Temporohyoid osteoarthropathy in the horse

Temporohyoid osteoarthropathy (THO) is a well‐recognised clinical entity in horses. Temporohyoid osteoarthropathy is characterised by progressive osseous proliferation of the proximal portion of the stylohyoid and petrous temporal bones, and is generally described as a disease of middle‐aged horses. More recent reports also attribute a variety of clinical syndromes in young horses to THO, requiring a diversification of approaches to confirm the diagnosis and its significance, and to guide conservative and surgical treatment options. This commentary will review the purported aetiology, clinical syndromes, available diagnostic tests and treatment options of equine THO.     

THE COMPUTED TOMOGRAPHIC APPEARANCE OF EQUINE TEMPOROHYOID OSTEOARTHROPATHY

Equine temporohyoid osteoarthropathy is characterized by progressive osseous proliferation of the temporohyoid articulation and surrounding structures. The diagnosis has generally been made using radiography and endoscopy of the guttural pouch. Recently, computed tomography (CT) has been used in the diagnosis of temporohyoid osteoarthropathy. This study was performed to determine the CT imaging characteristics of temporohyoid osteoarthropathy and to compare these to radiographic and endoscopic findings. CT scans from 16 horses with a final diagnosis of temporohyoid osteoarthropathy were reviewed. Five horses that had undergone CT scan for reasons other than temporohyoid osteoarthropathy were included as controls. Qualitative and quantitative data were used to describe the magnitude of the CT findings. Osseous proliferation of the stylohyoid bone and temporohyoid articulation was found to be a consistent feature of temporohyoid osteoarthropathy. Thickening of the ceratohyoid bone and proliferation of its articulation with the stylohyoid bone was frequently identified and this finding may have surgical implications. Horses with neurologic deficits had increased stylohyoid width that was significantly different than the subclinically affected side. CT evaluation also allowed the identification of subclinical bilateral disease in horses thought to be unilaterally affected based on clinical examination.     

Traumatic bilateral stylohyoid bone fracture in an Appaloosa

An Appaloosa gelding presented for a traumatic puncture wound of the head ventral to the base of his left ear, bilateral epistaxis and upper respiratory compromise. The horse did not exhibit dysphagia or cranial nerve deficits. The horse suffered bilateral oblique fractures of both stylohyoid bones due to the traumatic incident, diagnosed upon endoscopy of the guttural pouches. Treatment consisted of anti‐inflammatory medication, broad‐spectrum antibiotics, guttural pouch lavage and dietary management with soft feeds. At a one‐month follow‐up examination, endoscopic evaluation revealed a union at both stylohyoid bone fracture sites. Guttural pouch mycosis was diagnosed in the left guttural pouch on the lateral wall at the entrance of the lateral compartment. The guttural pouch mycosis was treated with a nystatin and gentamicin flush, followed by a course of oral fluconazole. At the 3‐month re‐evaluation, the guttural pouch mycosis had completely responded to treatment.