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.     

Electroacupuncture as an additional treatment for headshaking in six horses

Some success has been demonstrated using percutaneous electrical nerve stimulation (PENS) to treat trigeminal-mediated headshaking (TMHS) in horses. The aim of this study is to determine whether electroacupuncture (EA) can provide similar remission from the pain of this debilitating condition. EA is less invasive than PENS and can be carried out in the stable yard without the need for a hospital setting and expensive equipment. Six horses and ponies showing clinical signs of headshaking were treated with electroacupuncture of the infraorbital nerve under light sedation. The nerve was stimulated with alternating 2 and 80 Hz frequencies for a period of 25 min with the current adjusted so that there was visible twitching of the nostrils and/or lips. Follow-up treatments were given when the signs recurred or 4–7 days later if there was no initial response. The procedure was well tolerated by all the horses. Once a response was achieved, the period of remission often increased with subsequent treatments. Median remission time for the first treatment was 5.5 days (mean 7.6 days, range 0–13 days, n = 6). second treatment 8.5 days (mean 10.6 days, range 7–21 days, n = 6), third treatment 18 days (mean 28.8 days, range 6–71 days, n = 6), fourth treatment 47.5 days (mean 10 weeks, range 11 days–23 weeks, n = 6), fifth treatment 13 weeks 5 days (mean 18 weeks 5 days, range 5 weeks–46 weeks, n = 5), sixth treatment 24 days (mean 26 days, range 13–41 days, n = 3). The three horses that started treatment in 2015 received a single treatment in April or May of 2016 and were still asymptomatic at the end of the study period in October 2016. It was concluded that EA of the infraorbital nerve is an effective and well-tolerated treatment for the management of horses considered to be experiencing trigeminal-mediated headshaking.     

A randomised,blinded, crossover study to assess the efficacy of a feed supplement in alleviating the clinical signs of headshaking in 32 horses

Reasons for performing study: Feed supplements are commonly used by owners to alleviate headshaking; however, randomised, controlled trials are required to assess their efficacy. Objective: To determine the efficacy of a feed supplement for alleviation of the clinical signs of headshaking using a randomised, blinded, placebo‐controlled trial. Methods: Using a crossover design, 44 horses previously diagnosed with chronic idiopathic headshaking received both the supplement and a matching placebo per os for 28 days with a washout period between of 14 days. Video recordings were taken at rest and exercise prior to the study and at the end of both periods of treatment. The degree of headshaking was assessed in a blinded, randomised manner by 2 veterinary surgeons. At the same time points, owners completed a questionnaire to assess the severity of headshaking signs. A Wilcoxon signed rank test was used to compare the scores while on supplement and placebo. Results: Using the video assessments, there was no significant difference between scores while on supplement compared with placebo (P = 0.7). Using the questionnaire responses, there was no significant difference between scores for any activity when the placebo and the supplement were compared with each other. However, owners reported significant improvement during all activities for both placebo and supplement compared with pretreatment scores. Conclusions and potential relevance: The supplement offered no benefit over a placebo in alleviating the clinical signs of headshaking. There appeared to be a significant proxy placebo effect when the outcome was based on subjective owner perception of clinical signs. This study demonstrated no beneficial effect of this supplement on the clinical signs of headshaking. The study did show a significant placebo effect, thereby highlighting the necessity of properly conducted, randomised controlled trials, with blinding, to assess true treatment effects in trials in animals.     

Morphological variations of the infraorbital canal during CT has limited association with headshaking in horses

Headshaking is a common problem in horses. The etiology is unknown but thought to involve sensory input from branches of the trigeminal nerve, some of which are within the infraorbital canal. The objective of this retrospective cross‐sectional study was to describe the CT anatomy and variations of the infraorbital canal in horses with local disease processes and normal horses, and to examine associations between those findings and headshaking. Computed tomography scans were reviewed and morphological changes of the infraorbital canal were described. Presence of changes was then tested for association with headshaking prevalence, presence of disease processes in the region of the infraorbital canal, age, and sex. Nonparametric tests were used and a P‐value of .05 was considered significant. A total of 218 horses were included, 9% of which had headshaking and 45% had CT lesions in the region of the infraorbital canal. Morphological changes to the bone of the infraorbital canal were found in 121 horses (56%) and included the following: increased mineralization 39 (18%), decreased mineralization 89 (41%), deformed shape 51 (23%), displaced position 43 (20%), and disruption 11 (5%). All changes of the infraorbital canal significantly increased in frequency with the presence of adjacent disease. Increased mineralization and disruption of the infraorbital canal were significantly associated with headshaking in horses with adjacent disease; the latter only reached significance after exclusion of dentally immature horses. No other changes were significantly associated with the presence of headshaking. No association was found between headshaking and the age or sex of the horse.     

Variability of resting endoscopic grading for assessment of recurrent laryngeal neuropathy in horses

Reasons for performing study: The extent to which variability affects endoscopic grading of arytenoid cartilage movement is uncertain. Objective: To determine the observer and within horse variability of grading arytenoid cartilage movement in horses during resting endoscopic examination, using a 7‐grade system. Methods: Endoscopic recordings of the upper respiratory tract made at rest in 270 draught horses were reviewed independently by 2 veterinarians to assess interobserver variability when scoring horses' laryngeal function with a 7‐grade system. Grading was repeated by both examiners in 80 randomly selected recordings in order to assess intraobserver variability. In 120 horses, endoscopy was repeated after 24–48 h, with videos graded by both veterinarians to assess intrahorse variability. Results: The mean weighted κ statistic for concordance within examiners was 0.867, with a mean intraobserver agreement of 76.3%. The weighted κ statistic for concordance between the 2 examiners was 0.765, with an interobserver agreement of 63.1%. Of the horses receiving 2 endoscopic examinations, the same grade was assigned to 57.1% of horses at the second examination, when effects resulting from interobserver variability were removed. The mean weighted κ statistic for concordance between the grade assigned at first vs. second examinations was 0.588, indicating only moderate agreement. Conclusions and potential relevance: Intra‐ and interobserver reliability of resting endoscopic grading of arytenoid cartilage movement using a 7‐grade system was high when examinations were conducted by experienced veterinarians. However, there was moderate daily intrahorse variability, suggesting that results of resting endoscopic examinations performed on a single day should be interpreted with caution.     

Field study of the efficacy of three types of nose net for the treatment of headshaking in horses

Thirty-six owners of seasonally headshaking horses took part in a trial to compare the effectiveness of three types of nose net, a traditional cylindrical net (full net) and two forms of larger mesh nets which cover only the nostrils and dorsorostral muzzle (half nets). Baseline data relating to the overall severity of the problem and 18 specific behaviours describing the nature of the problem were recorded on a check sheet by the owners. A within-subjects repeated measures design experiment, with each net used for a week before reassessment, was then used to assess the effect of the nets on the headshaking problem. Approximately 75 per cent of owners reported some overall improvement with each net; around 60 per cent recorded a 50 per cent or greater improvement and 30 per cent a 70 per cent or greater improvement. The nets significantly reduced the overall headshaking score and the following specific behaviours: up-and-down headshaking, nose flipping, acting as if a bee had flown up the nose, shaking at exercise, shaking when excited, shaking in bright sunlight or in windy conditions (P < 0.0001), striking at the face, shaking at night, rubbing the nose when moving, rubbing the nose on objects, sneezing, shaking in the rain and shaking indoors (P < 0.05). There was no evidence of a significant effect on side-to-side headshaking, shaking at rest or rubbing the nose when stationary, but the effect on snorting was uncertain. There were few significant differences between the nets, but the half nets were reported to be significantly better at controlling 'bee up the nose' behaviour. Horses more than 10 years old were reportedly less likely to show a 50 per cent or greater improvement in 'nose flipping' and 'headshaking at exercise.     

Diagnosis and surgical treatment of epidural neoplasms in two ataxic horses

Two cases of ataxia caused by epidural neoplasia diagnosed with myelography and histopathology are presented in this report. One horse was diagnosed with lymphohistiocytic lymphosarcoma and the other with haemangiosarcoma. In both cases, subtotal dorsal decompression was performed as part of their treatment protocol. One horse was subjected to euthanasia immediately after surgery; however, the other horse recovered well, with no gait abnormalities and a normal myelographic dye column seen at 6 months post surgery. Although both horses were ultimately subjected to euthanasia, subtotal dorsal decompression provides a potential surgical treatment for epidural neoplasia.     

Outcome of superficial keratectomy without conjunctival graft as a surgical technique for immune-mediated keratitis in horses: Four cases

This case report describes four horses with unilateral superficial or mid-stromal immune-mediated keratitis (IMMK) treated with a superficial keratectomy (SK) without a conjunctival graft. In two horses, the surgery was performed under general anaesthesia, and in two horses standing with sedation and local blocks. Results of this report show that SK is a viable treatment option in horses with chronic superficial and/or mid-stromal IMMK that can even be performed in the standing, sedated horse. When sufficient corneal tissue is removed, no recurrence is to be expected in the long-term follow-up (up to 31 months). In two horses, healing occurred without complications. Two horses developed a secondary bacterial infection post-operatively (Enterococcus faecalis and Staphylococcus aureus). In one case, this resulted in a pre-perforating melting corneal ulcer necessitating conjunctival pedicle graft surgery 13 days post keratectomy. In three horses, there was no recurrence of the IMMK with a long-term follow-up of 6–31 months. One case showed recurrence of IMMK in the cornea region surrounding the keratectomy 9 months after surgery.     

Nd:YAG laser‐assisted transendoscopic procedure for treatment of otitis media in a horse

An 8‐year‐old Warmblood gelding was referred for evaluation of headshaking to the Clinic for Horses, University of Veterinary Medicine Hannover. Based on clinical signs and computed tomography – as well as magnetic resonance imaging – findings, otitis media was diagnosed. Medical treatment including trimethoprim potentiated sulfadimethoxine and meloxicam for 3 weeks did not result in cessation of clinical signs. Therefore, the tympanic cavity was opened transendoscopically using an Nd:YAG‐laser via the guttural pouch according to surgical procedures in human and small animal medicine, leading to a considerable improvement of clinical signs.     

Sparing the gut: COX-2 inhibitors herald a new era for treatment of horses with surgical colic

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage a wide variety of conditions in horses, including management of colic. Flunixin meglumine is by far the most commonly used drug in the control of colic pain and inflammation and has become a go-to for not only veterinarians but also horse-owners and nonmedical equine professionals. NSAID use, however, has always been controversial in critical cases due to a high risk of adverse effects associated with their potent cyclo-oxygenase (COX) inhibition. There are two important COX isoenzymes: COX-1 is generally beneficial for normal renal and gastrointestinal functions and COX-2 is associated with the pain and inflammation of disease. Newer selective NSAIDs can target COX-2-driven pathology while sparing important COX-1-driven physiology, which is of critical importance in horses with severe gastrointestinal disease. Emerging research suggests that firocoxib, a COX-2-selective NSAID labelled for use in horses, may be preferable for use in colic cases in spite of the decades-long dogma that flunixin saves lives.     

Results and complications of a novel technique for primary castration with an inguinal approach in horses

Reasons for performing study: Complications associated with equine castration can have medical and financial consequences. This retrospective study investigated a novel method of castration via an inguinal approach in mature stallions and compared the incidence of complications with other methods. Hypothesis: Castration via an inguinal approach has a low complication rate at the site of surgery compared with other castration techniques. Methods: Mature stallions (n = 238) were castrated under general anaesthesia in dorsal recumbency using an inguinal approach. The vaginal process was incised, the spermatic cord ligated twice and the testis removed. After suturing, the vaginal process and one or 2 layers of fascia, the subcutis and cutis were closed in a simple continuous pattern. Results: Five of 238 (2.1%) horses had post operative haemorrhage and a haematoma in the scrotal region, which required additional treatment. All horses made a full recovery. Five of 238 (2.1%) of the horses had a post operative respiratory infection, which resolved with antibiotic therapy. Sixteen of 238 (8.8%) had transient signs of colic shortly after surgery. Conclusion: This technique of castration with an inguinal approach had a low incidence of complications at the site of surgery compared with other methods. An inguinal approach and leaving the vaginal tunic in situ may cause less soft tissue trauma than a scrotal approach.     

A modified surgical technique for penile amputation and preputial ablation in the horse

The aim of this study was to describe a modified surgical technique for treatment of severe penile pathology, and the long‐term outcome. The surgery consisted of subischial urethrostomy and penile amputation with preputial ablation, with the horse in dorsal recumbency. A redundant section of the penis root and body was left in situ, rather than being retroflexed as described elsewhere. Follow‐up was obtained using a structured owner telephone questionnaire. The 15 cases included: 11 squamous cell carcinomas (73.3%); 2 melanomas; one chronic preputial discharge with no associated neoplasia; and one paraphimosis following routine sedation. Length of survival ranged from 0.9 to 74.6 months (median 25.1 months). From the 14 horses with follow‐up, 9 survived >18 months (64.3%) [Correction added on 17 August 2015, after first online publication: The percentage in the preceding sentence was wrong and has been corrected to '64.3%' from '69.2%']. Four euthanasias were due to presenting or post operative complications, while 2 were unrelated to the procedure. This procedure presents a simplified, viable option for treatment of extensive mixed penile lesions; reducing surgical complexity and time in comparison to previously described techniques requiring retroversion.