Treatment of guttural pouch tympany in foals with transnasal Foley catheter placement

This case series describes a technique to treat guttural pouch tympany that may be useful to equine practitioners. The objective of this work is to describe the treatment technique, outcome, possible complications and benefits. Data from a retrospective case series obtained by records review and follow‐up with owners and referring veterinarians were used. Foley catheters were placed into the guttural pouch using endoscopic guidance via the nasal passage, the balloon inflated and the catheter sutured to the external nares under tension. Foals were treated successfully with this method and complications were minor. This treatment method is a viable, low‐cost option for guttural pouch tympany in foals.     

Guttural pouch empyema caused by Corynebacterium pseudotuberculosis in a pregnant mare

During medical management of mild colic in a 12‐year‐old Quarter Horse, mid‐gestation mare, unilateral purulent nasal discharge from the right nostril was noted. Endoscopic examination revealed guttural pouch empyema. Culture was positive for Corynebacterium pseudotuberculosis and negative for Streptococcus equi ssp. equi. A synergistic haemolysis inhibition titre of 1024 was consistent with C. pseudotuberculosis infection. Treatment included serial lavages and local infusion of antibiotics into the guttural pouches along with a 6‐week course of oral trimethoprim–sulfamethoxazole and rifampicin. Overall, no additional sites of infection were identified and the mare responded well to treatment, delivering a healthy, full‐term foal. This case emphasises that C. pseudotuberculosis, although uncommon, should be considered as a differential for guttural pouch empyema.     

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.     

Dysphagia caused by focal guttural pouch mycosis: mononeuropathy of the pharyngeal ramus of the vagal nerve in a 20-year-old pony mare

A 20-year-old pony mare was presented to the equine hospital with a ten-day history of dysphagia, regurgitation and coughing. An obstruction of the oesophagus was excluded via endoscopy, but the proximal oesophagus appeared to be distended and circular contractions were missing. A guttural pouch endoscopy revealed a single, black-mottled plaque on the pharyngeal ramus of the vagus nerve in the left guttural pouch, causing a local swelling of this nerve. The pharyngeal ramus seemed to be atrophic distal to the lesion. A biopsy was taken from the lesion and histopathological findings proved the reasonable suspicion of a guttural pouch mycosis with a high degree of purulent-necrotic inflammation and invasion of fungal hyphae. There were no signs of neoplasia, such as melanoma. Daily guttural pouch irrigations with a clotrimazole emulsion (20 g Canesten^® Gyn⁴ solved in 500 ml water), led to a good recovery of the mucosa above the nerve. Periodic endoscopic examination of the left guttural pouch showed that local thickening and distal atrophy of this pharyngeal ramus did not improve, neither did the clinical symptoms. Due to progressive weight loss, acute respiratory distress and aspiration pneumonia, the 20-year-old pony mare unfortunately had to be euthanized three weeks after discharge. This case report emphasizes the enormous importance of a single nerve for the realization of the swallowing process. The one-sided loss of function of the pharyngeal branch of the vagal nerve cannot be compensated neither by the remaining ipsilateral nerves nor by the contralateral normal functioning glossopharyngeal and vagal nerves and thus inevitably leads to severe dysphagia.     

Treatment of equine glaucoma by transscleral neodymium:yttrium aluminum garnet laser cyclophotocoagulation: a retrospective study of 23 eyes of 16 horses

Contact neodymium:yttrium aluminum garnet (Nd:YAG) laser transscleral cyclophotocoagulation (TSCP) was performed on 23 eyes of 16 horses for treatment of glaucoma. The mean highest preoperative IOP was 51 ± 17 mmHg. Follow-up evaluation was available for 19 eyes 1 day after surgery, 14 eyes from 1 to 2 weeks, 16 eyes from 4 to 6 weeks, 9 eyes from 12 to 16 weeks, and 10 eyes greater than 20 weeks after laser treatment. The mean intraocular pressure (IOP) the day following surgery was 34 ± 13 mmHg. The mean IOP for each follow-up period was: one to two weeks postoperative, 23 ± 9 mmHg; four to six weeks, 24 ± 7 mmHg; 12–16 weeks, 28 ± 10 mmHg; and  20 weeks, 22 ± 9 mmHg. IOP measurements were significantly different from pretreatment values for all follow-up intervals except for weeks 12–16 ( P < 0.05). Treatment success was defined as maintenance of IOP < 30 mmHg. Treatment success was achieved in 93%, 88%, 78%, and 70% of the treated eyes at the 1–2 weeks, 4–6 weeks, 12–16 weeks, and the  20 weeks re-evaluation, respectively. No significant difference was found between the number of eyes visual at presentation (52.2%) and visual at 20 weeks (60%). The most common laser complications were conjunctival hyperemia (21.7%) and corneal ulcers (13.0%). Results of this study indicate that Nd:YAG TSCP is an effective method of controlling IOP and preserving vision in horses with glaucoma. An effective Nd:YAG laser protocol for TSCP in the equine glaucomatous eye is a power setting of 11 W, duration of 0.4 s, applied 5 mm posterior to the limbus at 60 sites, resulting in a total energy dose of 264 J.     

Occurrence of a vaginal septum in a foal diagnosed with pyometra

A 10-week-old Westphalian filly was presented for vaginal discharge of 14-days' duration. Examination revealed a partial vaginal septum and pyometra. Two Group B streptococcal pathogens (Streptococcus dysgalactiae subspecies equisimilis and Streptococcus equi subspecies zooepidemicus) were isolated from the uterus. Pyometra was successfully treated using endoscopically facilitated removal of intraluminal exudate and locally and systemically administered antimicrobials. The filly was reported to be progressing well at 12 months following treatment with no further evidence of disease. Pyometra has not been previously reported in foals, and vaginal septum is evidently rare in this species. These abnormalities should be considered when young fillies develop purulent vaginal discharge.     

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.     

Surgical treatment of extensive chondroid formation in the guttural pouch of a Warmblood horse

A Warmblood horse presented with a purulent nasal discharge that had failed to respond to antibiotic therapy. Radiography and endoscopy confirmed a large number of chondroid masses (over 200) in the left guttural pouch. Despite the large number of chondroids present, there was no external swelling evident. The masses were surgically removed via a hyovertebrotomy approach that provided excellent exposure, and no postoperative complications were encountered. Long term follow-up (3 years) confirmed a successful outcome.     

Surgical management of a pony with a traumatic medial luxation of the patella

This report describes a successful surgical repair of medial patellar luxation in a Miniature Shetland pony where manual reduction of the patella was not possible. The surgical procedure involves transection of the medial femoropatellar ligament to facilitate patellar release, the placement of a prosthetic suture to replace the lateral femoropatellar ligament and reinforcement of the lateral retinaculum by the use of a mesh implant. This is a newly described surgical technique for the rare but recognised condition of a medial luxation of the patella.     

Effect of ophthalmic Nd:YAG laser energy on intraocular lenses after posterior capsulotomy in normal dog eyes

OBJECTIVE: To determine Nd:YAG laser energy requirements for posterior capsulotomy and intraocular lens (IOL) damage threshold for foldable acrylic IOLs as compared to traditional polymethylmethacrylate (PMMA). MATERIALS AND PROCEDURES: Four groups of five-six fresh canine cadaver eyes were used in this study. The groups included (1) unaltered eyes (2) aphakic eyes (3) eyes implanted with PMMA IOLs, and (4) eyes implanted with acrylic IOLs. Laser energy was delivered to the posterior capsule in grid fashion for 10 sites each of five levels of laser energy ranging from 0.5 mJ to 9 mJ. Number of successful capsulotomy sites was recorded based on slit-lamp observation. Sites of IOL damage were evaluated using scanning electron microscopy (SEM). Statistical analysis of number of capsulotomies and IOL defects per laser energy level was conducted among and between groups using anova with Tukey's HSD test. RESULTS: When comparing groups (a) including all energy levels (n = 25) and (b) by specific energy levels (n = 5), there was no significant difference (P < 0.05) in number of successful capsulotomy sites between IOL types. The 50% incidence threshold for successful capsulotomy was 2.74 mJ for acrylic IOLs and 2.64 mJ for PMMA IOLs. Energy-dependent damage to both types of IOL was detected for medium, high-medium, and high laser energy. Calculated 50% damage threshold was 4.9 mJ for acrylic IOL and 5.7 mJ for PMMA IOL. Damage to the IOL varied subjectively between IOL type, but there was no significant difference in number of defects caused, with the exception of high-medium energy. CONCLUSIONS: Both posterior lens capsules and IOLs were disrupted in an energy-dependent manner with minimal difference in number of capsulotomy sites or damage to the IOL between acrylic and PMMA IOLs. A therapeutic margin between capsulotomy threshold (2.6-2.7 mJ) and IOL damage threshold (4.9-5.7 mJ) was determined to reliably achieve capsulotomies with minimal IOL damage for both acrylic and PMMA IOLs in normal canine cadaver eyes.     

Surgical treatment of synovial osteochondromatosis in the middle carpal joint of a pony

A 9‐year‐old Paint pony gelding presented for signs of left carpal swelling of 1–2 weeks' duration. Radiographic, ultrasonographic and arthroscopic evaluation of the left carpus was consistent with synovial osteochondromatosis. This presumptive clinical diagnosis was confirmed histopathologically. Arthroscopic removal of the osteochondral bodies resulted in resolution of the carpal effusion and return to previous athletic activity by 4.5 months post operatively. Arthroscopic removal of osteochondral bodies is the treatment of choice in cases of suspected synovial osteochondromatosis.     

Inguinal rupture with herniation of the urinary bladder through the scrotal fascia in a Shetland pony foal

Herniation of the urinary bladder in the inguinal region has not previously been described in the horse. A case of inguinal rupture with herniation of the bladder through the scrotal fascia in a 3‐month‐old Shetland pony, diagnosed by external palpation, urinary catheterisation and external ultrasonographic examination is reported. Surgical management of the case was by dissection of the scrotal fascia, partial cystectomy and unilateral castration. During the period of hospitalisation the only complication was a slight seroma, which resolved spontaneously. Follow‐up after 6 months did not reveal any abnormality.     

Diagnosis,treatment and outcome of spinal lymphoma in a pony

This report describes the diagnostic approach to, and treatment of, a case of severe pelvic limb ataxia in a Miniature Shetland pony. Diagnosis of an intradural‐extramedullary lesion at the level of T11–12 was made using CT myelography. Dorsolateral hemilaminectomy allowed surgical debulking of an intradural mass, diagnosed histopathologically as T cell rich B cell lymphoma. Post operative treatment with prednisolone, cytarabine and cyclophosphamide was tolerated well and the degree of ataxia reduced markedly, allowing the pony to return to normal management.     

Combined surgical and radiotherapy treatment of a mandibular ameloblastic carcinoma in a pony

A 9‐year‐old Welsh Section D gelding was referred to an equine hospital for evaluation and computed tomographic (CT) imaging of a left mandibular swelling. An expansile mass, found within the left mandible at the level of the caudal 2 cheek teeth, was surgically debulked and histology of the lesion identified it as an ameloblastic carcinoma. Radiotherapy using 4 fractions of 800 cGy, 7 days apart, was subsequently undertaken. The pony made excellent clinical progression following treatment. Repeat CT imaging at 7.5 and 19.5 months post surgery showed no apparent recurrence of the lesion and marked improvement in the remodelling of the mandible. In conclusion, radiotherapy in conjunction with surgical debulking appears to have been successful in treating an ameloblastic carcinoma in this pony and could be considered for similar tumours in other cases.