Use of distraction osteogenesis for the correction of deviated nasal septum and premaxilla in a horse

A 13-month-old female Andalusian was evaluated because of a congenital left deviation of the maxilla and nasal septum, which had resulted in a gross malocclusion of the maxillary incisor teeth. Surgical correction of a deviated nasal septum and premaxilla in a horse was first reported in 1978 and involved a pre-maxilla osteotomy and use of an autogenous rib graft, with a nasal septum osteotomy performed in a second surgery; to the authors' knowledge, no alternative surgical treatments have since been described. In this horse, a new surgical treatment by distraction osteogenesis without nasal septum osteotomy was attempted. After the procedure, the premaxilla and nasal septum deviations were corrected; however, an overjet lesion (rostral projection of maxillary arcade over the mandibular arcade) was evident, for which the owners declined treatment. Compared with previously recommended procedures, distraction osteogenesis appears to be a less invasive treatment for congenital facial deformities and may be considered an option in the treatment of congenital deviation of the nasal septum and premaxilla (wry nose), head scoliosis, brachygnathism, and prognathism in horses.     

Correcting Campylorrhinus Lateralis in a Foal by Bone Distraction: A Case Report

Campylorrhinus lateralis, also known as “wry nose,” is a congenital malformation that mainly affects Thoroughbreds. These horses have a unilateral deviation of the maxillae that may be to one side or the other side, and it causes airway obstruction and dental malocclusion. The choice of treatment is not necessarily operation; however, the treatment of choice, which aims to repair the maxillae deviation, is surgical to improve the horse’s respiratory condition and correct the dental occlusion. There are currently no reports describing the first surgical technique for such deformity described by Valdez et al. The present study describes the case of a 2-month-old foal of the Mangalarga Marchador breed that was diagnosed with wry nose. The foal presented with accentuated maxillae deviation to the right side, malocclusion of the incisor teeth, and respiratory noises. After diagnosis and physical examination, the foal was treated by surgical correction of the deviation. To correct the deviation, the bone distraction technique with unilateral osteotomy of the right maxillae and fixation of the external bone distractor was chosen. After 90 days, the bone distractor was removed; consequently, malocclusion of the incisors was greatly improved, and respiratory noises were eliminated.     

Extensive nasal septum resection in horses using a 3-wire method

OBJECTIVE: To describe a surgical technique for, and report outcome after, extensive nasal septum resection in horses with congenital or acquired septal diseases. STUDY DESIGN: Retrospective study. ANIMALS: Horses (5) with nasal septal deformity. METHODS: Under general anesthesia, obstetrical wires were preplaced around the ventral, caudal, and dorsal aspects of the nasal septum by combinations of manual guidance (ventral and caudal wires) and use of a trephine hole on the dorsal mid-line (dorsal and caudal wires). The rostral part of the septum was incised with a scalpel and the ventral, dorsal, and caudal septal incisions were made with the preplaced wires. After septum removal, the nasal cavity packed with a tampon and a temporary tracheotomy was performed. RESULTS: The diseased nasal septum was completely removed in all horses. It was possible to direct the caudal cut at a sufficient angle so that the remaining stump was in a wide part of the nasal passage, where it would have minimal effect on airflow. Four horses healed, and returned to intended use but continued to make a slight respiratory noise during exercise. At 13 months after surgery, 1 horse with a concurrent wry nose was retired from race training after 2 additional surgeries failed to relieve exercise intolerance at high speed. CONCLUSIONS: The 3 wire-cut method of nasal septum resection was technically easy to perform and safe, allowed return to function in most horses, and produced an excellent cosmetic appearance. CLINICAL RELEVANCE: This technique for nasal septum resection allows removal of a large portion of the nasal septum and provides a safe alternative to conventional techniques of nasal septum resection in the horse.     

Use of an external fixator to correct a wry nose in a yearling

Wry nose is a rare condition. The resultant deviation of the nasal septum and maxilla/premaxilla often complicates deglutition and respiration. Traditional treatment consists of internal fixation with pins after an osteotomy and a rib graft. A 17‐month‐old Arab yearling was presented for evaluation of deviation of the maxilla and nasal septum. This deviation was managed using an external fixation device after bilateral osteotomy of the maxilla/premaxilla and reduction of the deviation. Partial resection of the nasal septum by a dorsal approach was also performed. The dental malocclusion and respiratory noise were corrected.     

Nasal Septoplasty for Correction of Septal Deviation in a Foal

Objective — This article reports an alternative to septal resection in nasal septal deviations involving the rostral 7 to 10 cm of the nasal septum.
Study Design — Case report.
Sample Population — One client-owned foal.
Methods — A nasal approach with mucosal elevation was used to gain access to the cartilaginous portion of the nasal septum. Once exposed, a series of parasagittal incisions in the cartilage allowed the septum to be repositioned while providing some intrinsic stabilization.
Results — The nasal approach provided good access to the rostral 7 cm of the nasal septum. The technique resulted in minimal hemorrhage from the site. Bleeding was reduced with the use of ephedrine to vasoconstrict the mucosal vessels, and primary closure of the mucosa.
Conclusions — Use of an intrinsically stabilized septoplasty should be considered as a means of decreasing the airway obstruction caused by nasal septal deviation in foals while allowing for normal development of facial contour.     

Pes varus correction in Dachshunds using a hybrid external fixator

Objective— To describe surgical correction of pes varus deformity in Dachshunds by acute medial opening wedge osteotomy of the distal aspect of the tibia stabilized with a hybrid external skeletal fixator (HESF), and report clinical and radiographic outcomes.
Study Design— Multicenter, retrospective clinical study.
Animals— Immature Dachshunds (n=13) with pes varus deformity.
Methods— Limb function and lameness scores were assigned before and after surgery, and correction was determined visually at surgery. Tibiotarsal joint orientation (TTJO) and medial and lateral tibial cortex lengths, measured on radiographs of deformed and normal (when available) limbs, were compared before correction and after fixator removal.
Results— Pes varus deformities (n=14) were corrected; 93% had good to excellent clinical outcome. None of the dogs had a normal preoperative gait. Mean TTJO of abnormal and normal tibiae before surgery were 29° varus (median, 28°), and 12° valgus (median, 12°). Angular correction ranged from 20° to 51° (mean, 36±8°; median, 36°). M e an TTJO after fixator removal was 7° valgus (median, 7°). Two dogs had minor transient postoperative complications whereas 3 had major complications; only 1 of which was resolved.
Conclusions— Pes varus deformity in Dachshunds can be corrected by acute medial opening wedge osteotomy of the distal aspect of the tibia stabilized by HESF. Technique modifications are needed to improve correction precision.
Clinical Relevance— Visual inspection of limb alignment during surgery resulted in good to excellent clinical outcomes; however, 91% of tibiae were under- or overcorrected (mean, 6°; median, 5°). Limb alignment should be based on evaluation of immediate postoperative TTJO measurements, not solely on intraoperative visual assessment.     

Nasal Septum Resection in the Horse

The nasal septum was surgically removed from 22 horses with upper airway obstruction caused by thickening and/or deviation of the septum. The most common presenting complaints were a low-pitched, snoring, respiratory noise and respiratory difficulty during exercise, which usually occurs in young horses. Abnormalities of the septum were most commonly congenital defects or caused by trauma or inflammation secondary to severe respiratory infection.
Diagnosis was made based on history, clinical signs, and results of physical examination. Radiography and endoscopy were useful adjuncts in some horses.
Under general anesthesia, the septum was removed by scalpel and osteotome (19 horses) or by obstetrical wire and osteotome (1 horse). In two horses, the rostral one third of the septum was removed by scalpel alone.
In three horses, the alar folds and floor of the nasal diverticula were removed in an attempt to relieve airway obstruction caused by flattening of the bridge of the nose following removal of the nasal septum.
Follow-up was obtained on 18 horses: persistent noise during exercise continued in 90%; however, 50% returned to usefulness.     

Semilobar Holoprosencephaly Associated with Multiple Malformations in a Foal

A full‐term male foal born in a farm holidays in Maremma (Tuscany, Italy) was euthanized shortly after birth due to the presence of several malformations. The rostral maxilla and the nasal septum were deviated to the right (wry nose), and a severe cervico‐thoracic scoliosis and anus atresia were evident. Necropsy revealed ileum atresia and agenesis of the right kidney. The brain showed an incomplete separation of the hemispheres of the rostral third of the forebrain and the olfactory bulbs and tracts were absent (olfactory aplasia). A diagnosis of semilobar holoprosencephaly (HPE) was achieved. This is the first case of semilobar HPE associated with other organ anomalies in horses.     

COMPUTED TOMOGRAPHIC EVALUATION OF ANATOMIC AND PATHOLOGIC VARIATIONS IN THE FELINE NASAL SEPTUM AND PARANASAL SINUSES

The purpose of this study was to compare the prevalence of nasal septal deviation and variations of the paranasal sinuses in normal and diseased cats. Prevalence of nasal septal deviation was 86.7%, 68.4%, and 71.4% in cats with rhinitis, neoplasia, and normal cats, respectively, with no statistically significant difference (P = 0.244). There was a statistically significant difference (P = 0.01) in the magnitude of nasal septal deviation between cats with and cats without nasal disease, using a cutoff value of 1 mm for maximum distance of deviation from midline. There was a statistically significant difference (P = 0.019) between cats with rhinitis and neoplasia when comparing the presence of a mass (7.7% and 53.8%, respectively), but not when comparing for lysis of the septum. Deviation of the frontal sinus septum occurred in 27.7% of all cats, while the sphenoid septum was oblique and eccentric in 96.6% of all cats. The mean length of the frontal sinus was longer in male cats than female cats. The presence of nasal septal deviation alone cannot be used as a criterion to diagnose nasal disease, but cats with rhinitis or neoplasia have more marked deviation than normal cats. The presence of a mass and lysis of the septum were only seen in cats with nasal disease and a mass is more likely to be seen with neoplasia than rhinitis. Male cats have a longer frontal sinus than female cats. Almost all cats have an oblique, eccentric sphenoid septum.     

Correction of Rotational Deformity of the Pes with External Skeletal Fixation in Four Dogs

Objective— To report unilateral correction and initial stabilization with external skeletal fixation (ESF) of metatarsal rotation in 4 immature Bernese Mountain Dogs.
Study Design— Case series.
Animals— Bernese Mountain Dogs (n=4).
Methods— The limb deformity, including degree and origin of the deformity at the level of the proximal intertarsal joint and involvement of the central tarsal bone, was characterized by clinical and radiographic assessment. Unilateral surgical correction of the most severely affected limb was performed by disrupting the ligaments and debriding the articular cartilage of the proximal intertarsal joint to allow for derotation of the deformity and arthrodesis of the proximal intertarsal joint stabilized with either circular or linear ESF.
Results— Initial metatarsal rotation of the corrected limbs ranged from 60° to 80° of external rotation (mean, 72.5°). Three limb corrections were stabilized with circular ESF and 1 with a biplanar linear ESF. Implants were removed at the time of radiographic bony union (range, 7–10 weeks; mean, 8.6 weeks). Residual deformity was minimal, ranging from 6° to 15° (mean, 11°). Two minor complications (loosening of 1 pin, serous drainage from 1 pin) resolved with treatment.
Conclusion— Correction of rotational deformity of the pes with intertarsal arthrodesis yielded an excellent clinical outcome, with only a mild residual deformity.
Clinical Relevance— Rotational metatarsal deformities can have a significant impact on gait, ambulation, and appearance. Correction of these deformities and stabilization with ESF and intratarsal arthrodesis can yield an excellent functional outcome, with improved gait and ambulation.     

A dorsal approach for the removal of the nasal septum in the horse

OBJECTIVE: To describe and evaluate a technique involving a dorsal approach for the removal of the nasal septum in adult horses. STUDY DESIGN: Retrospective clinical study. ANIMALS: Four client-owned horses. METHODS: Access for partial nasal septum resection was through a dorsal nasal bone flap. Septum resection was performed because of reduced airflow from septal deviation and/or thickening caused by traumatic insult or neoplasia. Preoperative clinical signs and diagnostic results were recorded. Intra- and postoperative complications were noted and follow-up information was obtained from telephone interviews of owners or by clinical examination. RESULTS: The abnormal segment of the nasal septum was completely removed in all horses. A dorsal nasal bone flap approach provided excellent access to the septum and allowed immediate control of hemorrhage; blood transfusion was not needed. Cosmetic results were considered good to excellent by owners and horses returned to their previous level of work without perceived limitations associated with airway function. CONCLUSIONS: Nasal septum resection by the dorsal approach permits good observation of the abnormal septum, and provides exposure that facilitates removal of nasal masses and reduction of depression fractures with minimal complications. CLINICAL RELEVANCE: A dorsal nasal bone flap approach should be considered for horses that require nasal septum resection because it can be achieved with minimal hemorrhage, good cosmetic results, and return to function.     

Mandibular Osteodistraction for Correction of Deep Bite Class II Malocclusion in a Horse

Objective— To describe a technique for, and outcome after, mandibular osteodistraction in the horse.
Study Design— Clinical report.
Animals— Warmblood horse.
Methods— A half ring external fixator was applied on both sides of an osteotomy site performed on the mandible of a colt. A bite plate was placed on the upper incisors creating occlusion between lower and upper jaw. After a 5-day latency period, distraction was applied (1 mm/day) until the overjet was judged normal.
Results— Mandibular elongation and correction of brachygnathia was obtained without major complications. Six months after the procedure the overjet reduction was considered stable.
Conclusions— Mandibular osteodistraction can be considered for treatment of severe brachygnathia in yearlings.
Clinical Relevance— Distraction osteogenesis has the advantage of progressive elongation of the mandible, allowing concurrent bone remodeling and soft tissue adaptation. Severe mandibular incisor malocclusion in horses outside the maximal growth phase can be corrected using this technique.     

Nasal polyps in dogs: five cases (2005 to 2011)

This series describes five dogs with nasal polyps diagnosed between 2000 and 2011. Clinical signs included reverse sneezing, nasal discharge, epistaxsis, and stertor when breathing. Computerised tomographic findings included soft tissue mass, turbinate destruction, extension through the bony nasal septum and partial lysis of bones surrounding the nasal cavity. Three dogs were treated by dorsal rhinotomy, one dog was treated by ventral rhinotomy, and in one dog the polyp tissue was removed during nasal flushing. Three dogs have no clinical signs of nasal disease. One dog had confirmed recurrence of nasal polyps and was successfully treated with megavoltage radiation. One dog had recurrent nasal disease eight months after dorsal rhinotomy. Nasal polyps are a possible cause of nasal disease in dogs with nasal discharge, epistaxsis and stertor, and a differential diagnosis for dogs with extensive soft tissue lesions of the nasal cavities on computerised tomography. Nasal polyps can be treated successfully by rhinotomy in some cases but may reoccur.     

Campylorrhinus lateralis,Bilateral microphthalmia and odontoma temporalis in an Oldenburg Foal

An Oldenburg colt with wry nose was autopsied after having lived for only 30 min. It presented cyanotic oral mucosae, underdeveloped eyes and a right‐sided temporal osseous mass. The applicable nomenclature for the defects is discussed, and the potential etiopathogenesis is explored by describing the normal embryonic development of the affected body parts.     

An investigation into the usefulness of a rostrocaudal nasal radiographic view in the dog

A rostrocaudal (RCd) nasal view was developed in large breed mesaticephalic dogs using a complete, subsequently sectioned, skull and cadaver specimens to optimise the radiographic technique and evaluate normal anatomic features. Gelatin was placed in one nasal passage of the cadaver specimens to mimic the effects of nasal pathology. The latter specimens and 18 clinical cases with suspected nasal disease were evaluated to determine the usefulness of the RCd view compared to standard nasal views. An optimal RCd view was obtained with the dog in dorsal recumbency and the head symmetrically positioned with the hard palate perpendicular to the table using a table top technique with 8:1 grid, collimating to the nasal region and centring the primary beam on the philtrum. The dorsolateral aspects of the maxillary bone, the nasal bones, septal sulcus of the vomer, mucosa lined nasal septum and conchae could be seen. A centrodorsal more radiolucent area representing the ethmoid bone region was also visible. Gelatin soft tissue opacification of the nasal passage could be seen more clearly in RCd nasal view than in occlusal dorsoventral view. In clinical cases the RCd view was useful to build up a 3-dimensional image of nasal passage pathology as well as to detect nasal septum and osseous nasal border pathology not visible in other views. This view is particularly useful in cases where cross-sectional imaging modalities are not available or where the nasal investigation is limited by cost considerations.     

The radiological features of sixty cases of intra-nasal neoplasia in the dog

The radiographs of 60 cases of canine nasal neoplasia were reviewed. The dorso-ventral intra-oral view provided most information and the lateral view supplied supplementary detail. The most common changes were turbinate destruction rostrally and caudally, with a homogenous increase in radiopacity. Bilateral involvement was present in 38 cases. Absence (26) and thinning (7) of the vomer bone were found, as was deviation of the cartilaginous septum (11). Destruction of the maxilla or palatine bones produced radiolucencies which were superimposed on the increased radio-opacity in 17 cases.     

OSTEODYSTROPHIA FIBROSA IN HORSES AT PASTURE IN QUEENSLAND: FIELD AND LABORATORY OBSERVATIONS

Horses grazing manily Cenchrus ciliaris and/or Panicum maximum var. trichoglume pastures on over 30 properties in southern central Queensland developed lesions of osteodystrophia fibrosa. Horses on individual properties in coastal Queensland grazing Setaria anceps, Brachiaria mutica or Pennisetum clandestinum also developed the disease. Ill-thrift, lameness, and fibrous swellings of nasal bones, maxillae and mandibles were observed. Calcium and phosphorus levels of pasture were normal but all the above pasture species contained oxalates which were suspected of causing the disease.     

COMPUTED TOMOGRAPHIC IMAGING OF NASAL DISEASE IN 100 DOGS

One hundred dogs with nasal disease were evaluated by computed tomography (CT). Certain findings were significantly correlated with neoplasia. These included patchy areas of increased density within soft tissue opacity, destruction of part or all of the ethmoid bones, abnormal soft tissue in the retrobulbar spaces, destruction of one or both the lateral maxillae, destruction of the nasal bone or rostral dorsal maxilla, or hyperostosis of the lateral maxilla. Combinations of these findings were even more significant for neoplasia. No single finding or combination of findings was absolutely definitive of neoplasia. The results of this study are useful in indicating that biopsy results should be questioned if one or more of the above factors is present and a diagnosis of inflammation is made.     

Contribution of the nasal septum to the radiographic anatomy of the equine nasal cavity

The radiopacity of the equine cartilaginous nasal septum and its covering mucosa seen on dorsoventral radiographs was determined to be of sufficient density to be useful in the diagnosis of any disorder of this anatomic structure. Radiographically, the frontal and nasal bones dorsally and the vomer and palatine process of the incisive bone ventrally do not completely obscure the nasal septum and its covering mucous membrane.     

Hinged Ilizarov External Fixation for Correction of Antebrachial Deformities

Objective —To evaluate hinged circular external fixation for correction of antebrachial deformities in dogs.
Study Design —Uncontrolled clinical trial.
Animal Population —Seven client-owned dogs.
Methods —Six dogs had one radius corrected and one dog had both radii corrected. Preoperative planning included measurement of the craniocaudal and mediolateral angular deformities, rotational deformity, length deficit, origin of deformity, graphical or mathematical determination of the amplitude and direction of the actual limb deformity, and frame assembly.
Results —Preoperatively, function and cosmesis were assessed to be fair to poor in all dogs. Deformity correction started 48 to 60 hours postoperatively and ranged from 0.46 mm to 1.36 mm twice daily. Hospitalization time ranged from 4 to 6 days. Corrections were mostly made by the owners, at home. Lengthening and angular correction ranged from 3 to 38 mm and 18° to 48°. Mean residual deformities were 2.7% of radial length and 2.7°. The time duration with the circular external fixators in place ranged from 29 to 71 days. Two additional surgeries were necessary in one dog because of wire breakage. Mean follow-up was 40 months. Long-term function and cosmesis were good to excellent in all dogs.
Conclusion—Although complications were present in six of seven dogs, the outcome of hinged Ilizarov external fixation was successful in all dogs treated for deformities of the antebrachium.
Clinical Relevance —Despite complex preoperative planning, the placement of hinged circular external fixators is straightforward, and allows precise correction of complex antebrachial deformities with minimal tissue trauma.