Pinless External Fixation of Mandible Fractures in Cattle

Objective — This report describes our experience with a new technique for stabilization of mandibular fractures in cattle using a pinless external fixator.
Study Design — Mandibular fractures were stabilized with a pinless external fixator, which is a modification of a unilateral AO/ASIF (Association for the Study of Internal Fixation)-fixator in which pins are replaced with bone clamps.
Animals — Seven dairy cattle between 1 and 5 years of age.
Methods — Fracture stabilization was achieved by using the pinless external fixator. Postoperative management included intravenous administration of sodium chloride-glucose and antibiotics. A suspension of ruminal contents from a normal cow together with linseed and grass pellets was administered with a gastric tube.
Results — Three to 10 days after surgery six of seven cows masticated comfortably. The only failure was a yearling with a 10-day-old open infected fracture. This animal was slaughtered 9 days after surgery because of additional problems. In six cases there was enough callus formation 33 to 54 days after surgery to stabilize the fracture. The fixation devices were removed under heavy sedation. The major complication was bone sequestration at the fracture site, which required additional treatment.
Conclusion — The pinless fixator has proven satisfactory for external stabilization of unilateral horizontal ramus fractures of the mandible in cattle.
Clinical Relevance — The technique provides good stability without penetration of the medullary cavity and damage to the tooth roots. Other advantages of the technique include ease of application, minimal surgical trauma, and the short surgical time for application.     

Immediate mandibular reconstruction of a 5 cm defect using rhBMP-2 after partial mandibulectomy in a dog

Objective— To report treatment of a complex odontoma of the mandible by partial mandibulectomy and immediate surgical reconstruction using bridging plate fixation with a synthetic graft.
Study Design— Clinical case report.
Animals— A 4-year-old male castrated cocker spaniel.
Methods— Immediate reconstruction of the left mandible (5 cm gap) was performed after complete excision of a complex odontoma. Locking plate fixation was applied immediately before complete excision of the mass. Fixation was removed, then after partial mandibulectomy, including all abnormal tissue, restored to achieve occlusion. The resulting mandibular defect was filled with recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered in an absorbable collagen sponge containing hydroxyapatite/tricalcium phosphate granules (compression resistant matrix [CRM]).
Results— New bone growth was evident radiographically and on palpation at 3 months. Bony remodeling was evident during follow-up examinations up to 26 months. Bone collected by biopsy at the graft site at 7 months had robust new bone formation and evidence of continued remodeling. Only minor complications (repeated intraoral plate exposure) were encountered postoperatively and were easily resolved.
Conclusions— An osteoinductive factor (rhBMP-2/CRM) was successfully used as a graft substitute in immediate reconstruction of a large mandibular defect.
Clinical Relevance— Immediate reconstruction of large mandibular defects with osteoinductive materials as a graft substitute may be a viable alternative to partial mandibular resection or radiation therapy for benign odontogenic tumors in dogs.     

Coronoidectomy as a treatment for mandibular immobility caused by fracture of the coronoid process in three horses

This report describes the history, clinical signs and treatment of three horses suffering from deviation and immobility of the mandible resulting from fracture of a coronoid process of the mandible. Deviation and immobility resulted from impingement of a callus between the temporal bone and zygomatic arch. Fracture of the coronoid process was identified by using radiography, ultrasonography, computed tomography or a combination of two or more of these imaging modalities. Osteoarthritis of the ipsilateral temporomandibular joint of two horses was identified. All horses were treated by excising the fractured coronoid process, and two were also treated by excising the diseased ipsilateral mandibular condyle. All horses were able to open their mouth more widely immediately after surgery. One horse experienced moderate post-operative haemorrhage, and all had severe shear mouth. Shear mouth was ameliorated gradually over many months by rasping dental overgrowths. Mandibular movement of all horses improved, allowing efficient mastication of feed. One horse was able to be used as a showjumper, one horse was sold at Thoroughbred yearling sales and was lost to follow-up, and one horse died from an unrelated gastrointestinal disease 10 months after mandibular coronoidectomy and condylectomy.     

Mandibular Rim Excision in Seven Dogs

Objective— To describe a surgical technique for excision of minimally invasive mandibular tumors at the level of the premolar and molar teeth, and report outcome in 7 dogs that had mandibular rim excision. Study Design— Case series. Animals— Dogs (n=7) with a mandibular tumor at the level of the premolar and molar teeth. Methods— Using an intraoral approach to the mandible, buccal, and lingual mucosal incisions are made to obtain a 10 mm clean margin beyond neoplastic tissue. After subperiosteal soft tissue elevation, a curvilinear rim mandibulectomy is performed, leaving the mandibular canal and ventral cortex intact, followed by osteoplasty. The remaining attached gingiva and alveolar mucosa are sutured over the bony defect. Results— Seven dogs were treated (1997–2008) for odontogenic and early malignant neoplasms involving the mandible by mandibular rim excision. All dogs had healed, healthy gingival covering over the surgical defect, very good postoperative function, and good quality of life. Conclusion— Mandibular rim excision, with preservation of the ventral cortex and mandibular canal content, can be a good option for treatment of early odontogenic and malignant lesions of the mandible in medium to large breed dogs. Clinical Relevance— In medium to large dogs with minimally invasive mandibular neoplasia, mandibular rim excision should be considered as a viable surgical option.     

Repair of a longitudinal scapular fracture in a horse

Objective— To report repair of a longitudinal scapular fracture in a horse.
Study Design— Case report.
Animals— A 2-year-old Paint Horse colt.
Methods— A longitudinal scapular fracture was surgically repaired using four 4.5 mm dynamic compression plates.
Results— An acute longitudinal scapular fracture repaired surgically returned the horse to soundness within 6 months.
Conclusions— Internal fixation of longitudinal scapular fracture is possible with multiple 3–5 hole dynamic compression plates.
Clinical Relevance— Longitudinal fractures of the scapula should be considered when there is lateral instability of the shoulder after trauma. A displaced fracture can be adequately stabilized by internal fixation with a reasonable prognosis for soundness.     

Ovine craniofacial malformation: A morphometrical study

Craniofacial malformation in 64 sheep was phenotypically described as mandibular distoclusion. Digital radiographs were examined in order to determine the degree of morphological changes in certain bones of the skull. Therefore, laterolateral standardised digital radiographs were used to determine anatomic reference points. Subsequently, five reference lines were defined and 16 linear and seven angular measurements were determined to describe malformations in the bones of the skull. Statistical analysis revealed a significant shortening of the rostral part of the corpus mandibulae and of the ramus mandibulae. However, the molar part of the mandible remained unchanged. These morphological changes caused premolar and molar malocclusion. No further craniofacial abnormalities, such as an elongation of the maxilla or of the incisive bone, were identified. In conclusion, the phenotypically observed mandibular distoclusion is caused by a shortening of specific parts of the mandible. This form of ovine craniofacial malformation is therefore best described as brachygnathia inferior.     

Congenital odontogenic keratocyst in a filly

This report describes a congenital odontogenic keratocyst in the left mandible of a filly. A definitive diagnosis was only made after histopathological examination. Mandibular cysts of odontogenic and osteogenic origin have been reported in the past but a case of a keratocyst has not been previously reported in the horse.     

Surgical reconstruction of a severely comminuted mandibular fracture in a horse

A Palomino gelding presented for evaluation of a mandibular fracture and physical examination revealed swelling and excoriation of the skin over the ventral mandible. Upon further examination, malalignment of the incisors was appreciated in addition to instability and crepitance of both the rostral aspect and vertical ramus of the mandible. Radiographic examination revealed a comminuted fracture within the interdental space and fractures of both vertical ramii of the mandible. Under general anaesthesia via tracheotomy intubation, the fractures of the vertical ramii were reduced and compression plating techniques used along the caudal‐lateral border of both ramii for stabilisation. Intraoral tension band wires were used for repair of the interdental space fracture. A type II external skeletal fixator using Steinmann pins and polymethyl methacrylate connecting bars was applied to increase stability. The horse was maintained on broad spectrum antibiotics and phenylbutazone and discharged following 6 days of hospitalisation. Radiographs were taken 10 weeks after surgery and revealed evidence of adequate healing. On follow‐up 20 months later, the horse was reported to have no difficulties eating and was maintaining its bodyweight. This case is unique due to the severity of the mandibular fracture. The authors are unaware of any previous reports of such a severely comminuted mandibular fracture and its successful reconstruction employing multiple surgical techniques.     

Transpalpebral eye enucleation in 40 standing horses

Objective— To report a technique for eye enucleation in standing sedated horses and to report outcome in 40 horses.
Study Design— Retrospective study.
Animals— Horses (n=40) requiring eye enucleation.
Methods— The eye was enucleated using a transpalpebral technique in 40 horses restrained in stocks and sedated. Anesthesia of orbital structures was provided by local nerve blocks and infiltration of the surgical site with local anesthetic solution.
Results— Affected eyes were successfully enucleated with the horse standing. Short-term complications included moderate swelling (5 horses) and wound discharge (1). Long-term complications were not observed.
Conclusions— A diseased eye can be safely enucleated with a horse standing.
Clinical Relevance— Enucleating an equine eye in the standing position eliminates the risks and costs of general anesthesia.     

Actinomycosis of the mandible, mimicking a malignancy in a horse

Osteomyelitis of the mandible with Actinomyces species was diagnosed in a 4-year-old sports horse with radiographic changes suggestive of neoplasia. Surgical debridement, intravenous and local iodine solution treatment were administered. Mandibular Actinomyces infections are reported in humans and ruminants; they have not been previously reported in the horse.     

Endoscope-guided, transoral axial division of an entrapping epiglottic fold in fifteen standing horses

Objectives— To describe and evaluate the use of a transoral, endoscope-guided technique for transection of an entrapping epiglottic fold in sedated standing horses.
Study Design— Retrospective study.
Animals— Horses (n=16) with epiglottic fold entrapment (EFE).
Methods— Medical records (2005–2006) of 16 horses with EFE were reviewed to determine history, physical and endoscopic examination findings, postoperative complications, and outcome after axial division of EFE using a hooked bistoury, under an endoscopic-guided, transoral approach.
Results— EFE was confirmed by endoscopy. Axial division was successfully performed in 15 sedated, standing horses. One horse had to be anesthetized to complete the procedure. None of the horses made abnormal respiratory noise after surgery and all returned to their intended use. After surgery, 1 horse had a short, deformed epiglottis.
Conclusions— EFE can be axially divided safely and effectively using an endoscope-guided, transoral approach, with the horse sedated and standing.
Clinical Relevance— Endoscopic-guided, transoral axial division of EFE in sedated standing horses is an alternative choice to performing this procedure under general anesthesia.     

Mandibular Condylectomy Technique and Results in Normal Horses

A technique of mandibular condylectomy and menisectomy is described. Unilateral condylectomy and menisectomy were performed in two horses, and two horses were treated by bilateral condylectomy and unilateral meniscectomy. Minor temporary alterations in mastication occurred following unilateral condylectomy; more severe and longer lasting abnormalities of prehension and mastication occurred following bilateral condylectomy. Malocclusion occurred in all horses following surgery but was only clinically significant in one horse that developed occlusion of the lower incisor teeth 3 mm caudal to the upper incisor teeth following bilateral condylectomy. Maximal mouth opening was normal following unilateral condylectomy and increased following bilateral condylectomy, both immediately following surgery and after 16 weeks. Maximal lateral deviation of the mandible was increased immediately following unilateral and bilateral condylectomy; 16 weeks following surgery one joint had increased, and two had normal and three had decreased maximal lateral deviations. On radiographic, gross, and histological evaluation, the condylectomy sites underwent remodelling and bony proliferation to produce "pseudo" condyles. At necropsy, 16 weeks following surgery, five of the six operated temporomandibular joints contained fibrous tissue with single or multiple cavities lined by synoviocytes. The nonoperated temporomandibular joints were normal. Functional use of the mandible was good in three horses; the fourth horse developed significant malocclusion and had satisfactory function following bilateral condylectomy.     

Arthroscopic Removal of Metallic Foreign Body from the Talocrural Joint Using a Magnetic Retriever in a Horse

Objective— To report use of a magnetic retriever for arthroscopic removal of a metallic foreign body from the equine talocrural joint.
Study Design— Clinical report.
Animals— A 2-year-old Warmblood stallion.
Methods— A metallic foreign body was removed from a talocrural joint using a 10-mm magnetic retriever under arthroscopic guidance. Preoperative radiographs were used to locate the intra-articular position of the foreign body.
Results— Six months after surgery, the horse was no longer lame.
Conclusions— A magnetic retriever can be used for arthroscopic removal of metallic foreign bodies from the equine talocrural joint.
Clinical Relevance— A magnetic retriever may be useful for arthroscopic retrieval of metallic foreign bodies from synovial cavities in horses, especially when direct observation is impeded by inflamed synovial villi and fibrin.     

Locking Compression Plates for Pancarpal Arthrodesis in a Thoroughbred Filly

Objective— To report treatment of a comminuted ulnar carpal (UC) bone fracture associated with carpal instability by pancarpal arthrodesis using 2 locking compression plates (LCP).
Study Design— Case report.
Animals— A 2-year-old Thoroughbred filly.
Methods— An UC fracture and luxation of the proximal row of carpal bones was diagnosed radiographically. Pancarpal arthrodesis was performed with 2 LCP positioned dorsolaterally and dorsomedially and centered over the carpus through a single skin incision. The filly was maintained in a full limb cast for 15 days, followed by a tube cast for 14 days, and subsequently a full limb bandage with caudal splint for 21 days.
Results— Two LCP provided appropriate carpal stability resulting in a pasture sound horse 6 months after surgery. The filly was discharged from the hospital 63 days after surgery, walking well with only a slight mechanical lameness.
Conclusion— Use of 2 LCP applied on the dorsomedial and dorsolateral aspect of the carpus can provide carpal stability for pancarpal arthrodesis.
Clinical Relevance— Excellent stability of the carpal joints can be achieved with 2 LCP.     

Multiple Osteochondral Autografts for Treatment of a Medial Trochlear Ridge Subchondral Cystic Lesion in the Equine Tarsus

Objective— To adapt the multiple osteochondral autograft technique for treatment of a subchondral cystic lesion (SCL) of the proximal medial trochlear ridge (MTR) of the equine talus and assess long term outcome.
Study Design— Case report.
Animals— Quarter horse stallion with SCL of the proximal MTR of the talus.
Methods— Osteochondral autograft techniques used in dogs and humans were adapted and optimized in equine cadavers. A horse with a SCL of the MTR of the talus was treated by osteochondral autografting. Three osteochondral autografts were harvested from the distal lateral trochlear ridge of the talus in the affected tarsus. No curettage or debridement of the osteochondral lesion was performed. Three recipient beds were predrilled and osteochondral autografts were press-fit into the proximal MTR of the talus. Outcome was assessed by radiography, telephone interview of the owner, and direct observation during training.
Results— Postoperative radiographs indicated excellent filling of the osteochondral defect and graft-articular surface congruency. No complications were encountered after surgery. At 10 months after surgery, the horse successfully re-entered reining training, and continued to be sound and performing athletically 2 years after surgery.
Conclusion— Osteochondral autografting deserves consideration and further evaluation as a primary treatment option for SCL of the proximal MTR of the talus in horses.
Clinical Relevance— Based on the outcome of this case, osteochondral autografting appears to be a safe, valuable and realistic option for treating SCL of the proximal MTR of the talus in equine athletes.     

Repair of Bovine and Equine Mandibular Fractures

Clinical findings, surgical repair and postsurgical care of a unilateral fracture of the mandible of a bull and of a bilateral mandibular fracture in a horse are described. Compression plating limited the pain suffered by the animals and resulted in a quick return to function of the mandibles.     

Laparoscopic Removal of a Large Abdominal Testicular Teratoma in a Standing Horse

Objective— To describe laparoscopic removal of a large testicular teratoma in a standing horse.
Study Design— Clinical report.
Animals— Thoroughbred horse (11 months) with a testicular teratoma.
Methods— A unilateral cryptorchid testicle could not be removed by an inguinal approach under general anesthesia because of it s large size. After recovery from general anesthesia, ultrasound evaluation revealed a 24 × 19 cm fluid-filled testicular mass. The mass was removed by paralumbar fossa laparoscopy with the horse in a standing position. After fluid aspiration of the mass, the mesorchium and ductus deferens were ligated with extracorporeal knots and the mass retrieved inside a laparoscopic specimen pouch. Morphologic features were consistent with a teratoma.
Results— Laparoscopic-guided aspiration of fluid from the teratoma decreased mass size and increased ease of manipulation and retrieval. Retrieval of the teratoma in a laparoscopic specimen pouch prevented loss of abdominal insufflation, helped reduce fluid leakage, and potential seeding of neoplastic cells.
Conclusion— Use of laparoscopy for removal of neoplastic cryptorchid testicles offers many advantages including minimal invasiveness and increased safety associated with good visibility of structures.
Clinical Relevance— Standing laparoscopic surgery should be considered for removal of testicular neoplasms in horses.     

Multicentric leiomyosarcoma in a young male horse

A 2-year-old male Thoroughbred was evaluated for multiple firm, raised nodules of the maxilla and mandible that had been present since 6 months of age. The horse was evaluated as a yearling with a final histologic diagnosis of fibrosarcoma. As a 2-year-old, the colt made a loud upper airway sound and was agitated after strenuous exercise. Results of upper airway endoscopy indicated severe narrowing of the nasal passages and pharynx with normal resting function. Radiography revealed multiple circular bony lesions in the mandible, maxilla, multiple long bones, and cervical vertebrae. Biopsy specimens of the left mandible and right facial bone were obtained. A diagnosis of leiomyosarcoma with extensive metastatic bone formation was made on the basis of histologic features and the immunohistochemical staining properties of the biopsy specimens. Because of the diffuse distribution of the lesions, prognosis was guarded; 4 years after diagnosis, the horse had not pursued an athletic career.     

Congenital branchial apparatus malformation in a Haflinger colt

Objective— To report the diagnosis and treatment of a branchial apparatus anomaly (BAA) associated with a mandibular malformation in a foal.
Design— Clinical report.
Animal— Haflinger foal.
Methods— A 6-day-old foal had a fluctuating cystic mass in the pharyngeal (throatlatch) region, which changed in appearance after ingestion of milk. Upper airway endoscopy and diagnostic imaging (ultrasonography, radiography, computed tomography) permitted identification of the anatomic location of a communicating tract between the lumen of the cystic mass and the pharynx. The mass was surgically removed and communication with the pharynx ligated. Histologic appearance of this mass was consistent with a branchial cyst or sinus. The mandibular malformation was managed conservatively.
Results— Surgical resection of a third branchial sinus resulted in an excellent functional and cosmetic outcome. There was no evidence of any mandibular deformity 2 years later.
Conclusion— BAA may induce secondary mandibular deformation in utero and may cause respiratory compromise postpartum. Careful surgical dissection and removal of BAA resulted in an excellent outcome.
Clinical Relevance— BAAs should be included in the differential diagnosis of a throatlatch region mass in equine neonates. Complete surgical excision is recommended and full recovery of any associated mandibular deformity may be anticipated without additional treatment in very young patients.