Histopathology and computed tomography of age‐associated degeneration of the equine temporohyoid joint

Reasons for performing study: The aetiology of temporohyoid osteoarthropathy (THO) is unknown; both primary infectious and degenerative causes have been suggested. Hypothesis: There is a significant association between increasing age and severity of temporohyoid joint degeneration. To examine the histopathology of the temporohyoid articulation in aged horses and to compare the appearance of the joint with computed tomography (CT) and peripheral quantitative CT (pQCT). Methods: pQCT scans of the temporohyoid articulations were obtained bilaterally from 31 horses (range age 1–44 years) post mortem and images were graded by 2 blinded observers on 2 occasions for the presence of osteophytes, irregularity of the joint surface and mineralisation. Eight heads had been examined previously by CT, with the images similarly graded for the shape and density of the proximal stylohyoid bones, bone proliferation surrounding the joint, mineralisation of the tympanohyoid cartilage and the relationship of the petrous temporal bone to the stylohyoid bone. Sixteen temporohyoid joints were then evaluated histologically. Results: There was significant association between the mean pQCT degeneration score and age (rho = 0.75; P<0.0001), between the pQCT and CT score (rho = 0.63; P = 0.01) and between the degenerative changes identified within each temporohyoid joint within each horse (rho = 0.81; P<0.0001). Age‐associated changes included the development of a club shape by the proximal stylohyoid bone, rounding of the synostosis with the petrous temporal bone and extension of osteophytes from the petrous temporal bone to envelope the stylohyoid head and bridge the joint. In no horse was there any evidence of osteomyelitis within the petrous temporal bone, stylohyoid bone or tympanohyoid cartilage. Conclusions: This study provides evidence that age is associated with increasing severity of degenerative changes in the equine temporohyoid joint and that similar changes are commonly found bilaterally. Potential relevance: The changes identified appear similar, albeit milder to the changes reported in horses with THO, suggesting that degenerative, rather than infectious causes may underlie the aetiology of THO. Future work should be directed at examining the histopathology of clinical THO cases.     

Bilateral ceratohyoidectomy for the resolution of clinical signs associated with temporohyoid osteoarthropathy

Temporohyoid osteoarthropathy (THO) is a progressive bilateral disease of unknown aetiology that most commonly affects adult horses. Irrespective of aetiology, THO frequently results in pain or fracture of the petrous temporal bone during normal movement of the tongue and larynx. In an effort to decrease pain and reduce the likelihood of petrous temporal bone fracture, partial stylohyoidectomy and ceratohyoidectomy have been developed. Serious complications have been reported following stylohyoidectomy and therefore the current recommendation is to perform unilateral ceratohyoidectomy. Benefits of ceratohyoidectomy include a lower risk of vascular and nerve damage and a reduced risk of clinical signs recurrence when compared with stylohyoidectomy. This report describes a case of THO in which clinical signs recurred approximately 2 years after unilateral ceratohyoidectomy was performed. Due to this complication, resection of the contralateral ceratohyoid bone was performed, which resulted in complete resolution of clinical signs. Although the clinical signs are frequently unilateral, the disease is most commonly a progressive bilateral condition and some horses may not have complete resolution of clinical signs when unilateral ceratohyoidectomy is performed. Therefore, if clinical signs persist after unilateral ceratohyoidectomy, a therapeutic consideration should include bilateral ceratohyoidectomy. This report suggests a favourable short‐term prognosis for a horse treated with bilateral ceratohyoidectomy.     

Computed tomographic dimensions of the normal adult equine eye

There are limited data on whether the dimensions of the equine eye and its internal structures change with bodyweight in horses. The aim of this study was to identify whether the size of the equine eye and its individual structures varied in a predictable manner with bodyweight, and to examine the reliability of computed tomography (CT) scans in the measurement of the equine eye. Ninety horses which had undergone CT examination of the head for non‐ocular disease were included. All measurements of the eye were performed twice on all eyes by the same operator to quantify intra‐operator agreement, and in 10 cases were also performed by a second operator to quantify inter‐operator agreement. Agreement was excellent for all but the rostrocaudal measurement of the anterior chamber, which was fair. The following variables correlated significantly with bodyweight: anterior‐posterior size of the globe (correlation coefficient: 0.586) and posterior segment (correlation coefficient: 0.554); the latero‐medial size of the globe (correlation coefficient: 0.452), anterior chamber (correlation coefficient: 0.504) and posterior segment (correlation coefficient: 0.455); and the orbital fossa diameter (correlation coefficient: 0.219). The lens size and anterior‐posterior distance of the anterior chamber did not correlate significantly with bodyweight. These results suggest that overall eye size and the size of the orbital fossa change with the bodyweight of the horse, but lens size remains consistent, and that CT measurements of the internal structures of the eye are repeatable and reproducible. This information aids in interventional procedures for ocular pathology and assessment of normal anatomy.     

Computed tomographic diagnosis of a fracture of the floor of the pelvis in a Thoroughbred foal

This case report describes the clinical and diagnostic imaging findings, treatment and outcomes of a 15-day-old Thoroughbred foal referred for the evaluation of severe left hindlimb lameness of 8 days' duration. Radiographic examination of the left hindlimb and transcutaneous ultrasonographic examination of the pelvis were unremarkable. A computed tomographic (CT) examination was performed to investigate the proximal aspect of the limb and the pelvis; CT scans of the thorax were also acquired. In this case, CT images allowed detection of a closed, slightly displaced, oblique wedge-like fracture of the left caudal ramus of the pubis and medial ramus of the ischium, allowing an accurate diagnosis to guide appropriate treatment and prognostication. The foal was treated with anti-inflammatory drugs and box-rest. A follow-up by telephone interview with the trainer 3 years later revealed that the horse is in full athletic activity without any residual gait alteration related to the pelvic fracture.     

Computed tomographic anatomy of the temporomandibular joint in the young horse

Reasons for performing study: The equine temporomandibular joint (TMJ) and its surrounding structures can be difficult to investigate in cases with a clinical problem related to the region. Little previous attention has been given either to a computed tomographic (CT) imaging protocol for the joint or an interpretation of the structures displayed in CT images of the normal joint. Objectives: To provide a CT atlas of the normal cross‐sectional anatomy of the equine TMJ using frozen and plastinated sections as anatomical reference. Methods: Eight TMJs from 4 immature pure‐bred Spanish horses were examined by helical CT. Scans were processed with a detailed algorithm to enhance bony and soft tissue. Transverse CT images were reformatted into sagittal and dorsal planes. Transverse, sagittal and dorsal cryosections were then obtained, photographed and plastinated. Relevant anatomic structures were identified in the CT images and corresponding anatomical sections. Results: In the CT images, a bone window provided excellent bone detail, however, the soft tissue components of the TMJ were not as well visualised using a soft tissue window. The articular cartilage was observed as a hyperattenuating stripe over the low attenuated subchondral bone and good delineation was obtained between cortex and medulla. The tympanic and petrous part of the temporal bone (middle and inner ear) and the temporohyoid joint were seen in close proximity to the TMJ. Conclusions: Helical CT provided excellent images of the TMJ bone components to characterise the CT anatomy of the normal joint. Potential relevance: Detailed information is provided that may be used as a reference by equine veterinarians for the CT investigation of the equine TMJ and serve to assist them in the diagnosis of disorders of the TMJ and related structures (middle and inner ear). The study was performed at an immature stage and further studies of mature individuals are required in order to confirm that the clinical interpretation is not affected by changes occurring with age.     

Comminuted basilar skull fracture in a colt: Use of computed tomography to aid the diagnosis

The case of a one‐year‐old colt with acute onset of neurological dysfunction and epistaxis after a traumatic event is presented. After initiating emergency treatment, the colt was anaesthetised for diagnostic imaging. Radiographic examination of the head was suggestive of soft tissue opacity in the area of the guttural pouches, but was inconclusive about osseous involvement. A computed tomography (CT) scan, used to obtain further details, showed a comminuted basilar skull fracture with 2 displaced fragments that were not detected by radiography. Because of the poor prognosis for survival and return to athletic function, the horse was subjected to euthanasia. CT imaging provided the most useful diagnostic information about type, localisation, extension and severity of the basilar skull fracture.     

Computed tomographic myelography of a foal with discospondylitis and extradural spinal cord compression due to a vertebral abscess

A one‐month‐old Quarter Horse colt presented with progressive gait abnormalities and weakness. The foal was ataxic at presentation. Radiography identified focal endplate irregularities and lysis at C6–7. Radiographic diagnosis was discospondylitis. Computed tomographic myelography was performed immediately following euthanasia and identified an extradural compressive spinal cord lesion corresponding to the site of discospondylitis. Post mortem examination findings included abscess formation at the C6–7 intervertebral space with osteomyelitis extending into the adjacent physes and subchondral bone of caudal C6 and cranial C7. The vertebral abscess extended into the ventral spinal canal at C6–7 and was identified as the cause of extradural spinal cord compression. Salmonella sp. was cultured and isolated from purulent exudate at the intervertebral space. Computed tomographic myelography has not been previously reported for assessment of discospondylitis in horses and was successful at accurately characterising spinal cord compression in addition to osteolytic changes associated with discospondylitis.     

Epidemiological features and association with crib‐biting in horses with neurological disease associated with temporohyoid osteoarthropathy (1991–2008)

A retrospective study of 43 cases of temporohyoid osteoarthropathy was performed to evaluate the epidemiological features and a possible association with crib‐biting. Data collected from records included case details, what diagnostics were utilised, whether medical or surgical treatment was administered, and outcome. Owners were contacted via telephone and asked whether the horse had displayed crib‐biting behaviour. Forty‐three horses were diagnosed with neurological disease associated with temporohyoid osteoarthropathy, 62.8% of which were Quarter Horse‐types. Median age at presentation was 10 years and median duration of neurological signs prior to presentation was 3 days. Skull radiographs and guttural pouch endoscopy were used to definitively diagnose temporohyoid osteoarthropathy in 72% of the cases. Of 43 horses, 21 received medical treatment and 15 surgical treatment, with an overall survival rate of 55.8%. Crib‐biting was observed in 31.3% of cases and there was a significant association between being afflicted with THO and likelihood of possessing the behaviour. Horses with neurological disease associated with THO were 8 times more likely to be crib‐biters compared to the general population.     

Computed tomography assisted repair of a central tarsal bone slab fracture in a horse

A 13‐year‐old Quarter Horse gelding was presented for repair of a central tarsal bone fracture. Radiographs showed a single large nondisplaced sagittal slab fracture; however, computed tomography (CT) revealed an additional small, displaced central tarsal bone fragment. The complex fracture was repaired, under the same anaesthetic period as the CT examination, using the CT hard copies images, intraoperative fluoroscopy and radiographs. The horse recovered well and after rehabilitation showed no residual lameness at work. Computed tomography was instrumental in achieving precise screw placement and successful fracture repair.     

Comparison between radiography and computed tomography for diagnosis of equine skull fractures

The equine head is a complex structure prone to traumatic injuries. To determine the value and limitations of radiography and (CT) for the diagnosis of skull fracture, the differences between the two modalities were described. Two observers retrospectively reviewed the radiographic and CT images of 18 horses with a skull fracture. To allow direct comparison between the two modalities, a simplified fracture classification system was used. In 3/18 cases the evaluation of the radiographic examination concluded no injuries visible. In 2/15 cases soft tissue involvement was not detected and in 7/15 cases the extension of the fracture was underestimated with radiography. Radiography classified 4/10 multiple fractures incorrectly as single fracture and 5/15 comminuted fractures on CT were diagnosed as simple fracture with radiography. The number of fragments was underestimated with radiography in 14/15 cases. In conclusion, radiography is able to diagnose a skull fracture in most cases. Skull fractures however are not similarly classified after radiographic and CT evaluation, which causes a difference in interpretation and perception of the fractures. Therefore, CT should be the modality of choice for surgical planning and prognosis.     

Computed tomographic evaluation of the distal limb in the standing sedated horse: Technique,imaging diagnoses,feasibility, and artifacts

In several veterinary institutions, adjustments of CT machines have been made that allow for imaging of the standing horse. The risk of general anesthesia is eliminated and the shorter scan completion time reduces cost to clients. The objective of this retrospective, analytical study was to evaluate the technique, imaging diagnoses, feasibility, and image artifacts of multi-slice helical CT of horses’ distal limbs acquired under standing sedation. The CT images of 250 horses of various breeds, aged 3–23 years, that underwent standing distal limb CT were evaluated. Three observers assessed the CT images for artifacts and inter-observer agreement was calculated. Eighty-six percent (95% confidence interval (CI), 81–90) of the scans were carried out on the forelimbs, while 14% (95% CI, 10–19) were of the hindlimbs. A total of 65% (95% CI, 59–71) of horses that underwent standing sedated CT had single imaging diagnoses. Seventy-one percent (95% CI, 65–77) of the cases had unilateral lesions, 27% (95% CI, 22–33) had bilateral lesions and 2% (95% CI, 1–4) had no diagnosed lesions. The average CT acquisition time was 17.5 minutes (range = 15–20). The average number of acquisitions per horse was 1.7 (median = 1; range = 1–4). There was good to excellent agreement between all three observers for the presence of motion artifact in the metacarpo/metatarsophalangeal joints, identification of marked beam hardening artifact, mild solar/ skin dirt, and photon starvation artifact (kappa 0.61-0.80). No complications were encountered. Standing examination of the distal limb achieved diagnostic image quality that was obtained with minimal acquisition attempts and in a timely manner.