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.     

Surgical correction of wry nose in four horses

Objective— To describe surgical techniques used for correction of congenital nasal deviation (wry nose) in horses (wry nose) and to report outcome.
Study Design— Retrospective study.
Animals— Horses (n=4), 5–17 months old with wry nose.
Methods— Nasal deviation was corrected by transecting the premaxillae/maxillae and nasal bones at their site of maximum curvature and realigning and stabilizing the bones in a more normal alignment using internal fixation. The nasal septum was removed during the same anesthetic period.
Results— For each horse, physical appearance was improved and respiratory stridor eliminated.
Conclusions— Wry nose can be corrected by transecting the premaxillae/maxillae and nasal bones and stabilizing the transected bones in a more normal alignment; the nasal septum can be removed concurrently.
Clinical Relevance— Surgical correction of wry nose may provide a good functional and cosmetic outcome.     

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.     

Treatment of Mycotic Rhinitis With Itraconazole in Three Horses

Itraconazole, a third-generation azole, was evaluated for treatment of resistant nasal mycotic infections in horses. Two horses with Aspergillus spp nasal granulomas and 1 horse with Conidiobolus coronatus nasal infection were treated with itraconazole (3 mg/kg PO bid). One of the horses with nasal aspergillosis was also treated by surgical resection of the nasal septum. The treatment time for the horses ranged from 3 to 4.5 months. No adverse effects were noted in any of the horses during the treatment period. Peak and trough serum itraconazole concentrations were < 0.5 μg/mL in all 3 horses. Itraconazole (3 mg/kg PO bid) appears to be effective in the treatment of nasal Aspergillus spp infections in horses because the fungal infection was eliminated in both horses. One horse still had excessive nasal sounds during exercise and was retired from training, whereas the other horse returned to normal. The nasal C. coronatus infection appeared resistant to itraconazole treatment in the affected horse because the granulomas were still present after 4.5 months of treatment.     

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.     

Use of the Ilizarov method of distraction osteogenesis for the treatment of radial hemimelia in a dog

A 6-month-old female crossbred dog with unilateral radial hemimelia was treated with a circular external fixator. During the first surgery, the dog underwent transverse osteotomy through the distal ulnar physis and rotation of the distal ulnar fragment (epiphysis) together with the forepaw in a lateral direction to achieve contact with the end of the proximal ulnar segment (shaft of the ulna); a circular external fixator was then applied. After removal of the fixator, a cast was applied. The initial intent was to preserve mobility of the ulnocarpal joint; however, the joint fused naturally. A second surgery was performed to lengthen the ulna by use of distraction osteogenesis. An Ilizarov external fixator was used, and the ulna was lengthened 25 mm. During the third surgery, osteotomy of the distal portion of the ulna was performed to treat residual deviation of the forepaw. The surgical treatment resulted in satisfactory use of the limb and a better quality of life.     

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.     

Suture exostosis with concurrent nasal septum chondrosarcoma in a horse

A 15‐year‐old Hanoverian mare presented with a 10‐day history of facial swelling in the right maxillary and frontal regions, left epiphora and intermittent right epistaxis. Radiographs revealed suture exostosis of both nasofrontal sutures and a deviated and thickened nasal septum. Computed tomography (CT) of the skull revealed exostosis of the nasolacrimal sutures and ducts bilaterally of both nasofrontal sutures and of the right zygomatocomaxillary and lacrimomaxillary sutures. The mid‐to‐caudal aspect of the nasal septum was thickened and had multiple well demarcated hypoattenuated regions within the septum. Histological examination of biopsies taken from the right nasofrontal suture and the nasal septal mass revealed suture exostosis and nasal septum chondrosarcoma. The horse was treated with rest and anti‐inflammatories. The facial swelling and left epiphora were improved at 7 months telephone follow‐up. This report is the first to describe a nasal septum chondrosarcoma in a horse. Additionally, we suggest that the suture exostosis may have developed due to an alteration of the biomechanics of the skull sutures secondary to the septal tumour.     

Cosmetic rostral nasal reconstruction after nasal planum and premaxilla resection: technique and results in two dogs

Objective— To describe a novel reconstructive technique after nasal planum and premaxilla resection.
Study Design— Case report.
Animals— Dogs (n=2) with squamous cell carcinoma (SCC) of the nasal planum.
Methods— A 9-year-old neutered female Labrador retriever (dog 1) and an 11–year-old neutered male Golden retriever (dog 2) had resection of the nasal planum and premaxilla for treatment of locally invasive SCC. Reconstruction of a nasal planum facsimile was based on use of the nonhaired pigmented margins of bilateral labial mucocutaneous rotation-advancement flaps.
Results— Reconstruction of the premaxilla by construction of a nasal planum facsimile resulted in uncomplicated wound healing and improved cosmesis. There was no tumor recurrence at 1290 (dog 1) and 210 (dog 2) days after surgery.
Conclusion— Reconstruction of a nasal planum facsimile was successfully performed without complications in 2 dogs with high owner satisfaction with cosmetic appearance.
Clinical Relevance— This technique represents a significant advancement in surgical cosmetic outcome, may potentially reduce postoperative complications, and should be considered for dogs requiring nasal reconstruction after nasal planum resection with premaxillectomy.     

Combined Resection of the Nasal Planum and Premaxilla in Three Dogs

Surgical techniques for removal of tumors that affect the nasal planum or the premaxilla have been described. For extensively invasive malignancies, these techniques may be inadequate if used alone to achieve wide surgical margins. An operative technique that combines resection of the nasal planum and premaxilla has been developed for extensive malignant tumors of the nasal planum or premaxilla. This technique was used in three dogs and resulted in an acceptable cosmetic appearance and good function and tumor control. Complications after surgery included minor bleeding and partial dehiseence of the suture lines in two dogs and stenosis of the nasal orifice in one dog.     

Acrylic bite plane for treatment of malocclusion in a young horse

A 5-month-old quarter horse filly was presented for evaluation of a congenital overbite. The horse was diagnosed with a class 2 malocclusion. A non-removable, acrylic bite plane was constructed to provide a surface for the occlusal forces to be directed in a manner maintaining the normal anatomic position of the premaxilla. The preservation of normal anatomic relationships provided free range of motion of the mandible and maximized its growth potential, limiting the malocclusion. Although normal occlusion was not attained, partial incisor occlusion was present 20-months following initial treatment. Regular occlusal equilibration is mandatory to optimize occlusion and minimize future complications associated with malocclusion.     

Transmaxillary anchored silicon embedded gauze plug in the post-operative treatment of a large oromaxillary fistula caused by a supernumerary cheek tooth

A 9-year-old Hungarian sport horse gelding was presented to the clinic in poor condition displaying malodorous bilateral purulent nasal discharge. Oral examination revealed the presence of supernumerary 111 and 211. Bilateral diastema formation between the third maxillary molars and the supernumerary teeth with deep periodontal pockets and massive food impactions were diagnosed endoscopically. Radiography revealed inhomogenous sinus opacities in the left and right paranasal sinuses. Following bilateral oral extractions of the supernumerary cheek teeth and third maxillary molars, bilateral oromaxillary fistula formations were diagnosed (about 17 mm diameter on the right side). Bilateral frontal and right-sided maxillary trephinations and resection of the right bulla of the maxillary septum were performed. Massive food impactions of the left and right paranasal sinuses were removed under endoscopic control. Repeated trans-endoscopic sinus lavage was performed post-operatively. After 2.5 months, the large right-sided oromaxillary communication was temporarily closed with a transmaxillary anchored, gauze-cored silicon plug on an outpatient basis. Follow-up examination after 187 days revealed complete closure of the oromaxillary fistula and absence of sinusitis. In a 1.5-year follow-up control, no pathological conditions were found.     

Sclerosing odontogenic carcinoma in the mandible of a horse

A 15-year-old Cob mare was presented for investigation of a mandibular mass. Radiography identified an oval-shaped mass occupying the intramandibular space, with a heterogeneous osseous opacity throughout the left hemimandible. Histopathology combined with immunohistochemistry was consistent with a diagnosis of sclerosing odontogenic carcinoma, which to date has only been described, rarely, in human patients. The mass was removed using a mandibular-sparing surgical technique allowing preservation of the dental arcade. Follow-up 5 years after surgery confirmed no signs of regrowth. This case report describes the successful treatment of a previously unreported mandibular neoplasm in the horse.     

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.     

True cementomas (cementoblastomas) associated with a nonvital left maxillary second premolar in an 11‐year‐old miniature horse

An 11‐year‐old miniature horse gelding presented for a left maxillary facial swelling and surgical removal of 2 ovoid mineralised masses located near the tooth roots of the left maxillary second and third premolars. Preoperative radiographs were performed to triangulate the location of the calcified masses for removal, and an oral examination revealed that the left maxillary second premolar was nonvital with multiple feed‐packed pulp exposures. Both the radiographs and oral examination indicated that the mineralised masses were associated with the nonvital second premolar. Therefore, the tooth was extracted intraorally, and the masses were removed via a maxillary trephine dorsal to the extracted tooth. Both masses were submitted for histopathology, which diagnosed the masses as true cementomas (cementoblastomas) with adenomatous hyperplasia of the surrounding nasal glandular tissue.     

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.     

Surgical management of compound odontoma in two horses

Two horses were admitted for evaluation of mandibular swelling (horse 1) or maxillary distortion (horse 2). Both horses had radiographic evidence of tumors of dental origin that had the appearance of a compound odontoma. Extensive surgical resection was performed for treatment. Horse 1 was treated with 1-stage surgical resection, but an iatrogenic fracture occurred during surgery, which was managed successfully with a type I external fixator and extraoral alimentation. Horse 2 was treated in multiple stages to remove all portions of the tumor. To manage an extensive orosinal fistula, a custom-designed dental bridge was constructed to occlude the fistula. For both horses, the histopathologic diagnosis was compound odontoma. Compound odontomas are benign, locally expansive tumors of dental origin. Compound odontomas can be treated successfully; however, multiple surgeries may be necessary.     

Pseudallescheria boydii infection of the nasal cavity of a horse

An 18-year-old 454-kg (1,000-lb) American Quarter Horse gelding was evaluated because of chronic intermittent malodorous right-sided nasal discharge. Endoscopy revealed a mycotic plaque in the nasal cavity adjacent to the nasomaxillary opening of the right caudal maxillary sinus. The nasomaxillary opening appeared to be larger than normal. Fungal culture of specimens of the mycotic plaque yielded Pseudallescheria boydii. The horse was treated with 2% miconazole intranasally, sodium iodide i.v., and potassium iodide p.o. Thirty and 60 days after treatment was initiated, the nasal cavity was found to be free of infection.     

Examination of the upper and lower respiratory tract relevant to purchase.

The intent and extent of the respiratory tract examination relevant to purchase are dictated by numerous factors, including historical information, signs suggestive of respiratory tract abnormalities, intended use of the horse, and economic considerations. Following a thorough and systematic examination of the horse at rest, evaluation during and following exercise may be warranted. The physical examination should include evaluation of regional symmetry of the head, neck, and thorax; evaluation of nasal airflow and patency; palpation of the nasal septum, larynx, and trachea; examination for surgical scars; and auscultation and percussion. Special examination techniques, including endoscopy, stress evaluation, and radiography, may be indicated. Much has been learned about the URT in recent years, particularly regarding endoscopy of the region and the interpretation of endoscopic findings. The reader is referred to a generous list of references to gain further detailed information regarding the endoscopic diagnosis of other URT conditions.