Tiziana Liuti

Critical evaluation of ex vivo restoration of carious equine maxillary cheek teeth infundibulae following high-pressure gas and micro-particle abrasion

Infundibular caries of the equine maxillary cheek teeth is an important disorder that can lead to dental fracture or apical infection. Treatment by removing food debris and carious dental tissue from affected infundibulae using high-pressure abrasion with aluminium hydroxide micro-particles, followed by filling the cleaned defect with endodontic restorative materials is a recommended treatment. However, although anecdotally considered a successful treatment option, there is currently no objective evidence to support this claim. Forty maxillary cheek teeth (CT) that contained 55 infundibulae with caries (mainly grade 2) were extracted post-mortem from 21 adult horses. Five of the CT were sectioned prior to treatment to facilitate visual examination of the carious infundibulae. The remaining carious infundibulae were cleaned using high-pressure abrasion with aluminium hydroxide particles and five CT were sectioned to assess the efficacy of this cleaning process. The remaining 30 CT containing 39 carious infundibulae were then filled with a composite restorative material. The efficacy of this restoration was assessed by computed tomography imaging followed by direct visual examination after sectioning the teeth. Only 46% (18/39) of restored infundibulae, all with shallow (mean 9.6u2009mm deep) defects, were fully cleaned of food debris and carious material, and filled with restorative material to their full depth. Of these 18, 11 had peripheral defects around the restoration, leaving just 18% (7/39) of restorations without any gross defects. The remaining 54% (21/39) of infundibulae (mean depth of infundibular caries defect, 18.3u2009mm) still contained food debris and/or carious material in more apical locations, with infundibulae with the deepest caries defects being the least effectively cleaned. The findings of this study indicate that high-pressure micro-particle abrasion is only effective in cleaning food debris from shallow, carious CT infundibulae and consequently, the majority of subsequent infundibular restorations are imperfect.

An anatomical study of the dorsal and ventral nasal conchal bullae in normal horses: Computed tomographic anatomical and morphometric findings.

REASONS FOR PERFORMING STUDYnInfection of the dorsal nasal conchal bulla and ventral nasal conchal bulla has recently been shown to cause clinical disease in horses, but the anatomy of these 2 structures is poorly documented.nnnOBJECTIVESnTo describe the anatomical features, dimensions and relationships to adjacent structures of the dorsal conchal bulla and ventra conchal bulla in normal horses using computed tomography (CT).nnnSTUDY DESIGNnDescriptive imaging study using cadavers.nnnMETHODSnComputed tomographic images acquired from 60 equine cadaver heads that were shown to be free of sinonasal disease were categorised into 3 age groups (0-5; 6-15; >16 years old). Linear and volumetric measurements and descriptive anatomical assessments of the dorsal conchal bulla and ventral conchal bulla were produced from these CT images and the anatomical relationships between the dorsal conchal bulla and ventral conchal bulla and the adjacent structures, particularly the maxillary cheek teeth, were examined. The associations between bullae dimensions with horse ages and skull dimensions were assessed using linear regression.nnnRESULTSnMean (range) dorsal conchal bulla measurements were: length 7.5 cm (4.6-14), width 1.9 cm (1.3-2.5), height 2.8 cm (1.8-4), volume 24 cm3 (5.9-50.5). Mean ventral conchal bulla measurements were: length 5.7 cm (2.5-8.5), width 1.6 cm (0.7-2.9), height 2.4 cm (0.8-3.7), volume 15 cm3 (0.4-30). In both dorsal conchal bulla and ventral conchal bulla, there were significant differences in sizes between the different age groups (smaller in younger animals). In the ventral conchal bulla, this was probably related to protrusion of the large dental alveoli of younger horses into the lateral nasal cavity. Measures of bullae size and volume were significantly associated with head size. The anatomical positions (rostro-caudal boundaries) of the dorsal conchal bulla and ventral conchal bulla were closely associated with specific maxillary cheek teeth.nnnCONCLUSIONSnComputed tomography was a useful technique to establish the linear and volumetric dimensions of the nasal conchal bullae in normal horses. Both dorsal conchal bulla and ventral conchal bulla sizes increased with animal age. Relatively consistent anatomical relationships were shown between the rostral and caudal limits of the bullae and certain maxillary cheek teeth, which would be of diagnostic value with conventional radiography and act as landmarks in the surgical treatment of nasal bulla disease.

Canine Brachycephaly Is Associated with a Retrotransposon-Mediated Missplicing of SMOC2

Summary In morphological terms, “form” is used to describe an object’s shape and size. In dogs, facial form is stunningly diverse. Facial retrusion, the proximodistal shortening of the snout and widening of the hard palate is common to brachycephalic dogs and is a welfare concern, as the incidence of respiratory distress and ocular trauma observed in this class of dogs is highly correlated with their skull form. Progress to identify the molecular underpinnings of facial retrusion is limited to association of a missense mutation in BMP3 among small brachycephalic dogs. Here, we used morphometrics of skull isosurfaces derived from 374 pedigree and mixed-breed dogs to dissect the genetics of skull form. Through deconvolution of facial forms, we identified quantitative trait loci that are responsible for canine facial shapes and sizes. Our novel insights include recognition that the FGF4 retrogene insertion, previously associated with appendicular chondrodysplasia, also reduces neurocranium size. Focusing on facial shape, we resolved a quantitative trait locus on canine chromosome 1 to a 188-kb critical interval that encompasses SMOC2. An intronic, transposable element within SMOC2 promotes the utilization of cryptic splice sites, causing its incorporation into transcripts, and drastically reduces SMOC2 gene expression in brachycephalic dogs. SMOC2 disruption affects the facial skeleton in a dose-dependent manner. The size effects of the associated SMOC2 haplotype are profound, accounting for 36% of facial length variation in the dogs we tested. Our data bring new focus to SMOC2 by highlighting its clinical implications in both human and veterinary medicine.

Pericardial cyst in a 2-year-old Maine Coon cat following peritoneopericardial diaphragmatic hernia repair

A pericardial cyst developed in a 2-year-old male neutered Maine Coon cat following surgery for an incidentally diagnosed congenital peritoneopericardial diaphragmatic hernia. The cyst caused no clinical signs in the cat, although clinical findings included positional right-sided cardiac tamponade and compression of thoracic structures, associated with a cardiac arrhythmia and axis deviation on electrocardiography. Extensive assessment of the cyst included radiography, echocardiography, computed tomography, exploratory thoracotomy, electrocardiography, histopathology and fluid analysis. Surgical removal of the cyst was curative, and the arrhythmia and axis deviation resolved. This report details case management from initial diagnosis to long-term follow-up, adding to the limited body of literature available on feline pericardial cysts. This is also the first report to associate cardiac arrhythmia with a pericardial cyst.

Radiographic, computed tomographic, gross pathological and histological findings with suspected apical infection in 32 equine maxillary cheek teeth (2012-2015)

BACKGROUNDnEquine maxillary cheek teeth apical infections are a significant disorder because of frequent spread of infection to the supporting bones. The accuracy of computed tomographic imaging (CT) of this disorder has not been fully assessed.nnnOBJECTIVESnTo compare the radiographic and CT findings in horses diagnosed with maxillary cheek teeth apical infections with pathological findings in the extracted teeth to assess the accuracy of these imaging techniques.nnnSTUDY DESIGNnObservational clinical study.nnnMETHODSnThirty-two maxillary cheek teeth (in 29 horses) diagnosed with apical infections by clinical, radiographic and principally by CT examinations, were extracted orally. The extracted teeth were subjected to further CT, gross pathological and histological examinations. Four normal teeth extracted from a cadaver served as controls.nnnRESULTSnPulpar and apical changes highly indicative of maxillary cheek teeth apical infection were present in all 32 teeth on CT, but in just 17/32 teeth (53%) radiographically. Gross pulpar/apical abnormalities and histological pulpar/periapical changes were present in 31/32 (97%) extracted teeth. On CT, one tooth contained small gas pockets in the apical aspect of one pulp and adjacent periodontal space, however no pathological changes were found following its extraction.nnnMAIN LIMITATIONSnThe study is descriptive and is confined to a small number of cases.nnnCONCLUSIONnThis study showed a 97% agreement between CT diagnosis of maxillary cheek teeth apical infection and the presence of pathological changes in the extracted teeth, confirming the diagnostic accuracy of CT compared with radiography for this disorder.

Restored vision in a young dog following corticosteroid treatment of presumptive hypophysitis

BackgroundHypophysitis is an umbrella term for a group of disorders involving inflammation of the pituitary gland. A rare occurrence in humans, hypophysitis can produce a range of clinical signs including (but not limited to) visual deficits and diabetes insipidus. Only five cases of canine hypophysitis exist in the literature, all presenting in mature dogs with no visual deficits and a grave outcome. This case report describes the clinical and advanced imaging features of blindness-inducing presumptive hypophysitis in a dog, which rapidly resolved with medical management.Case presentationA 1-year-and-seven-month-old neutered male Standard Poodle presented with subacute blindness, ataxia, and polyuria/polydipsia (PUPD). Magnetic resonance imaging (MRI) detected a contrast-enhancing pituitary mass with perilesional oedema compromising the optic chiasm. Suspecting neoplasia, anti-inflammatory corticosteroid was commenced prior to radiation therapy planning. Complete resolution of neurological and visual deficits occurred within 12xa0days of starting steroid treatment. Repeated advanced imaging indicated macroscopic resolution of the lesion. An extended thyroid panel with insulin-like growth factor-1 analysis supported a diagnosis of hypophysitis. Resolution of PUPD was achieved with tapering courses of prednisolone and desmopressin; the dog has since been clinically normal for 14xa0months and treatment-free for 11xa0months.ConclusionsTo the authors’ knowledge, this is the first instance in which a canine pituitary mass has demonstrated long-term resolution with palliative medical treatment alone, alongside reversal of associated blindness and presumptive diabetes insipidus. We suspect this lesion to be a form of hypophysitis, which should be included among differential diagnoses for pituitary masses, and for subacute blindness in dogs. Where possible, we advocate biopsy-confirmation of hypophysitis prior to timely intervention with anti-inflammatory treatment.

Horses with solar foot penetration, deep digital flexor tendon injury, and absence of concurrent synovial sepsis can have a positive outcome

Solar foot penetration is one of the causes of deep digital flexor tendon injuries in horses, however, limited information is available on the prognosis for return to soundness in the absence of synovial sepsis. Objectives of this retrospective observational study were to describe low-field magnetic resonance imaging (MRI) findings and long-term outcome for a group of horses with this combination of clinical problems. Horses were included if low-field standing MRI of the foot was performed following puncture wounds, injury of the deep digital flexor tendon was diagnosed, and sepsis was confirmed to be absent in all adjacent synovial structures (distal interphalangeal joint, navicular bursa, and digital flexor tendon sheath). Medical records were reviewed and MRI studies were re-interpreted. Follow-up information was obtained via a telephone questionnaire at a minimum of 6 months post-injury. A total of 11 horses met inclusion criteria. In three horses, the deep digital flexor tendon injury was only visible in the T2 fast spin echo sequence and contrast radiography improved diagnostic certainty. The most commonly affected area was between the distal border of the distal sesamoid bone and the facies flexoria of the distal phalanx (6/11, 55%). Six horses (60%) had an excellent outcome (5, show jumping; 1, general purpose) and returned to full athletic function. Five horses (40%) were sound but had not yet resumed full work at the time of follow-up. Findings indicated that the prognosis for return to soundness can be good for horses with solar penetration, deep digital flexor injury, and absence of synovial sepsis.

The effect of recumbency and hindlimb position on the lumbosacral interlaminar distance in dogs: a cadaveric computed tomography study

OBJECTIVEnTo examine the effect of sternal or lateral recumbency, with or without cranial extension of the hindlimbs, on the distance between the dorsal lumbosacral laminae in dogs.nnnSTUDY DESIGNnBlinded, randomized, crossover, experimental study.nnnANIMALSnA total of 19 canine cadavers.nnnMETHODSnComputed tomography of the lumbosacral junction was performed in four positions: sternal and right lateral recumbency, with hindlimbs extended cranially or not. Order of positioning was randomized. The lumbosacral interlaminar (LSI) distance, defined as the distance between the dorsal laminae of the seventh lumbar vertebra (caudal margin) and sacrum (cranial margin), was measured for each position by two independent assessors who were unaware of positioning. Mean distances in each position were compared using a paired t-test, corrected for multiple comparisons.nnnRESULTSnFor nxa0= 19 cadavers [6 female; median (range) age 9 (0.3-16) years; weight, 20.4 (1.0-34.0) kg], cranial extension of the hindlimbs increased the LSI distance, compared with control, in both sternal (9.2 ± 2.2 mm versus 3.1 ± 1.3 mm, p < 0.001) and right lateral recumbency (8.2 ± 1.9 mm versus 4.9 ± 1.5 mm, p < 0.001). With the hindlimbs extended cranially, sternal recumbency increased LSI distance when compared with right lateral recumbency (p < 0.001).nnnCONCLUSIONS AND CLINICAL RELEVANCEnCranial extension of the hindlimbs in both sternal and lateral recumbency increases the LSI distance to an extent that is both statistically significant and of potential clinical relevance. Although ease of epidural access or injection was not assessed, the small (1 mm) difference in LSI distance between cranial hindlimb extension in sternal and right lateral recumbency is unlikely to be of clinical relevance. Conversely, cranial extension of the hindlimbs in either sternal or lateral recumbency would be expected to facilitate epidural injection.

A COMPARISON OF COMPUTED TOMOGRAPHIC, RADIOGRAPHIC, GROSS AND HISTOLOGICAL, DENTAL AND ALVEOLAR FINDINGS IN 30 ABNORMAL CHEEK TEETH FROM EQUINE CADAVERS

Background Equine cheek teeth disorders, especially pulpar/apical infections, can have very serious consequences due to the frequent extension of infection to the supporting bones and/or adjacent paranasal sinuses. Limited studies have assessed the accuracy of computed tomographic (CT) imaging in the diagnosis of these disorders, and no study has directly compared imaging and pathological findings of the alveoli of diseased equine cheek teeth. Objective To validate the accuracy of CT and radiographic imaging of cheek teeth disorders by comparing CT and radiographic imaging, gross and histological findings in abnormal cheek teeth and their alveoli extracted from equine cadaver heads. Study design Ex vivo original study. Methods Fifty-four cadaver heads from horses with unknown histories that had died or been euthanized on humane grounds obtained from a rendering plant had radiography, CT imaging, and gross pathological examinations performed. Based on imaging and gross examination findings, 30 abnormal cheek teeth (26 maxillary and 4 mandibular) identified in 26 heads were extracted along with their dental alveoli where possible, and further CT imaging, gross, and histological examinations were performed. Eight maxillary cheek teeth (including four with attached alveolar bone) from these heads, that were normal on gross and CT examinations, were used as controls. Results Gross pathological and histological examinations indicated that 28/30 teeth, including two supernumerary teeth, had pulpar/apical infection, including pulpar and apical changes. A further supernumerary and a dysplastic tooth were also identified. Abnormal calcified tissue architecture was present in all three supernumerary and in the dysplastic tooth. CT imaging strongly indicated the presence of pulpar/apical infection in 27 of the 28 (96.4%) pulpar/apically infected teeth, including the presence of intrapulpar gas (Nu2009=u200919/28), apical clubbing (Nu2009=u200920), periapical halo (Nu2009=u20094), root lysis or fragmentation (Nu2009=u20097), and periapical gas (Nu2009=u20092). Also present were alveolar bone sclerosis (Nu2009=u200920), alveolar bone thickening (Nu2009=u20093), and lytic/erosive changes (Nu2009=u20098). Radiographic abnormalities strongly indicative of pulpar/apical infection including periapical sclerosis (Nu2009=u20098/28) and apical clubbing (Nu2009=u200914/28) were found in 14/28 (50%) of apically infected teeth. Histological changes were present in alveolar bone of all 21 cases of apical infection where alveolus remained attached to the tooth and was marked in 16 cases, all which had CT alveolar changes. Histological changes included disruption of the normal trabecular pattern, increased osteoclastic activity, and the presence of islands of bone with a scalloped profile within the thickened attached periodontal ligament. No gross pathological or histological changes were present in the eight control teeth or their alveoli (Nu2009=u20094). Main limitations No history or breed-related information was available on these cases. Conclusion There was a 96.4% correlation between a CT diagnosis and confirmative pathological findings in 28 apically infected teeth confirming the accuracy of CT imaging in diagnosing equine pulpar/apical infections. There was also excellent correlation between CT and histological alveolar bone findings.

Computed tomographic assessment of equine maxillary cheek teeth anatomical relationships, and paranasal sinus volumes

Disorders affecting the equine maxillary cheek teeth and paranasal sinuses are relatively common, but limited objective information is available on the dimensions and relationships of these structures in horses of different ages. The aims of this study were to assess age-related changes in the positioning and anatomical relationships of the individual maxillary cheek teeth with the infraorbital canal and maxillary septum and the volumes of the individual sinus compartments. CT and gross examination were performed on 60 normal equine cadaver heads that were aged by their dentition. The intrasinus position of cheek teeth, length of reserve crowns, relationship to the infraorbital canal and measurements of rostral drift and sinus compartment volumes were assessed from CT images. The findings included that Triadan 10 alveoli lay fully or partially in the rostral maxillary sinus (RMS) in 60% of cases. The infraorbital canal lay directly on the medial aspect of the alveolar apex in younger horses. The Triadan 11’sclinical crowns and apices drifted a mean of 2.48 and 2.83u2009cm more rostral to the orbit, respectively, in the >15 years old vs the <6 years old age group. The mean volumes of sinus compartments ranged from 175u2009cm3 for the caudal maxillary sinus (CMS) to 4u2009cm3 for the ethmoidal sinus (ES). This information should be of value in the diagnosis and treatment of equine dental and sinus disorders and as reference values for further studies.