provides consistent access to the RMS and VCS. It facilitates diagnosis of many sinus disorders and endoscopically guided treatment of many horses with sinus cysts and primary sinusitis, in combination with sinus lavage. CLINICAL RELEVANCE Many diseases affecting the RMS and VCS can be diagnosed and resolved endoscopically using a CFS approach with VCB fenestration, thus avoiding the need for osteoplastic sinus surgery and its associated risks and complications.

Treatment of oromaxillary fistulae in nine standing horses (2002-2006).

REASONS FOR PERFORMING STUDY There is minimal published information on equine oromaxillary fistulae that are unrelated to cheek teeth (CT) repulsion or on the conservative treatment of these atypical fistulae. OBJECTIVES To report equine oromaxillary fistulae unrelated to CT extraction and describe their management in standing horses. METHODS Case details of oromaxillary fistulae of atypical aetiology occurring at 2 referral centres between 2002-2006, including their treatment and response to treatment were examined. RESULTS Nine cases of oromaxillary fistula were recorded, mainly in aged horses (median 22 years). Fistulae were associated with CT diastemata in 7 cases, fractured CT in one and a central defect in a worn CT in another. After removing food and exudate from the sinuses, 6 cases were treated successfully by filling the diastema or dental defect with polymethylmethacrylate (PMMA). Following dental extraction, the other 3 cases were treated successfully by use of PMMA alveolar packing. CONCLUSION Older horses can spontaneously develop oromaxillary fistulae, usually secondary to CT diastemata. In the absence of apical infection, this disorder can usually be treated successfully in standing horses by treating the sinusitis and sealing the oral aspect of the diastema with PMMA. POTENTIAL RELEVANCE Older horses with sinusitis should be assessed for the presence of CT diastemata and oromaxillary fistulae. If detected, these disorders can be treated successfully in the standing horse.

Investigation of the sensitivity and specificity of radiological signs for diagnosis of periapical infection of equine cheek teeth

REASONS FOR PERFORMING STUDY Radiography is commonly used for the diagnosis of equine cheek teeth (CT) infection but, to our knowledge, no study to date has evaluated the relative values of individual specific radiographic signs when making a diagnosis. OBJECTIVES To investigate the sensitivity and specificity of individual radiographic signs identified from the literature for the diagnosis of CT apical infection using a retrospective case-control study. METHODS Cropped radiographs taken using computed radiography of 41 apically infected CT and 41 control CT were independently blindly evaluated by 3 clinicians for the presence of 12 predetermined radiographic signs associated with CT apical infection. A final diagnosis of either noninfected or infected was made. Sensitivity and specificity were calculated for the presence or absence of each radiographic sign for each clinician. Uni- and multivariable conditional logistic regression were used to determine strength of association of the 12 radiographic signs with apical infection. RESULTS Median sensitivity and specificity for the diagnosis of CT apical infection were 76 and 90%, respectively. Periapical sclerosis, clubbing of one or 2 roots, degree of clubbing and periapical halo formation had the highest sensitivities (73-90%), with moderate specificity (61-63%). Multivariable conditional logistic regression revealed that severity of periapical sclerosis and extensive periapical halo were strongly associated with CT apical infection. CONCLUSIONS The presence of periapical sclerosis and formation of a periapical halo were strongly associated with CT apical infection. Computed radiography appears to have a higher sensitivity but similar specificity to previously published results using film radiography to detect CT apical infection. POTENTIAL RELEVANCE These findings may aid practitioners when interpreting radiographs of equine CT as to the relative significance of their findings.

Evaluation of the long-term oral consequences of equine exodontia in 50 horses.

The aims of this study were to objectively evaluate and quantify the process of post-extraction cheek teeth (CT) dental drift in horses, and to report on associated disorders of CT wear and long-term periodontal health. Fifty horses that had CT oral extraction because of apical infection were prospectively re-examined and a full oral examination, including measurements of some dental parameters, was performed. Narrowing of the extraction space was noted in all cases with complete closure occurring in 18% of horses. The rate of dental drift was calculated as 15.7% of extraction space/year (range 4-50%) and was not associated with the age at extraction (P=0.78) or frequency of dental care since extraction (P=0.48). There was a significant negative relationship between the rate of dental drift and the duration of time since extraction (P=0.008). Overgrowths were present on the opposite CT row in 98% of horses, including opposite the extracted CT and on the Triadan 06s and 11s. No significant difference was noted in either the number of diastemata (P=0.9) or periodontal disease score (P=0.8) between the extraction and the contralateral cheek tooth rows.