A CONGENITAL MALFORMATION OF THE MAXILLA OF A HORSE

A 1-month-old male American Paint Horse was evaluated for a hard swelling on the right side of the maxillary region. On radiographs there was a large, expansile outpouching of the right maxillary bone between the second and third premolar teeth. Computed tomography further characterized the expansile lesion to have a soft tissue component and to originate in the region of a caudal maxillary tooth. Surgical reconstruction of the defect was unsuccessful and the animal was euthanetized. Based on failure to find histopathologic evidence of a neoplasm or cyst, the diagnosis was a congenital malformation.     

A novel technique for ventral orbital stabilization: the masseter muscle flap

Loss of the caudal maxilla and ventral orbit after tumor resections can have negative functional and esthetic influences on the eye involved. This article reports on a case of a caudal maxillary acanthomatous ameloblastoma involving the ventral orbit that was resected and stabilized with a masseter muscle flap. The masseter muscle flap was generated from the superficial belly of the masseter muscle in order to close a defect in the orbital rim, created by a caudal maxillectomy. None of the published complications such as enophthalmos, excessive lacrimation, globe deviation, or strabismus were noted, 8 months following the procedure. The only clinical sign present at the time of re‐evaluation was mild lacrimation. The authors propose the use of a masseter muscle flap as a viable technique in stabilizing the ventral orbit after caudal maxillectomy and ventral orbitectomy, preventing the complications associated with this surgery.     

Equine Nasal and Paranasal Sinus Tumours: Part 2: A Contribution of 28 Case Reports

The clinical and pathological findings of 28 cases (27 horses, 1 donkey) of equid sinonasal tumours examined at the Edinburgh Veterinary School are presented and include: seven cases of squamous cell carcinoma (SCC); five adenocarcinomas; three undifferentiated carcinomas; two adenomas; five fibro-osseous and bone tumours; and single cases of ameloblastoma, fibroma, fibrosarcoma, undifferentiated sarcoma, melanoma and lymphosarcoma. The median ages of animals affected with epithelial, and fibro-osseous/bone tumours were 14 and 4 years, respectively. Unilateral purulent or mucopurulent nasal discharge (81% of cases) and gross facial swellings (82% of cases) were the most common presenting signs with sinonasal tumours, with epistaxis recorded in just 23% of cases. Radiology and endoscopy were the most useful ancillary diagnostic techniques. The maxillary area was the most common site of tumour origin, and only three cases were definitively identified as originating in the nasal cavity. Four of the maxillary SCC lesions originated within the nasal cavities or maxillary sinuses, while two originated in the oral cavity. Fourteen of 15 carcinomas, but only two of the 13 remaining tumours, spread to other sites in the head. Only three cases of sinonasal tumour had lymph node metastases, and none had distant metastases. In the long term, surgical treatment with seven malignant tumours was unsuccessful (6 months median survival post-operatively), but was successful with four out of five benign tumours (no regrowth at a median of 4 years post-operatively).     

Morphologic features of the root canal system of the maxillary fourth premolar and the mandibular first molar in dogs

Root canal morphology was evaluated in 72 maxillary fourth premolar and 59 mandibular first molar teeth. An apical delta was present in all roots (n = 334). The apical delta represented approximately 12-18% of the total root length for all roots. Non-apical ramifications from the main canal were observed in 25.1% of roots. Secondary canal(s) were present in 20.6% of roots, while lateral canal(s) were present in 6.9% of roots. The distal root of the maxillary fourth premolar had the highest incidence (47.2%) of non-apical ramifications. Overall, 68.0 and 20.4% of maxillary fourth premolar and mandibular first molar teeth had non-apical ramifications, respectively. The prevalence and location of non-apical ramifications may influence clinical decision making when performing endodontic therapy.     

Intraosseous maxillary hemangioma in an immature Bassett Hound

A 6-month-old Bassett Hound dog presented for evaluation of recurrent oral bleeding and a right maxillary swelling. Oral examination revealed right maxillary enlargement extending from the level of the right maxillary canine tooth to the area of the second and third premolar teeth. A discolored persistent right maxillary deciduous canine tooth and gingival inflammation was noted. Biopsies taken at the time of extraction of the persistent deciduous canine tooth resulted in significant hemorrhage and a biopsy report of reactive bone. The right maxillary enlargement did not resolve following the extraction procedure and empirical antimicrobial therapy. The owner elected euthanasia and post-mortem evaluation. Histopathologic assessment provided a diagnosis of maxillary hemangioma.     

Surgical repair of a chronic,oronasal fistula in a horse using an alveolar bone flap

An 8‐year‐old Andalusian stallion was presented to the Equine Hospital with a 1.5 year history of an oronasal fistula measuring approximately 2 cm long (caudal to rostral) by 1.5 cm wide following an oral extraction of the right second maxillary premolar (106). An alveolar bone flap was created adjacent to the oronasal fistula and rotated axially and ventrally to close the oral aspect of the fistula. At 3 days after surgery, clinical signs of the fistula, such as green‐tinged purulent nasal discharge and malodorous breath, were no longer evident. At 10 days after surgery, the oral opening of the fistula filled with granulation tissue and mucosa and decreased in size to less than 2 ml. The horse was fed a pelleted mash and grass diet and the small fistula was flushed orally twice daily until it completely healed. At 6 months following surgery, the fistula had completely healed. Few options are available for repairing an oroantral or an oronasal fistula in horses. This case report suggests that a large, chronic oronasal fistula involving the alveolus of a maxillary second premolar can be repaired successfully with an alveolar bone flap.     

Oronasal fistula repair utilizing a temporalis muscle flap in a dog with severe trismus

A 9 yr old spayed female cocker spaniel presented for evaluation of an invasive maxillary squamous cell carcinoma. Curative intent surgery and radiation therapy allowed for local control of the neoplasm; however, the development of a persistent oronasal fistula prevented a complete recovery. A temporalis myofascial rotation flap allowed for successful resolution of the maxillary defect. Implementation of the flap was relatively simple and was associated with few complications.     

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.     

RADIOGRAPHY OF THE CANINE NASAL CAVITY: SIGNIFICANCE OF THE PRESENCE OR ABSENCE OF THE TRABECULAR PATTERN

A radiographic study was performed on the maxilla of two healthy dogs to assess the effect of replacement of air by fluid and removal of conchae on the radiographic appearance. The purpose was to determine the significance of the presence or absence of the fine trabecular pattern on radiographs of the canine nasal cavity. The results indicate that the radiographic appearance of the maxillary conchae is primarily based on the presence of soft tissues covering the bony conchae, in combination with surrounding air. The radiographic appearance of the ethmoidal conchae is caused by the bony structures themselves. It is concluded that a loss of the characteristic parallel pattern in the cranial part of the nose is primarily the result of silhouetting of maxillary conchae by fluid. A loss of the fine trabecular pattern is caused by destruction of conchae.     

CT FEATURES OF ALVEOLITIS AND SINUSITIS IN HORSES

Sinusitis is a common disorder in horses and may result from trauma, dental diseases, or space-occupying lesions. Radiography can only provide a limited amount of information. Computed tomography (CT) has been documented as an alternative imaging method. Eighteen horses (mostly Warmblood) with signs of chronic sinusitis were examined preoperatively with CT to assist in diagnosis of the underlying cause. There was a group of common CT features in horses with dental disease and sinusitis. The first molar was the most frequently affected maxillary cheek tooth. Hypoattenuation of the cementum, destruction of the enamel, and filling of the infundibular cavity with gas were the most frequent CT findings associated with caries. Gas bubbles within the bulging root area or fragmentation of the root in combination with swelling of the adjacent sinus lining were the most important CT features of dental decay. CT findings associated with sinusitis included excessive thickening of the respiratory epithelium in the rostral maxillary sinus; the caudal maxillary sinus was less often involved. The infraorbital canal, the nasomaxillary duct, and the frontomaxillary aperture were usually involved. The maxillary bone, however, especially the facial crest, was involved in nearly every horse, being characterized by endosteal sclerosis, thickening, periosteal reaction, and deformation leading to facial swelling in chronic infections. CT images allowed identification of involvement of individual teeth more clearly to reveal the diseased one for treatment. Three-dimensional imaging allowed improved understanding of the extent and severity of the pathologic change.     

COMPUTED TOMOGRAPHIC FEATURES OF INCISOR PSEUDO‐ODONTOMAS IN PRAIRIE DOGS (CYNOMYS LUDOVICIANUS)

Maxillary incisor pseudo‐odontomas are common in pet prairie dogs and can cause progressive respiratory obstruction, while mandibular pseudo‐odontomas are rarely clinically significant. The aim of this retrospective cross‐sectional study was to describe CT features of maxillary and mandibular incisor pseudo‐odontomas vs. normal incisors in a group of pet prairie dogs. All pet prairie dogs with head CT scans acquired during the period of 2013–2015 were included. A veterinary radiologist who was aware of final diagnosis reviewed CT scans and recorded qualitative features of affected and normal incisors. Mean density values for the pulp cavity and palatal and buccal dentin were also recorded. A total of 16 prairie dogs were sampled (12 normal maxillary incisors, 20 confirmed maxillary incisor pseudo‐odontomas, 20 normal mandibular incisors, 12 presumed mandibular incisor pseudo‐odontomas). Maxillary incisors with confirmed pseudo‐odontomas had a significantly hyperattenuating pulp and dentin in the reserve crown and apical zone, when compared to normal maxillary incisors. Pseudo‐odontomas appeared as enlargements of the apical zone with a globular/multilobular hyperattenuating mass formation haphazardly arranged, encroaching on midline and growing caudally and ventrally. Presumed mandibular incisor pseudo‐odontomas had similar CT characteristics. In 60% of prairie dogs with maxillary incisor pseudo‐odontomas, the hard palate was deformed and the mass bulged into the oral cavity causing loss of the palatine bone. The common nasal meatus was partially or totally obliterated in 81.8% of prairie dogs with maxillary pseudo‐odontomas. Findings supported the use of CT for characterizing extent of involvement and surgical planning in prairie dogs with pseudo‐odontomas.     

Hemisection and partial retention of carnassial teeth in client-owned dogs

Nine client-owned dogs presented with periodontally and/or endodontically involved mandibular or maxillary carnassial teeth that were either individually affected or adjacent to a jaw fracture. A total of 10 teeth were hemisected (8 mandibular first molar teeth and 2 maxillary fourth premolar teeth), and one crown-root segment was extracted for each tooth. Gingival tissues were approximated and sutured over the extraction sites, and the retained tooth portions were treated by means of standard root canal therapy or vital pulp therapy followed by standard root canal therapy. Retained crown-root segments of 2 of the 10 hemisected teeth were extracted following short- and long-term postoperative examinations due to continued periodontal complications. It was concluded that resection of a portion of a tooth can be a useful treatment for periodontally and/or endodontically involved carnassial teeth that are affected individually or located adjacent to a jaw fracture in dogs.     

Clinical and computed tomography features of secondary renal hyperparathyroidism

An atypical case of secondary renal hyperparathyroidism was diagnosed in a 9-year-old miniature schnauzer after a skull computed tomography (CT) showed the presence of 2 bilateral and symmetrical soft tissue maxillary masses, and osteopenia of the skull.     

USING SEMI‐AUTOMATED SEGMENTATION OF COMPUTED TOMOGRAPHY DATASETS FOR THREE‐DIMENSIONAL VISUALIZATION AND VOLUME MEASUREMENTS OF EQUINE PARANASAL SINUSES

The system of the paranasal sinuses morphologically represents one of the most complex parts of the equine body. A clear understanding of spatial relationships is needed for correct diagnosis and treatment. The purpose of this study was to describe the anatomy and volume of equine paranasal sinuses using three‐dimensional (3D) reformatted renderings of computed tomography (CT) slices. Heads of 18 cadaver horses, aged 2–25 years, were analyzed by the use of separate semi‐automated segmentation of the following bilateral paranasal sinus compartments: rostral maxillary sinus (Sinus maxillaris rostralis), ventral conchal sinus (Sinus conchae ventralis), caudal maxillary sinus (Sinus maxillaris caudalis), dorsal conchal sinus (Sinus conchae dorsalis), frontal sinus (Sinus frontalis), sphenopalatine sinus (Sinus sphenopalatinus), and middle conchal sinus (Sinus conchae mediae). Reconstructed structures were displayed separately, grouped, or altogether as transparent or solid elements to visualize individual paranasal sinus morphology. The paranasal sinuses appeared to be divided into two systems by the maxillary septum (Septum sinuum maxillarium). The first or rostral system included the rostral maxillary and ventral conchal sinus. The second or caudal system included the caudal maxillary, dorsal conchal, frontal, sphenopalatine, and middle conchal sinuses. These two systems overlapped and were interlocked due to the oblique orientation of the maxillary septum. Total volumes of the paranasal sinuses ranged from 911.50 to 1502.00 ml (mean ± SD, 1151.00 ± 186.30 ml). 3D renderings of equine paranasal sinuses by use of semi‐automated segmentation of CT‐datasets improved understanding of this anatomically challenging region.     

Guttural pouch hemorrhage associated with lesions of the maxillary artery in two horses

A two year old Thoroughbred gelding, presented with guttural pouch hemorrhage, had the internal and external carotid arteries ligated. Guttural pouch mycosis was detected on endoscopic examination. After one month of topical antifungal therapy, the horse was returned and euthanized because of recurrent epistaxis. A bacterial infection of the guttural pouch with associated ulceration and hemorrhage from the maxillary artery was found at necropsy.

A two year old grade gelding had ulceration and hemorrhage from the external carotid artery. Utilizing balloon-tipped catheters and arterial ligation, hemestasis was achieved in the internal carotid artery and the external carotid artery and its branches. Mycotic ulceration of the internal carotid artery was detected endoscopically and treated with local antifungal therapy for one month. Thirty-three days postoperatively the horse returned, bleeding from a lesion in the maxillary artery. The rationale for surgical intervention to prevent epistaxis associated with guttural pouch mycosis and possible etiologies for postsurgical epistaxis are discussed.

     

Management of a complicated maxillary fourth premolar crown-root fracture in a dog

A five-year-old spayed/female Border Collie was presented with a crown-root fracture of the maxillary left fourth premolar. Surgical endodontic, and restorative techniques were performed to maintain the tooth. Re-examination 18-months following therapy indicated a successful outcome with no radiographic signs of periapical pathology.     

Direct approach to the nasal cavity through a bone flap for the treatment of a large nasal cyst

A 21‐year‐old Warmblood mare was referred to the Equine Department, Vetsuisse Faculty, University of Zurich, because of recurrent unilateral nasal discharge 3 months after partial removal of a large cyst from the left maxillary and frontal sinuses. Endoscopic, radiographic and computed tomographic examinations showed that the remnant of the cyst, which originally had extended from the left maxillary and frontal sinuses into the left nasal cavity, had expanded and was obliterating the left middle nasal meatus. A direct surgical approach to the cyst through the left nasal and maxillary bones rostral to the facial crest was chosen, which allowed evaluation and removal of the entire cyst. Endoscopic examination 3 days post operatively showed no remnants of the cyst, and the mare was discharged in good health. Re‐examination one year later showed no recurrence of the cyst.     

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.     

Results of Partial Mandibulectomy for the Treatment of Oral Tumors in 142 Dogs

Partial mandibulectomy was performed for the treatment of benign or malignant oral tumors in 142 dogs. Forty-two dogs with a benign tumor (ameloblastoma) had a 22.5 month (range, 6 to 74 months) median disease-free interval, with a 97% 1-year survival rate; there was local recurrence in one dog. Twenty-four dogs with squamous cell carcinoma had a disease-free interval of 26 months (range, 6 to 84 months), with a 91% 1-year survival rate; recurrence and metastasis developed in two dogs and metastatic disease in one dog. Based on survival curves, 37 dogs with a melanoma had a median survival time of 9.9 months (range, 1 to 36 months), with a 21% 1-year survival rate; 20 dogs died or were euthanatized for recurrent or metastatic disease. Twenty dogs with osteosarcoma had a median survival time of 13.6 months (range, 3 to 28 months), with a 35% 1-year survival rate; nine dogs died or were euthanatized for recurrent or metastatic disease. Nineteen dogs with fibrosarcoma had median survival time of 10.6 months (range, 3 to 32 months), with a 50% 1-year survival rate; 12 dogs died or were euthanatized for recurrent or metastatic disease. Results of this and previous studies demonstrated that partial mandibulectomy was effective in prolonging survival and decreasing recurrence for squamous cell carcinoma and ameloblastoma. Progressive disease and corresponding low survival times were common in dogs with melanoma, osteosarcoma, and fibrosarcoma. There were no differences in survival times or the progression of disease among five partial hemimandibulectomy procedures. The high rates of recurrence and metastasis in dogs with these tumors suggest a need for evaluation of ancillary chemotherapy and local radiation therapy to decrease the prevalence of progressive disease.