Use of rotational periosteal flaps in primary repair of sinofacial fractures in seven horses

ABSTRACT

Case history: Medical records were reviewed of horses (n?=?7) undergoing surgery for fracture of one or more facial bones extending into the paranasal sinuses that was repaired primarily within 24 hours of the time of injury using a rotational periosteal flap, between April 2009 and May 2017. A kick from another horse was the cause of the injury of three horses, and one horse was injured when it collided with a tree. The cause of the injury of three horses was unknown.

Clinical findings and treatment: Fractures were of the right maxillary bone in two horses, the left maxillary bone in two horses, the left frontal and left nasal bones in two horses, and the right frontal bones in one horse. The fracture of all but one horse was accompanied by an open wound. The fracture of all seven horses was reduced, stabilised, and covered with a rotational, periosteal flap. Surgery was carried out while standing in six horses, and while anesthetised in one horse. All horses had a deficit in the fractured facial bones after the fracture was reduced. Four horses had complications following surgery, but all horses were reported to have excellent cosmetic outcomes and had retuned to their previous level of activity, as reported by their owners.

Clinical relevance: Covering a primarily repaired sinofacial fracture of a horse with a rotational periosteal flap resulted in good cosmetic outcomes, and may be especially beneficial if the fracture is accompanied by loss of bone.     

DETERMINATION OF TIME OF ONSET AND LOCATION OF EARLY SKELETAL LESIONS IN YOUNG DOGS EXPERIMENTALLY INFECTED WITH HEPATOZOON AMERICANUM USING BONE SCINTIGRAPHY

Canine hepatozoonosis caused by Hepatozoon americanum has periosteal proliferation on long bones, pelvis, vertebrae, and skull. The pathogenesis of the periosteal proliferation is unknown but may be similar to hypertrophic osteopathy. Objectives were to determine the time frame for onset of bone lesions, to characterize spatial distribution of early bone lesions, and to describe the scintigraphic appearance of bone lesions in six immature dogs infected with 400 H. americanum oocysts on day 0. 99mTc-MDP bone scintigraphy was performed before and after infection. The onset bone lesions noted using scintigraphy was before day 35/36 in three dogs, day 46 in one dog, day 53 in one dog, and between days 46 and 67 in one dog. Early bone lesions primarily occur proximal to the carpus/tarsus and on the axial skeleton. Bone lesions were diffuse, bilaterally symmetric, homogenous, high intensity regions of radiopharmaceutical uptake.     

Use of reversed periosteal flaps in the repair of large nasocutaneous fistulas in two horses

Head injuries occur frequently in horses and a successful outcome after repair depends upon the severity of the initial trauma, the anatomical structures involved and the extent of tissue loss. Often these injuries involve facial bones and enter into the nasal passages or paranasal sinus system. When these injuries occur in conjunction with substantial tissue loss, the resulting defect may be difficult to close and naso/sinocutaneous fistulae can develop. These defects can be challenging and time consuming to repair and an appropriate reconstructive technique must be selected. We describe the use of reverse periosteal flaps as a technique in repairing large nasocutaneous fistulae in 2 horses after previous attempts to close the defects by other means had failed.     

Repair of sinocutaneous fistulae in two horses

Chronic facial defects extending into the sinuses of two mares were repaired using periosteal flaps. Partial osseous bridging was established over the defects following repair. Previous attempts to close the defects with skin alone had failed. A periosteal flap is a simple surgical technique that provides the foundations for successful repair, despite the chronicity of some fistulae.     

Comparison of results from the semiautomated serum bone alkaline phosphatase isoenzyme assay with the periosteal alkaline phosphatase assay for use in rat models

BACKGROUND: Assessment of bone formation activity is an important component of pharmacologic efficacy and toxicity evaluations for compounds in development for osteoporosis therapies. Antemortem biomarkers of bone formation and remodeling in rodents are uncommon. While the periosteal alkaline phosphatase (ALP) assay is a postmortem and laborious means of testing bone-building activity, the semiautomated ALP isoenzyme assay is an antemortem assay that is performed on an automated chemistry analyzer after 2 simple dilutions of the initial serum sample and a short incubation. OBJECTIVES: The goal of our investigation was to determine if the serum bone ALP (BALP) data obtained from the semiautomated ALP isoenzyme assay had a similar pattern of response when compared with the periosteal ALP (PALP) assay for use in pharmacologic screening in rats. METHODS: Serum and bone tissue samples were obtained from orchidectomized Wistar rats, a model of clinically induced osteoporosis. Subsequent bone formation was initiated via treatment with one of several compounds. In study 1, orchidectomized male rats were given either vehicle, dihydrotestosterone or a testosterone derivative subcutaneously every 4 days for 28 days. In study 2, orchidectomized male rats were given either vehicle or compounds A, B, or C by oral gavage daily for 15 days. Blood and tibias were collected at necropsy. Serum was analyzed for BALP activity using a semiautomated ALP assay. Tibias from the same rats were analyzed for PALP activity. RESULTS: Serum BALP activity paralleled PALP activity within each group when compared with the controls. CONCLUSION: Our data indicate that the semiautomated serum BALP isoenzyme assay may be used as a biomarker of bone-building potential in rat models of osteoporosis. This assay affords many advantages to investigators of musculoskeletal diseases, including the potential to measure multiple data points in a single study.     

A review of 14 cases of hypertrophic osteopathy (Marie's disease) in horses in the Republic of Ireland

There are few reports describing hypertrophic osteopathy (HO) in horses and no reports describing this in the Irish equine population. This case series outlines the clinical, radiological and pathological features of HO in horses in Ireland and compares and contrasts the findings to previous reports. Overall, the prevalence of HO in Irish horses was found to be low with clinical signs similar to previous reports. Diagnosis of the primary lesion was low, largely due to the limited diagnostic evaluation in a large proportion of the horses evaluated. The horses had a low average age and a high prevalence (35.5%) of mandibular and facial involvement.     

Pocket technique or pocket technique combined with modified orbital rim anchorage for the replacement of a prolapsed gland of the third eyelid in dogs: 353 dogs

The aim of this retrospective study was to evaluate the results obtained in 353 dogs (420 eyes) using two different surgical techniques for correction of a prolapsed gland of the third eyelid: the Morgan's pocket technique and a technique combining Morgan's approach with a slightly modified periosteal anchoring technique of Stanley and Kaswan. The pocket technique was used in 234 eyes and the combined technique in 186 eyes. Successful repositioning was obtained in 95% of all cases, with recurrence occurring in 5%. The recurrence rate in large breed dogs such as the English Bulldog and Boxer was lower with the combined technique than with the pocket technique.     

Hepatozoonosis in a dog with skeletal involvement and meningoencephalomyelitis

Abstract: A 15‐month‐old, female mongrel dog was presented with a 6‐week history of inappetence, weight loss, and tetraparesis. Physical examination revealed weakness, poor body condition, mild fever, pale mucous membranes, and diffuse muscle atrophy. The right hind limb was painful and edematous, with large ecchymoses. The femur was irregular on palpation and moderate popliteal lymphadenopathy was evident. Results of a CBC showed severe anemia with mild regeneration, an inflammatory leukogram with 90% of neutrophils parasitized by Hepatozoon sp. gamonts, and moderate thrombocytopenia. A bone marrow aspirate had myeloid hyperplasia and contained a few extracellular Hepatozoon meronts and a few intracellular gamonts within neutrophils. Serum chemistry abnormalities included hypoalbuminemia, hyperglobulinemia, hypoglycemia, hypercalcemia, hyperphosphatemia, and elevated alkaline phosphatase activity. Radiologic findings of the right femur included periosteal bone proliferation and lesions compatible with osteomyelitis. A fine needle aspirate specimen from the bone lesion had neutrophilic inflammation; 36% of the neutrophils contained Hepatozoon gamonts. Results of cerebrospinal fluid analysis included a protein concentration of 37 mg/dL and marked mononuclear pleocytosis (243 cell/μL) with a predominance of lymphocytes. An ELISA was positive for Hepatozoon canis and PCR results with DNA sequencing confirmed infection with this organism. A diagnosis of hepatozoonosis with skeletal involvement and meningoencephalomyelitis was made. The dog recovered almost completely neurologically and had no gamonts in the blood after 60 days of therapy with imidocarb dipropionate and prednisone. This is an unusual case of canine hepatozoonosis involving neurologic signs and a periosteal reaction more typical of H. americanum infection and rarely reported in dogs infected with H. canis.     

Canine calvarial subperiosteal hematomas are fluid to soft tissue attenuating mass‐like lesions with smoothly marginated peripheral mineralization on CT

Subperiosteal hematomas are accumulations of blood between a bone and the periosteum leading to elevation of the periosteum. When ossified they have a mineralized outer rim. For this retrospective, multi‐institutional case series, medical records were searched to identify dogs that underwent CT for focal calvarial swellings noted acutely after trauma. A total of four dogs were included. Computed tomography images were reviewed for each case. The focal swellings had progressed in size during the weeks after the head trauma until the time of imaging. Findings in all cases included a fluid to soft tissue attenuating mass‐like lesion with smoothly marginated peripheral mineralization. Diagnosis was confirmed in two cases by cytology and/or histopathology. Therefore, authors recommend that subperiosteal hematoma be included in the differential diagnosis list for dogs with these clinical and CT characteristics. Based on our review of the literature, this is the first report to describe the CT features of calvarial subperiosteal hematomas in dogs.