Surgical repair of a mandibular degloving injury in a 5‐month‐old colt

A 5‐month‐old colt sustained a mandibular degloving injury and penetrating cheek wound after catching his cheek on a metal hook. Avulsion of the lower left lip and cheek exposed parts of the underlying labial surface, interalveolar margin and body of the mandible. The injury prevented the colt from closing his mouth completely and food accumulated between the degloved mandible and avulsed soft tissues. Surgical repair included 7 stented, transmandibular mattress sutures placed over the length of the interalveolar margin, closing the dead space and repositioning the avulsed soft tissues. The horse recovered without complications and functional as well as cosmetic outcome were excellent.     

Facial swelling and discharging lesions associated with abnormalities of the mandible in kunekune pigs

Abstract

CASE HISTORIES: Four adult kunekune pigs developed facial swelling at the base of the right ear that ruptured and discharged food material. A further six pigs that had similar clinical signs were reported by members of the New Zealand Kunekune Association who responded to an email survey, one of which was confirmed by post-mortem examination.

CLINICAL FINDINGS: Inside the mouth of each pig there was an opening at the junction of the body and ramus of the mandible just lateral to the most caudal visible molar that was impacted with masticated feed. The food packed into the mandible resulted in infection and progressive erosion of the medullary cavity of the bone until it reached the ramus where it eroded through the lateral cortex. The feed material then tracked through the soft tissues to form a subcutaneous abscess, which eventually ruptured resulting in a draining lesion. In Case 2, which had had the lesion for 2 years, the cavity in the mandible was lined with mucosa that had healed to the skin to produce a fistula. In all four pigs there was also a lesion in the left side of the mandible that was not as developed as that on the right side.

DIAGNOSIS: The facial swellings were produced by feed material that had impacted into the mandible through an opening immediately caudal to the cheek teeth and then emerged through one or more lesions in the lateral aspect of the ramus of the mandible.

CLINICAL RELEVANCE: Although it has not been previously reported, anecdotal reports and our survey suggest that this condition may occur relatively frequently in kunekune pigs. It should be considered as a differential diagnosis for facial swellings and discharging lesions in these animals.     

Percutaneous drainage of an abscess in the lateral neck region of a horse

A large abscess in the lateral neck region of a horse was treated with percutaneous drainage. The abscess was localized with ultrasonography and aspirated by use of a 7.7-cm spinal needle. A stainless-steel guide wire was passed through the needle, and tissue dilators were used to enlarge the percutaneous hole. A multiperforated polyvinylchloride catheter that was placed within the abscess cavity permitted aspiration and lavage of the abscess. The abscess resolved over the next 10 days with no complications. Percutaneous abscess drainage is commonly performed in people and may have application in veterinary medicine.     

Right Dorsal Colon Resection and Bypass for Treatment of Right Dorsal Colitis in a Horse

Objective: To describe a novel surgical technique for management of right dorsal colitis in the horse. Study Design: Clinical report. Animals: 14‐year‐old Warmblood gelding. Methods: The horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavity was entered during the approach. Surgical resection of the RDC and side‐to‐side anastomosis of the diaphragmatic flexure to the small colon (bypass) was performed. The thoracic cavity was closed by attaching the diaphragm to the body wall and air was removed at the completion of surgery. Results: Resection of the RDC and bypass of the resected area was successfully performed. The colic signs and hypoproteinemia resolved. Complications of surgery included a deep surgical site infection with development of a large intrathoracic abscess. The abscess was managed with drainage and long‐term antimicrobial treatment. Conclusion: Right dorsal colitis can be treated successfully with resection and bypass of the RDC. In cases where the thoracic cavity is penetrated during the abdominal approach, the diaphragm should be sutured to the body wall at the beginning of surgery to avoid development of an infection within the thoracic cavity. Clinical Relevance: RDC resection and bypass may be an alternative approach for management of horses with right dorsal colitis.     

Surgical treatment of a mandibular ameloblastic carcinoma with metastases to the mandibular lymph nodes in a pony

A 4-year-old Connemara filly was presented with a rapidly growing oral mass on the right rostrolateral mandible and a right mandibular lymphadenopathy. Radiographs of the rostral mandible revealed a lytic, infiltrative mass consistent with soft tissue and mineralised material, and displacement of tooth 403. A biopsy showed characteristic histopathological features of an ameloblastic carcinoma. Subsequent FNA of the right abnormally firm and enlarged mandibular lymph node confirmed the metastatic spread. Computed tomography of the head was performed for surgical planning, including sentinel lymph node mapping to rule out other lymph node involvement. An aggressive lesion, consistent with soft tissue of the rostral right mandible was identified with intralesional contrast injection showing drainage of contrast within the right mandibular lymph nodes (Sentinel node). Based on the infiltrative and destructive nature reported in ameloblastic carcinoma in humans, a rostral mandibulectomy was performed, along with complete mandibular lymphadenectomy. The horse recovered uneventfully from surgery. In the early post-operative period marked lymphoedema of the ventral mandibular region was observed, which resolved 4–5 days post-operatively. Optimal cosmesis was maintained post-operatively, and no recurrence has been observed to date – 12 months post-surgery.     

Extraperitoneal incisional abscess formation after colic surgery in 3 horses

In this article we report 3 horses that developed an extraperitoneal abscess after colic surgery at the incision site. All 3 horses presented with nonspecific clinical signs and extraperitoneal abscess was diagnosed from ultrasound evaluations and cytological examination of abscess aspirates. One horse developed dehiscence of the incision after drainage of the abscess through the incision. In 2 cases a small standing paramedian incision was performed through which the abscess was drained and lavaged; complete resolution of the abscess and healing of the incision was achieved in both cases. Extraperitoneal abscess is a previously unreported incisional complication after colic surgery in horses. Early and careful ultrasonographic examination of the abdominal incision is required for diagnosis in cases with nonspecific clinical signs. A paramedian incision through the rectus abdominis muscle into the abscess cavity permitted adequate drainage and debridement of the abscess in 2 cases.     

Multiple mandibular ossifying fibromas in a yearling Belgian Draught horse filly

A yearling Belgian Draught horse filly was presented with a history of bilateral, progressive, painful swelling of the mandible, fever and anorexia. Radiographs and computed tomographic images showed an expansile lesion with a coalescing, well‐defined cystic pattern at the level of the horizontal ramii of the mandible. The histopathological findings confirmed the diagnoses of bilateral, multiple ossifying fibroma. This report indicates that ossifying fibroma should be included in a differential diagnosis if multiple expansile lesions of the jaw are present.     

Anaerobic orbital abscess/cellulitis in a Yorkshire Terrier dog

A retrobulbar abscess/cellulitis occurred in a Yorkshire Terrier dog. The clinical signs were exophthalmos, prolapsed nictitating membrane and purulent ocular discharge. Ultrasonography showed a marked soft tissue swelling of the retrobulbar tissues as well as echogenic parallel lines between the globe and the medial orbital rim. Surgical exploration of the orbit was performed and no foreign body was found. The pterygopalatine fossa was incised and therapeutic retrobulbar drainage attempted. A drain was placed to encourage ventral drainage of the abscess. Anaerobic cultures revealed heavy growth of gram negative rods (prevotella bivia and prevotella buccae were isolated). Recovery was successful but subsequent treatment for keratoconjunctivitis sicca was necessary. A full recovery of tear production occurred after several weeks.     

Extranodal lymphoblastic lymphoma of suspected B-cell lineage in the gingiva of a racehorse,accompanied by mandibular osteolysis

A mass developed in the mandibular gingiva of a thoroughbred racehorse. When the horse could no longer eat unassisted, it was killed and immediately autopsied. Macroscopically, the mandible exhibited extensive osteolysis, with only a small amount of bone remaining around the tooth roots. The cut surface of the mass around the mandible consisted of neoplastic medullary tissue, in which osteogenesis was observed. The medullary tissue was composed of pleomorphic medium-sized to large cells, interlaced by collagen bundles. These cells had large, pale, round or ovoid, sometimes cleaved nuclei, with one or two prominent nucleoli. Mitoses were numerous. Electron microscopy showed that the cells in the medullary tissues were similar in shape to undifferentiated lymphocytes. Immunohistochemically, these cells were positive for B-cell associated antigen in the pre-B-cell stage. Our findings suggest that the horse had extranodal lymphoblastic lymphoma of suspected B-cell lineage, possibly originating from the lymphatic system of the gingiva. We consider that the osteolysis resulted from activation of osteoclasts by proliferation of the tumour cells.     

Medial pterygoid myositis in a Thoroughbred gelding

This case report describes the investigation and treatment of an adult horse with purulent, malodorous exudate originating from a large intermandibular mass. Microbial culture of fluid aspirated from a draining tract yielded Peptostreptococcus and Prevotella species which are usually considered to originate from the oral cavity. Computed tomography (CT) was used to aid in the diagnosis and to allow careful presurgical planning, and the horse underwent successful debridement of the abscess cavity under general anaesthesia. Post-operatively, the horse developed trismus (reduced opening of the jaws) but repeat CT identified that the surgery site was healing appropriately. It was recommended to continue feeding the horse hay to act as physiotherapy and the masticatory action of the horse subsequently returned to normal.     

Para-aural abscess in the dog and cat

The term para-aural abscess is used to describe the condition when suppuration has extended from the external ear canal or the middle ear cavity into the surrounding soft tissues. This report describes a series of 17 dogs and three cats in which otitis had advanced to the stage of para-aural abscess formation. The diagnostic procedures and subsequent treatments are rationalized but it is concluded that the prognosis is not favourable in most animals in which otitis has progressed to this state.     

Bacterial meningitis and brain abscesses secondary to infectious disease processes involving the head in horses: seven cases (1980-2001)

OBJECTIVE: To determine clinical features of horses with bacterial meningitis or brain abscesses secondary to infectious disease processes involving the head. DESIGN: Retrospective study. ANIMALS: 7 adult horses. PROCEDURE: Medical records of Tufts University, the University of Pennsylvania, and the Livestock Disease Diagnostic Center (Lexington, Ky) were reviewed to identify adult (> 12 months old) horses in which a postmortem diagnosis of bacterial meningitis or brain abscess had been made. Horses were included in the study if an intracranial infection was confirmed, the horse had a primary infectious disease process involving the head, and there were no signs of systemic infection. RESULTS: 23 adult horses with bacterial meningitis or a brain abscess were examined during the study period, but only 7 met the criteria for inclusion in the study. Primary sites of infection included the paranasal sinuses, nasal cavity, periocular tissues, and submandibular lymph nodes. Three horses died suddenly prior to hospitalization, and 1 horse was hospitalized but died 7 days after the onset of neurologic abnormalities. The remaining 3 horses were euthanatized because of a rapid deterioration in clinical status. CONCLUSIONS AND CLINICAL RELEVANCE: Although rare, fatal intracranial complications can develop in horses with infectious diseases involving the head.     

Treatment and ophthalmic sequelae in a horse with facial cellulitis and orbital abscess

A 22‐year‐old Quarter Horse gelding with a history of dental (107) extraction 2 weeks previously was presented with facial cellulitis and an orbital abscess. The abscess was drained surgically dorsally and ventrally to the zygomatic arch and the horse was treated with parenteral antimicrobial and anti‐inflammatory drugs. The affected eye was protected with a temporary tarsorrhaphy and treated via a subpalpebral catheter. Six months after presentation, the horse was in excellent general condition and returned to previous level of exercise but showed blindness on the affected side. Pallor of the optic disc and severe attenuation of the retinal vessels, suggestive of optic disc atrophy, were present.     

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.     

Lateral orbitotomy for treatment of an orbital abscess in a dog

A two‐year‐old Jack Russell terrier was diagnosed with a retrobulbar abscess and orbital cellulitis. The diagnosis was confirmed by ultrasound, magnetic resonance imaging examination and ultrasound‐guided fine‐needle aspiration. Transoral ventral drainage was attempted but was unsuccessful. The abscess was successfully treated by open drainage through a lateral orbitotomy. Despite the exposure of the orbital structures, the orbital soft tissues healed by second intention without further complications. The open drainage was well tolerated and resulted in immediate reduction of inflammation and pain, allowing a quick recovery. This report describes the diagnosis and, surgical management and the long‐term (3 years) follow‐up of an unusual case of orbital abscess associated with diffuse periorbital cellulitis successfully treated by open drainage through a lateral orbitotomy.     

A technique for computed tomography (CT) of the foot in the standing horse

Computed tomography (CT) in equine orthopaedics is currently limited because of the price, availability, impossibility to transport the scanner into surgical theatre, and the contraindications of general anaesthesia in some patients. A pQCT (peripheral quantitative computerised tomography) scanner was designed by the authors to image the limbs of the horse, both in standing or recumbent position. Standing computed tomography of the foot with a pQCT scanner is feasible and well tolerated by the horse. It enables good visualisation of bony structures but is not suitable to evaluate soft tissues. The technique can also assist surgery by assessing the 3D configuration of bone lesions.     

Use of 111In-labeled autologous leukocytes to image an abdominal abscess in a horse

Indium 111-labeled autologous leukocytes were used to image an abdominal abscess in a horse with a palpable abdominal mass and history of Streptococcus equi infection. A focal area of radioactivity was identified in the location corresponding to the abscess. Imaging of this focal uptake was optimal 48 hours after injection. Similar scans obtained in 2 clinically normal horses revealed no evidence of focal radioactivity in this region. The cell labeling procedure gave acceptable labeling efficiency (87.5%) but an excessive number of damaged WBC, resulting in persistent lung radioactivity on all images. No adverse effects were noted. Radiation measured in the horse and its excreta were well within acceptable limits.     

Equine Mandibular Fibrosarcoma in Two Horses: Clinical,Diagnostic, and Therapeutic Considerations

A 25 year old Arabian gelding (case 1) presented for a large mandibular swelling involving the caudal aspect of the left horizontal mandible and a 14 year old Quarter Horse gelding (case 2) presented for a soft tissue swelling on the labial mucosa adjacent to 304. Both horses were bright and alert on presentation. Computed tomography allowed for further characterization regarding the extent of bone penetration within the lesions. This facilitated surgical planning and resection in Case 2. Histopathology of both masses diagnosed fibrosarcomas. Case 1 was humanely euthanized due to the severity of bone involvement and the grave prognosis. Case 2 underwent a left subtotal rostral hemimandibulectomy that proved to be successful in complete resection of the fibrosarcoma with a comfortable and cosmetic post-operative outcome. Surgeries that were once deemed radical should be considered for the treatment of neoplastic masses involving the soft tissues and bony structures of the oral cavity. With the aid of computed tomography, assessment of tumor penetration into deeper tissues can be achieved, thus facilitating complete surgical excision.     

Perirectal abscess, colic, and dyschezia in a horse

A quarter horse gelding with intermittent colic was diagnosed with a perirectal abscess and dyschezia. Rectal ultrasonography identified a multiloculated, fluid-filled mass. A perirectal abscess was diagnosed when the mass ruptured and drained into the rectum. The abscess was treated successfully with warm soapy water enemas and trimethoprim and sulfamethoxazole.     

Primary sinonasal malignant melanoma with systemic metastasis in a non-gray horse

A 27-y-old Anglo-Arabian gelding with bay coat color was presented with a swelling of the left maxillary region. Fenestration on the left maxilla revealed that the left maxillary sinus was filled with black-red tissue. A portion of the tissue was excised and diagnosed histologically as malignant melanoma. Genotyping of the STX17 gene for gray coat color revealed that the horse did not have the “gray” factor. The horse was euthanized ~3 mo after first presentation. During autopsy, a black-to-gray mass extended from the left nasal cavity to the surrounding paranasal sinus and invaded the hard palate, cribriform plate, and the cranial portion of the left olfactory bulb. Moreover, identical black nodules were present in lymph nodes from the mandible to the larynx, and in the spleen, liver, kidney, and adrenal glands. However, masses were not found in the skin, perineal region, or pelvic cavity. All of the black-to-gray nodules were malignant melanomas that were histologically identical to the initial biopsy; tumor emboli were also found in the kidney. Sinonasal mucosal melanoma is a rare disease in horses.