W. H. Tremaine

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.

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.

A database survey of equine tumours in the United Kingdom

REASONS FOR PERFORMING STUDY Survey data on equine tumours are sparse compared with other species and may have changed over time. OBJECTIVES To describe the most frequently diagnosed equine tumours recorded by a diagnostic pathology laboratory over 29 years, to identify background factors associated with tumour type, and to identify any changes in the tumours diagnosed or the background of cases submitted during the study period. STUDY DESIGN Observational; cross-sectional analysis of records of a diagnostic pathology laboratory. METHODS The records of all neoplastic equine histology submissions to the University of Bristol (January 1982-December 2010) were accessed from a database, and a list of diagnoses compiled. The 6 most commonly diagnosed tumour types were analysed using logistic regression to identify background factors associated with tumour type. The overall population of equine tumour submissions and the relative frequency of diagnosis of the most common tumour types were compared between decades. RESULTS There were 964 cases included. The most frequently diagnosed tumours were: sarcoid (24% cases), squamous cell carcinoma (SCC) (19%), lymphoma (14%), melanoma (6%), gonadal stromal tumour (6%) and mast cell tumour (MCT) (4%). With sarcoid, Thoroughbred/Thoroughbred cross and gelding as reference categories: increasing age was significantly associated with the odds of each of the other tumour types, mares were at reduced risk of SCC, Arab/Arab cross had a higher risk of MCT, Cob/Cob cross had an increased risk of SCC and MCT, and ponies had an increased risk of melanoma. The mean age of submissions increased in each successive decade and the breed composition became broader. Sarcoids and lymphoma formed a smaller proportion of diagnoses in later decades. CONCLUSIONS The types of tumours submitted to this laboratory have changed over the last 3 decades. Current data inform clinicians and researchers and further studies are warranted to follow trends.

Supernumerary cheek teeth (n = 24): clinical features, diagnosis, treatment and outcome in 15 horses.

REASONS FOR PERFORMING STUDY There are few reports of case series of horses with supernumerary cheek teeth (SCT) that document clinical findings, treatment and long-term outcome. OBJECTIVES To review the clinical and ancillary diagnostic findings and responses to different treatments in horses with SCT. METHODS The case records of 15 horses were reviewed and long-term outcomes obtained by telephone interview. RESULTS Fifteen horses with a total of 24 SCT were identified. Two SCT were incidental findings and were not treated. Clinical signs were improved or resolved in 11 of 13 of the teeth treated conservatively and all 6 treated by extraction had a favourable outcome. Four horses were subjected to euthanasia within a short period of diagnosis, either due to a poor prognosis at the outset or failure to respond to initial conservative treatment. CONCLUSIONS Some SCT are chance findings and do not cause clinical signs. In those instances where clinical signs of dental disease are mild, conservative treatment including the management of diastema and reduction of overgrowths is often effective. Horses with severe clinical signs attributable to an SCT are likely to require extraction of the offending tooth. POTENTIAL RELEVANCE An SCT is an uncommon dental anomaly but should be considered in the differential diagnosis of cases with signs of severe dental disease. The preferred management for SCT is very variable and determined by the severity of the associated changes, but ranges from conservative measures through forceps extraction per os to major facial flap surgery.

Clinical features and management of equine post operative ileus: Survey of diplomates of the European Colleges of Equine Internal Medicine (ECEIM) and Veterinary Surgeons (ECVS)

REASONS FOR PERFORMING STUDY There is a need for an improved understanding of equine post operative ileus (POI), in terms of both clinical definition and optimal management. Although the pharmacological strategies that are used to treat POI continue to evolve, little is known about the supplementary strategies used to prevent and manage this condition. OBJECTIVES To report the current strategies used to diagnose, prevent and manage POI following emergency abdominal surgeries. STUDY DESIGN Cross-sectional survey. METHODS An electronic survey invitation was sent by email to 306 European college diplomates (European Colleges of Equine Internal Medicine, ECEIM n = 120, and Veterinary Surgeons, ECVS n = 186). RESULTS The response rate was 33% (100 of 306). The median reported estimated incidence of POI was 10-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. Lesions involving the small intestine were thought to be the leading risk factors for developing POI. Anti-inflammatory drugs, antimicrobial drugs and i.v. fluids were the primary preventative strategies when managing cases at high risk for POI. Flunixin meglumine and lidocaine were the drugs most commonly used to treat horses with POI. Supplementary preventative and treatment strategies for POI included control of endotoxaemia, fluid therapy, early ambulation and judicious timing of post operative feeding. CONCLUSIONS Appreciation of the potential risk factors associated with the development of POI appeared to have an impact on the choice of management strategies that are implemented. The majority of ECEIM and ECVS Diplomates in the survey used flunixin meglumine and lidocaine, often in combination, to treat horses with POI, which is likely to reflect the contributory role of inflammation in its pathophysiology. Various supplementary strategies were used to prevent and manage POI risk factors intraoperatively and post operatively.

The prevalence of secondary dentinal lesions in cheek teeth from horses with clinical signs of pulpitis compared to controls

REASONS FOR PERFORMING STUDY With the advent of detailed oral examination in horses using dental mirrors and rigid endoscopy, secondary dentinal lesions are observed more frequently. More information regarding the association of secondary dentinal defects with apical dental disease would improve the sensitivity of oral examination as a diagnostic aid for pulpitis. OBJECTIVES To assess prevalence and severity of secondary dentinal defects observed on examination of occlusal surfaces of cheek teeth (CT) from horses showing clinical signs of pulpitis compared to asymptomatic controls. METHODS Records from all cases of equine CT exodontia at the University of Bristol over a 4 year period were examined. Case selection criteria included the presence of clinical signs of pulpitis, an intact extracted tooth and availability of a complete history and follow up. Cases where coronal fracture or periodontal pocketing featured were excluded. CT from cadavers with no history of dental disease served as normal controls. Triadan positions and eruption ages of control teeth were matched with those of teeth extracted from cases. CT from selected cases and control teeth were examined occlusally. Secondary dentinal defects were identified and graded. Prevalence of occlusal lesions in CT with pulpitis and controls was compared. RESULTS From the records of 120 horses where exodontia was performed, 40 cases matched selection criteria. Twenty-three mandibular and 21 maxillary CT were extracted from cases. The controls consisted of 60 mandibular and 60 maxillary CT from 7 cadaver skulls. Secondary dentinal defects were significantly over-represented in CT extracted from cases of pulpitis (P < 0.001). Of diseased mandibular CT, 56.5% had defects compared to none of the controls. Of diseased maxillary CT, 57% had defects compared with 1.6% of controls. Multiple defective secondary dentinal areas and severe lesions were more prevalent in diseased mandibular CT compared with diseased maxillary CT. CONCLUSIONS AND PRACTICAL SIGNIFICANCE: Careful examination of occlusal secondary dentine is an essential component in investigation of suspected pulpitis in equine CT.

Clinical features and management of equine post operative ileus (POI): Survey of Diplomates of the American Colleges of Veterinary Internal Medicine (ACVIM), Veterinary Surgeons (ACVS) and Veterinary Emergency and Critical Care (ACVECC)

REASONS FOR PERFORMING STUDY A recent survey of European Colleges (European College of Equine Internal Medicine [ECEIM] and European College of Veterinary Surgeons [ECVS]) revealed the different strategies implemented by, and some of the challenges facing, European clinicians presented with cases of post operative ileus (POI). It was concluded that further comparative analysis of opinions, canvassed from additional colleges of equine veterinary specialism worldwide, would provide valuable additional insight into current POI knowledge on a more global scale. OBJECTIVES To report and compare the current strategies favoured by American veterinary specialists when managing POI in horses that underwent emergency colic surgery. STUDY DESIGN Cross-sectional survey. METHODS Electronic invitations were sent to 814 Large Animal specialists, including 3 colleges: the American College of Veterinary Internal Medicine (ACVIM), American College of Veterinary Surgeons (ACVS) and the American College of Veterinary Emergency and Critical Care (ACVECC). RESULTS The response rate was 14% (115/814). The majority of respondents (68%) reported an estimated prevalence range of POI of 0-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. A lesion involving the small intestine was considered the main risk factor for POI. Anti-inflammatory drugs, intravenous (i.v.) fluids and antimicrobial drugs were the primary strategies used when managing POI. Flunixin meglumine and i.v. lidocaine were the drugs most commonly used in the treatment of horses with POI. Supplementary management strategies targeted mainly the prevention of post operative adhesions, infection and inflammation. CONCLUSIONS There is a lack of consensus on the clinical definition of POI. Prospective and objective clinical assessment of the effectiveness of the different strategies contained within this and the European survey is necessary in order to identify a standardised approach to the management of equine POI.

Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal‐mediated headshaking: A safe procedure resulting in medium‐term remission in five of seven horses

REASONS FOR PERFORMING STUDY There are no consistently safe and effective methods for the treatment of trigeminal-mediated headshaking in horses. In affected horses, the trigeminal nerve is sensitised, appearing to result in neuropathic pain. Percutaneous electrical nerve stimulation (PENS) therapy is a minimally invasive neuromodulatory treatment used in people to manage neuropathic pain. OBJECTIVES To determine whether PENS therapy is safe, tolerated and effective for the management of trigeminal-mediated headshaking in horses. STUDY DESIGN Descriptive case series. METHODS Seven horses diagnosed with trigeminal-mediated headshaking and currently showing clinical signs were studied. All procedures were carried out in sedated horses with a needle-prick sized area of skin desensitised with local anaesthetic to facilitate probe insertion. A disposable PENS probe was advanced subcutaneously adjacent to the nerve, rostral to the infraorbital foramen under ultrasonographic guidance. The nerve was stimulated for 25 min following a protocol of alternating frequencies and a perception threshold based on human clinical data. The probe was removed and the procedure repeated on the contralateral side. The protocol used comprised a series of 3 or 4 treatments, with treatments being repeated when signs of headshaking recurred. RESULTS All horses tolerated the procedure well. Three horses developed a haematoma at the site on one occasion and 2 had increased clinical signs for up to 3 days following first treatment. Six horses demonstrated a positive response to their first treatment, returning to ridden work at the same level as prior to onset of headshaking, with 5 continuing to respond. Median remission time for first treatment was 3.8 days (range 0-8 days, n = 7), second treatment 2.5 weeks (0-8 weeks, n = 7), third treatment 15.5 weeks (0-24 weeks, n = 5) and fourth treatment 20 weeks (12-28 weeks ongoing, n = 2). CONCLUSIONS Percutaneous electrical nerve stimulation therapy is a safe, well tolerated, minimally invasive, repeatable management option for trigeminal-mediated headshaking, with encouraging efficacy for amelioration of clinical signs in the short- to medium term.

Gross, computed tomographic and histological findings in mandibular cheek teeth extracted from horses with clinical signs of pulpitis due to apical infection.

REASONS FOR PERFORMING STUDY The most prevalent type of equine dental pulpitis due to apical infection is not associated with coronal fractures or periodontal disease. The pathogenesis of this type of pulpitis is not fully understood. Computed tomography (CT) is increasingly used to investigate equine dental disorders. However, gross, tomographic and histopathological changes in equine dental pulpitis have not been compared previously. OBJECTIVES To compare gross, CT and histological appearances of sectioned mandibular cheek teeth extracted from horses with clinical signs of pulpitis without coronal fractures or periodontal disease. To contribute to understanding the pathogenesis of equine dental pulpitis. STUDY DESIGN Descriptive study using diseased and healthy teeth. METHODS Mandibular cheek teeth extracted from horses with clinical signs of pulpitis (cases), and from cadavers with no history of dental disease (controls), were compared using CT in the transverse plane at 1 mm intervals. Teeth were then sectioned transversely, photographed and processed for histopathological examination. Tomographs were compared with corresponding gross and histological sections. RESULTS Cement, dentine and bone had similar ranges of attenuation (550-2000 Hounsfield Units, HU) in tomographs but could be differentiated from pulp (-400 to 500 HU) and enamel (> 2500 HU). Twelve discrete dental lesions were identified grossly, 10 of which were characterised histologically. Reactive and reparative dentinogenesis and extensive pulpar mineralisation, previously undescribed, were identified. Pulpar oedema, neutrophilic inflammation, cement and enamel defects, and reactive cemental deposition were also observed. The CT and pathological findings corresponded well where there was mineralised tissue deposited, defects in mineralised tissue, or food material in the pulpar area. Pulpar and dentinal necrosis and cement destruction, evident grossly and histologically, did not correspond to CT changes. CONCLUSIONS Computed tomography is useful for identifying deposition and defects of mineralised material but less useful for identifying inflammation and tissue destruction. The equine dentine-pulp complex responds to insult with reactive and reparative changes.

The effect of the laryngeal tie-forward procedure and soft palate cautery on nasopharyngeal diameter in horses

The laryngeal tie-forward (LTF) procedure has been shown to move the larynx rostrally and dorsally whilst repositioning the basihyoid bone caudally and dorsally. Other studies have shown that the position of the hyoid bones influences the size of the nasopharynx. The effect of the LTF procedure on the size of the nasopharynx is unknown. It was hypothesised that the LTF procedure would result in a decrease in dorsoventral nasopharyngeal diameter. Twenty-five thoroughbred horses which underwent LTF with or without soft palate cautery (LTF±SPC) for treatment of dorsal displacement of the soft palate were included in this study. Preoperative and postoperative lateral radiographs were used to determine changes in laryngohyoid position and nasopharyngeal diameter. The LTF±SPC procedure resulted in a significant reduction (14–17 per cent) in dorsoventral nasopharyngeal diameter (P<0.001). The LTF procedure decreases nasopharyngeal diameter. The impact on upper respiratory tract function during exercise remains unclear.