Repulsion of maxillary and mandibular cheek teeth in standing horses

Objective: To report the technique and results of cheek teeth repulsion in standing, sedated horses. Study Design: Case series. Animals: Horses (n=12), ponies (6). Methods: Medical records (2006–2009) of horses that had cheek tooth repulsion while standing were reviewed. Inclusion criteria included: maxillary or mandibular cheek tooth disease diagnosed by clinical and radiographic examination where attempted oral extraction failed necessitating repulsion. Horses were sedated and a local nerve block performed. Intraoperative radiographs facilitated instrument positioning and ensured repulsion of all dental remnants. Alveolar cavities were packed postoperatively and secondary dental sinusitis treated with lavage. Results: Median horse age was 7 years (range, 1–30 years). Maxillary (n=15) and mandibular (5) cheek teeth were removed successfully. One horse was euthanatized 1 week after tooth removal because of concurrent liver disease and 10 horses (59%) had resolution of discharge after the 1st treatment; 41% of extractions required follow‐up medical or surgical treatment to resolve signs [6/12 maxillary sinusitis and 1/5 persistent mandibular drainage]. Conclusions: Standing repulsion of diseased and fractured cheek teeth is an effective means of resolving clinical signs of dental disease when oral extraction fails. Chronic sinus involvement increased the risk of postextraction surgical treatment for sinusitis.     

Treatment of oromaxillary fistulae in nine standing horses (2002–2006)

Reasons for performing study: There is minimal published information on equine oromaxillary fistulae that are unrelated to cheek teeth (CT) repulsion or on the conservative treatment of these atypical fistulae. Objectives: To report equine oromaxillary fistulae unrelated to CT extraction and describe their management in standing horses. Methods: Case details of oromaxillary fistulae of atypical aetiology occurring at 2 referral centres between 2002–2006, including their treatment and response to treatment were examined. Results: Nine cases of oromaxillary fistula were recorded, mainly in aged horses (median 22 years). Fistulae were associated with CT diastemata in 7 cases, fractured CT in one and a central defect in a worn CT in another. After removing food and exudate from the sinuses, 6 cases were treated successfully by filling the diastema or dental defect with polymethylmethacrylate (PMMA). Following dental extraction, the other 3 cases were treated successfully by use of PMMA alveolar packing. Conclusion: Older horses can spontaneously develop oromaxillary fistulae, usually secondary to CT diastemata. In the absence of apical infection, this disorder can usually be treated successfully in standing horses by treating the sinusitis and sealing the oral aspect of the diastema with PMMA. Potential relevance: Older horses with sinusitis should be assessed for the presence of CT diastemata and oromaxillary fistulae. If detected, these disorders can be treated successfully in the standing horse.     

Extraction of cheek teeth using a lateral buccotomy approach in 114 horses (1999-2009)

Reason for performing the study: There are few published data regarding the success rates of cheek tooth (CT) removal by lateral buccotomy in the horse. Objectives: A retrospective study of 114 horses admitted to 2 private equine referral hospitals over a 10 year period (1999–2009), which underwent CT removal via a lateral buccotomy. Methods: Hospital records were analysed and details including case details, presenting complaint and results of all diagnostic tests and surgical reports were documented. Information obtained during post operative reassessment was also available for analysis. Long‐term follow‐up information (>2 months) was obtained for 112 horses. Results: Short‐term complications (<2 months) occurred in 24/77 horses (31%) undergoing exodontia of the maxillary CT and 10/37 horses (27%) involving mandibular CT, with the majority arising from partial wound dehiscence and infection following 16 extractions (47%). All healed well by second intention. Other complications included both temporary (n = 6) and permanent (n = 3) facial nerve paralysis, myositis (n = 4) and the inadvertent establishment of an oroantral fistula (n = 4). One myositis case was subjected to euthanasia 24 h post operatively. Five horses had persistent sinusitis following surgery due to dental remnants (n = 2) and excessive packing material (n = 1) found in the sinuses. No inciting cause could be found in the remaining 2 horses. One further horse suffered a fatal cardiac arrest at induction of anaesthesia. Of all horses, 92% operated on had returned to their previous level of work after >2 months with no complications. Conclusion: Horses with CT removal by a lateral buccotomy have a reasonable prognosis for long‐term outcome. Potential relevance: Performing a lateral buccotomy is a justified treatment alternative for the surgical removal of equine CT following unsuccessful attempts by standing oral extraction, offering advantages over alternatives such as retropulsion, endodontic therapy and periapical curettage.     

Extraction of fractured cheek teeth under oral endoscopic guidance in standing horses

Objective: To evaluate a technique for oral extraction of fractured cheek teeth (CT) under oral endoscopic guidance. Study Design: Case series. Animals: Horses (n=30) with fractured CT. Methods: Medical records (April 2007–August 2010) of horses that had standing oral extraction of fractured CT under endoscopic guidance were reviewed. Results: Thirty horses (median age, 11.5 years; range, 5–23 years) had 31 fractured CT (21 maxillary, 10 mandibular) removed. Midline sagittal fractures of maxillary teeth (n=13; 42%) were the most common type, followed by buccal or palatal (10; 32%), and transverse or multiple (5; 16%) fractures. Extraction under endoscopic guidance was successful for 27 (87%) teeth. Median age of the surgical failure group was 7 years (range, 5–8 years), significantly lower than that of the surgical success group (P=.0135, Mann–Whitney U‐test). Conclusions: Endoscopic viewing facilitates instrument use and removal of fractured CT in standing horses.     

Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): treatments and long-term results of treatments

Reasons for performing study: There is limited objective information available on the treatment and the long‐term response to treatment of the different types of equine sinus disease. Objectives: To document the treatments and long‐term response to these treatments in 200 cases of equine sinus disease (1997–2009). Methods: The treatments of horses affected with subacute primary sinusitis (n = 52); chronic primary sinusitis (n = 37); dental sinusitis (n = 40); sinus cyst (n = 26); traumatic (n = 13); dental‐related oromaxillary fistula (n = 8); sinus neoplasia (n = 10); mycotic sinus disease (n = 7); and intrasinus progressive ethmoid haematoma (n = 7) and the long‐term response to these treatments were retrospectively reviewed. Results: Treatments evolved throughout the study and latterly were as conservative as possible, including sinoscopic lavage and standing sinusotomy, with a maxillary sinusotomy approach preferred for the mainly mature horses treated in this study. Removal of intrasinus inspissated pus, including transendoscopically (by sinusotomy and via existing sinonasal fistulae), was the main treatment for chronic primary sinusitis and sinonasal fistulation was seldom performed latterly. Attempted oral extraction of infected cheek teeth, even if unsuccessful, facilitated subsequent dental repulsion, resulting in few post operative problems. Sinus cyst removal carried an excellent prognosis. Except for cases of sinus neoplasia (only 22% cured), an excellent long‐term response to treatment (91% fully cured, 7% partially cured) was obtained for all other types of sinus disease following a median of one treatment. Conclusions: More conservative treatments, including removal of intrasinus inspissated pus by sinoscopy, pre‐existing sinonasal fistula or sinusotomy, are effective for chronic primary sinus disease. Standing sinusotomy, mainly using a small maxillary site, was suitable for most cases of sinus disease in mature horses.     

Standing computed tomography of the equine limb using a multi-slice helical scanner: Technique and feasibility study

Computed tomography (CT) is an important cross-sectional diagnostic modality for lameness localised to the equine distal limb. The necessity of general anaesthesia to perform CT scans has limited its use in the equine orthopaedic field. Therefore, many attempts have been made to perform CT of the distal limb in standing horses. This retrospective report aims to describe the technical set-up and the feasibility of using a multi-slice helical CT unit recently introduced into the equine market. The medical records of the patients undergoing a standing CT in the period between March 2019 and January 2020 were reviewed. The imaged anatomical region and the image quality were assessed. Thirty-two horses met the inclusion criteria, and the following anatomical areas have been imaged: front foot/pastern (n = 14), metacarpophalangeal joint (n = 11), front proximal suspensory ligament (n = 2), carpus (n = 2), metatarsophalangeal joint (n = 2) and tarsus (n = 1). In 97% of the cases, excellent imaging quality was obtained. Motion artefact is the main cause of poor image quality. The feet and the metacarpophalangeal region can be easily imaged. Imaging the proximal anatomical regions of the limb is more challenging but achievable.     

Short‐ and long‐term results following standing fracture repair in 34 horses

Reasons for performing study: Standing fracture repair in the horse is a recently described surgical procedure and currently there are few follow‐up data. This case series contains 2 novel aspects in the standing horse: repair of incomplete sagittal fractures of the proximal phalanx and medial condylar repair from a lateral aspect. Objectives: To describe outcome in a case series of horses that had lower limb fractures repaired under standing sedation at Rossdales Equine Hospital. Method: Case records for all horses that had a fracture surgically repaired, by one surgeon at Rossdales Equine Hospital, under standing sedation and local anaesthesia up until June 2011, were retrieved. Hospital records, owner/trainer telephone questionnaire and the Racing Post website were used to evaluate follow‐up. Results: Thirty‐four horses satisfied the inclusion criteria. Fracture sites included the proximal phalanx (incomplete sagittal fracture, n = 14); the third metacarpal bone (lateral condyle, n = 12, and medial condyle, n = 7); and the third metatarsal bone (lateral condyle, n = 1). One horse required euthanasia due to caecal rupture 10 days post operatively. Twenty horses (66.7% of those with available follow‐up) have returned to racing. Where available, mean time from operation to return to racing was 226 days (range 143–433 days). Conclusions: Standing fracture repair produced similar results to fracture repair under general anaesthesia in terms of both the number of horses that returned to racing and the time between surgery and race. Potential relevance: Repair of lower limb fracture in the horse under standing sedation is a procedure that has the potential for tangible benefits, including avoidance of the inherent risks of general anaesthesia. The preliminary findings in this series of horses are encouraging and informative when discussing options available prior to fracture repair.     

Equine perioperative fatalities associated with general anaesthesia at a private practice--a retrospective case series

OBJECTIVE: To determine the fatality rate of horses undergoing general anaesthesia at a private equine referral practice using a limited number of anaesthetic protocols. METHODS: A retrospective analysis of records (n = 17 961) from all horses undergoing general anaesthesia for surgical procedures from 1997 to 2001 at Rood and Riddle Equine Hospital, Lexington, Kentucky, USA. Results were reported as percentage of the population, and as crude mortality rates for each procedure (deaths per 1000). RESULTS: The prevalence of equine fatalities directly related to anaesthesia was 0.12% (n = 21) and this rose to 0.24% (n = 42) with the inclusion of horses killed or dying within 7 days post general anaesthesia. Causes of death directly related to anaesthesia were cardiac arrest (n = 10), fracture in recovery stall (n = 8), neuropathy and myopathy necessitating euthanasia (n = 3). Crude mortality rates per procedure were < or =7 deaths per 1000 cases, except arthrodesis/osteotomy cases were 66.7 deaths per 1000 cases. CONCLUSIONS: The anaesthetic fatality rate at this practice is lower than has been reported previously. CLINICAL RELEVANCE: Familiarity with an anaesthetic protocol in combination with reduced anaesthetic time, emergencies of shorter duration between diagnosis and surgery, and adequate preoperative examination appear to minimize the risks associated with general anaesthesia in horses.     

A review of equine dental disorders

Equine dentistry is a very important but until recently rather neglected area of equine practice, with many horses suffering from undiagnosed, painful dental disorders. A thorough clinical examination using a full mouth speculum is a pre-requisite to performing any equine dental procedure. Common incisor disorders include: prolonged retention of deciduous incisors, supernumerary incisors and overjet--the latter usually accompanied by cheek teeth (CT) overgrowths. Overjet can be surgically corrected, but perhaps should not be in breeding animals. In younger horses, traumatically fractured incisors with pulpar exposure may survive by laying down tertiary dentine. Loss or maleruption of incisors can cause uneven occlusal wear that can affect mastication. Idiopathic fractures and apical infection of incisors are rare. The main disorder of canine teeth is the development of calculus of the lower canines, and occasionally, developmental displacements and traumatic fractures. The main indications for extraction of "wolf teeth" (Triadan 05s) are the presence of displaced or enlarged wolf teeth, or their presence in the mandible. Developmental abnormalities of the CT include; rostral positioning of the upper CT rows in relation to the lower CT rows--with resultant development of focal overgrowths on the upper 06s and the lower 11s. Displaced CT develop overgrowths on unopposed aspects of the teeth and also develop periodontal disease in the inevitable abnormal spaces (diastemata) that are present between displaced and normal teeth. Diastemata of the CT due to excessive developmental spacing between the CT or to inadequate compression of the CT rows is a common but under diagnosed problem in many horses and causes very painful periodontal disease and quidding. Supernumerary CT mainly occur at the caudal aspect of the CT rows and periodontal disease commonly occurs around these teeth. Eruption disorders of CT include prolonged retention of remnants of deciduous CT ("caps") and vertical impaction of erupting CT that may lead to large eruption cysts and possibly then to apical infections. Disorders of wear, especially enamel overgrowths ("enamel points"), are the main equine dental disorder and are believed to be largely due to the dietary alterations associated with domestication. If untreated, such disorders will eventually lead to more severe CT disorders such as shearmouth and also to widespread periodontal disease. More focal dental overgrowths will develop opposite any CT not in full opposition to their counterpart, e.g., following maleruption of or loss of a CT. Because of the great length of reserve crown in young (hypsodont) CT, apical infections usually cause infection of the supporting bones and depending on the CT involved, cause facial swellings and fistulae and possibly sinusitis. Diagnosis of apical infection requires radiography, and possibly scintigraphy and other advanced imaging techniques in some early cases. When possible, oral extraction of affected CT is advocated, because it reduces the costs and risks of general anaesthesia and has much less post-extraction sequelae than CT repulsion or buccotomy.     

Extraction of 22 equine cheek teeth with displaced sagittal fractures using polymethylmethacrylate stabilisation (2011–2016)

Displaced sagittal cheek tooth fractures are a cause of oral pain, quidding and apical infection. Intraoral extraction is the preferred technique to remove affected teeth, but can be difficult due to displaced and friable fracture fragments. Stabilising fracture fragments via filling of the fracture space with polymethymethacrylate (PMMA) prior to removal may be a useful method to facilitate intraoral extraction. Case details were examined retrospectively. A total of 22 cheek teeth required extraction in 20 horses because of displaced sagittal fractures. Clinical diagnoses were made using oral examination, oral endoscopy, skull radiography and computed tomography. All procedures were performed in standing, sedated horses in stocks. Fracture spaces were cleaned and packed with PMMA and teeth removed using a routine intraoral extraction technique. Digital photographs of extracted teeth were taken and tooth measurements calibrated using digital image software. Intraoperative difficulties, as well as post-operative complications were recorded. A total of 21 maxillary and one mandibular cheek teeth were extracted. All maxillary teeth had advanced infundibular caries. Intraoral extraction was successful in 16 cases; six were unsuccessful and required repulsion due to tooth fragmentation or abnormal dental anatomy. In 11 cases, maxillary or conchofrontal sinus trephination was performed to either treat sinusitis, repulse the tooth, or both. Two horses developed short-term complications following local anaesthesia of the maxillary nerve. The mean ratio of fracture depth to tooth length was 0.59 and mean ratio of fracture width to tooth width 0.53. The limitations of the study are its small sample size, retrospective nature and lack of control group to compare extraction success in PMMA and non-PMMA groups. It was concluded that using PMMA to stabilise displaced sagittal fractures in equine cheek teeth is a simple, effective method of facilitating intraoral extraction and may reduce the need for more invasive procedures.     

Self‐inflicted lingual trauma secondary to inferior alveolar nerve block in 3 horses

Exodontia is the typical treatment recommended in severe cases of dental disease where alternative treatment techniques fail to salvage the affected tooth. Exodontias are frequently performed in the standing horse with the benefit of sedation and regional anaesthesia in order to avoid the risks and expense of general anaesthesia. The inferior alveolar nerve block is commonly utilised when extracting diseased mandibular dentition. Because of the close anatomical relationship of the lingual and inferior alveolar nerves both may be desensitised following anaesthesia of the inferior alveolar nerve. Desensitisation of the tongue may result in horses traumatising it during mastication before sensation returns. This report describes 3 horses that sustained self‐inflicted lingual trauma following inferior alveolar nerve blocks performed for standing oral surgical procedures.     

Conservative management of cystorrhexis in four adult horses

Rupture of the urinary bladder is rare in adult horses with various standing or recumbent surgical repair techniques historically reported as the treatments of choice. This case series describes the successful conservative management of cystorrhexis in 4 adult horses. Conservative management is therefore a potentially viable treatment option which forgoes the risks of general anaesthesia and may reduce the post operative complications associated with surgery of the bladder.     

Equine idiopathic cheek teeth fractures: part 3: a hospital-based survey of 68 referred horses (1999-2005)

REASONS FOR PERFORMING STUDY: There is limited information available on the more serious sequellae of idiopathic cheek teeth (CT) fractures. OBJECTIVES: To obtain information on clinical and ancillary diagnostic findings in referred horses with idiopathic CT fractures. METHODS: Details of all horses suffering from idiopathic CT fractures referred to the Equine Hospital at the University of Edinburgh 1999-2005 were examined, and information concerning fracture patterns, clinical and ancillary diagnostic findings, treatments and long-term response to treatments were obtained and analysed. RESULTS: A total of 60 maxillary and 17 mandibular idiopathic CT fractures were diagnosed in 68 horses. Fracture patterns included maxillary CT lateral slab fractures (45%), maxillary CT midline sagittal fractures (16%) and various other patterns of maxillary CT fractures (17%). In the mandibular CT, lateral slab fractures were found (12%) and various other CT fracture patterns were present in 10%. The more centrally positioned CT (maxillary and mandibular Triadan 08s and 09) were preferentially fractured. Clinical signs included quidding in 47% of cases; bitting and behavioural problems (28%); signs of apical infection, including bony swellings and nasal discharge (21%); anorexia/weight loss (15%); halitosis (13%); and buccal food impaction (12%). The treatment of all cases was conservative whenever possible and included corrective rasping of the remaining tooth (46% of cases); oral extraction of the smaller and loose dental fragment (32%) and extraction of the entire fractured tooth by oral extraction (28%) or by repulsion (13%). Prophylactic treatment of adjacent, nonfractured CT with carious infundibula was possibly of value in preventing further midline sagittal maxillary CT fractures. CONCLUSIONS: Horses referred with idiopathic CT fractures frequently have clinical signs of apical infection of the fractured CT and these teeth require extraction, orally if possible. More conservative treatment of idiopathic CT fractures without signs of gross apical infection can resolve clinical signs in most cases. POTENTIAL RELEVANCE: In the absence of apical infection, extraction of only the loose dental fragments of CT with idiopathic fractures is usually successful.     

Survival of horses following strangulating large colon volvulus

Reasons for performing study: The pattern of long‐term survival and specific factors associated with long‐term survival have not previously been evaluated in horses with a strangulating large colon volvulus (LCV). Objectives: To provide data on the long‐term survival of horses with LCV and to identify pre‐, intra‐ and post operative variables associated with survival. Methods: Clinical data and long‐term follow‐up information were obtained from 116 horses with a strangulating LCV (≥360°) undergoing general anaesthesia. Two multivariable Cox proportional hazards models for post operative survival time were developed: Model 1 included all horses and evaluated preoperative variables and Model 2 included horses that survived anaesthesia and evaluated pre‐, intra‐ and post operative variables. Results: The study population comprised 116 horses. Eighty‐nine (76.7%) survived general anaesthesia. Of these, the percentage that survived until discharge, to one year and to 2 years was 70.7%, 48.3% and 33.7%, respectively. Median survival time for horses that survived general anaesthesia was 365 days. In Model 1 increased preoperative packed cell volume (PCV) was significantly associated with reduced post operative survival (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.05–1.11). However, this effect changed over time. In Model 2 abnormal serosal colour intraoperatively (HR 3.61, 95% CI 1.55–8.44), increased heart rate at 48 h post surgery (HR 1.04, 95% CI 1.02–1.06), and colic during post operative hospitalisation (HR 2.63, 95% CI 1.00–6.95), were all significantly associated with reduced post operative survival. Conclusions: Survival time in horses with a LCV was associated with preoperative PCV, serosal colour, heart rate at 48 h post operatively and colic during post operative hospitalisation. Potential relevance: This study provides evidence‐based information on the long‐term survival of horses with LCV and identifies parameters that may assist decision‐making by clinicians and owners.     

Head and neck abscessation and thrombophlebitis following cheek tooth extraction in a pony

Due to their long hypsodont reserve crowns, extraction of equid cheek teeth can be difficult and result in more complications than the extraction of their shorter brachydont counterparts although the more recent resumption of oral extraction has greatly reduced such complications. The more common post-extraction sequelae in equids include non-healing alveoli due to retained dental or alveolar sequestrae which may lead to oromaxillary or oronasal fistula formation, chronic external sinus tract formation or osteomyelitis of the supporting bones. Collateral damage to adjacent teeth has also occasionally been reported during dental repulsion. Systemic complications following equine cheek tooth extraction have been infrequently described, including a small number of cases of exodontia-related bacterial meningioencephalitis. This is surprising, as dental manipulation can lead to bacteraemia in many species, including horses. Infections at distant sites related to the spread of dental pathogens have been well described in humans and in small animals. This report describes deep abscessation of the masseter muscles followed by extensive thrombophlebitis of the jugular, facial and rostral cervical veins following oral cheek tooth extraction in a pony affected by pituitary pars intermedia dysfunction (PPID) that was successfully treated by abscess drainage and thrombectomy of the affected veins.     

Long-term Outcome of Tooth Repulsion in Horses A Retrospective Study of 61 Cases

The records of 61 horses undergoing tooth repulsion for treatment of alveolar periostitis were reviewed. Seventeen of 36 horses (47%) in which maxillary teeth were removed had serious postoperative complications, such as infection of a second tooth, bone sequestration, chronic sinusitis, draining tracts, retained dental packing, feed impaction of the alveolus or sinus, suture-line dehiscence, or skin-flap sloughs. Eight horses required at least one additional surgical procedure. Eight of 25 horses (32%) in which mandibular teeth were removed had serious postoperative complications, and four horses required an additional surgical procedure. Hospitalization lasted 2 to 61 days (median, 22 days) for maxillary teeth and 3 to 35 days (median, 8 days) for mandibular teeth. Long-term follow-up (at least 5 months) was possible in 47 horses. Twenty-four of 30 horses (80%) with maxillary tooth repulsion healed without further problems; six horses had persistent nasal discharge. Fourteen of 17 horses (82%) with mandibular tooth repulsion healed with no further problems or with only minor complications; three horses had a chronic draining tract.     

Equine dental disease part 4: a long-term study of 400 cases: apical infections of cheek teeth

Of 400 horses referred because of equine dental disease, 162 suffered from primary apical infections of their cheek teeth (CT), including 92 with maxillary CT infections and 70 with mandibular CT infections. Maxillary swellings and sinus tracts were more common (82 and 26% incidence, respectively) with infections of the rostral 3 maxillary CT, than with infections of the caudal 3 maxillary CT (39 and 5% incidence, respectively). Nasal discharge was more commonly present with caudal (95%) than rostral (23%) maxillary CT infections. Mandibular CT apical infections commonly had mandibular swellings (91%) and mandibular sinus tracts (59%) and these infections were closely related to eruption of the affected CT. A variety of treatments, including medical treatment, apical curettage, repulsion and oral extraction of affected teeth were utilised in these cases, with oral extraction appearing to be most satisfactory. Infections of caudal maxillary CT with a secondary paranasal sinusitis were most refractory to treatment, with a complete response to the initial treatment achieved in just 33% of these cases. Most other cases responded fully to their initial treatment. The long-term response to treatment was good in most cases.     

The use of computed tomography to assist orthopaedic surgery in 86 horses (2002–2010)

Imaging‐assisted orthopaedic surgery is becoming part of routine orthopaedic practice in horses and several techniques have been reported. However, there are no published reports describing the use of intraoperative computed tomography (CT) for surgical guidance and immediate post operative control in the horse. This use of CT in equine orthopaedics is currently limited because of the logistic problems associated with availability of CT scans in surgical theatres as well as concerns over radiation safety. The aim of this report was retrospectively to report CT assisted orthopaedic surgical cases in our practice through identifying the types of surgery where it was used, to list the technical problems that were encountered, to describe solutions to these, and to discuss the applications of the technique. All surgical procedures were performed with the assistance of a peripheral quantitative computed tomography (pQCT) scanner. CT assisted orthopaedic surgery in 86 patients during the study period. Reasons for CT included: 1) use of CT at the beginning of the surgical procedure to document the lesion and identify surgical landmarks (n = 75); 2) pre, intra‐ and post operative use of CT in comminuted fractures of the middle or proximal phalanx to guide and control internal fixation (n = 7); and 3) post operative use of CT to monitor the results of the surgical procedure (n = 4). Proper planning in both the draping steps and the use of polyvinyl splints to stabilise the limb allowed for movements of the gantry around the limb. The time required to obtain one slice was not dissimilar to the time that is necessary to take and process a single digital radiograph. The radiation dose with the pQCT described here is <0.5 µSv and its acquisition time should be balanced against radiation risks of conventional CT systems.     

Transpalpebral enucleation using a chain écraseur

This study was undertaken to describe the technique, complications and outcome of the use of a chain écraseur for transpalpebral enucleation in horses under general anaesthesia. We report its use in 53 horses, reviewing the subject details, reasons for enucleation, surgical technique, intra‐ and post operative complications, and long‐term outcome. Intraoperative complications included mild to moderate bleeding in 4 horses. Post operative complications included mild periorbital post operative swelling in one horse, transient head tilt in one horse and severe enterocolitis, which resulted in euthanasia in one horse; another 2 horses were subjected to euthanasia after long bone fractures that occurred during recovery from general anaesthesia and 2 horses had the prosthesis removed as a result of inflammatory reaction or infection. Long‐term outcome was available for 38 horses, 25 of which returned to their previous activities and 13 were retired. Twelve horses were lost for follow‐up. Transpalpebral enucleation using a chain écraseur is a feasible alternative to traditional enucleation techniques that can provide adequate haemostasis during transection of the optic pedicle when used properly.