Retrospective study of neurological signs and management of seven English horses with temporohyoid osteoarthropathy

This retrospective study summarises the case details, presenting signs, management and outcome in cases of temporohyoid osteoarthropathy (THO) and describes the findings of diagnostic imaging modalities. The condition appears to be relatively rare in Europe and the objective of this study is to make clinicians aware that THO can have a range of various neurological and clinical presentations. The records of 2 referral equine practices in England were reviewed and 7 horses with THO diagnosed on guttural pouch endoscopy indentified. The clinical and neurological signs, diagnostic procedures, treatment and outcomes were reviewed. Although small, this group is the largest case series of THO from Europe. One horse was a yearling, whereas THO is generally considered usually to affect middle aged and older horses. Computed tomography was used to confirm the diagnosis and demonstrated stylohyoid bone fractures in 2 cases while there was mild increased radionuclide uptake in one of 2 cases undergoing nuclear scintigraphy. Treatment is still controversial, although ceratohyoidectomy led to complete resolution of signs in 2 of 5 cases thus treated and improvement in the other 3. One horse with mild signs treated with antimicrobials and nonsteroidal anti‐inflammatory drugs made a full recovery while another, presented with head shaking and managed with a phased exercise programme, improved but did not resolve completely.     

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.     

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.     

Temporohyoid osteoarthropathy in two young horses

Two cases of temporohyoid osteoarthropathy (THO) in young Australian horses are described. The pathogenesis of THO is yet to be fully elucidated, but current theories include extension of infection from otitis media or interna to the temporohyoid joint or a primary but non‐infectious degenerative condition within the temporohyoid joint. The young age of the horses and the unilateral distribution suggested an infectious aetiology. Both horses partially responded to treatment with broad‐spectrum antimicrobial and anti‐inflammatory drugs with concurrent management of ulcerative keratitis. The management of violent head shaking in one horse included the administration of gabapentin, an anticonvulsant known to have antihyperalgesic effects and reduce neuropathic pain.     

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.     

Computed tomographic diagnosis: Traumatic lingual process fracture and surgical resection

A 9‐year‐old mare was presented with abnormal behaviour and head‐shaking when ridden. Pathology of the hyoid apparatus was suspected and computed tomographic (CT) examination of the head was suggested. Computed tomographic images revealed a fractured lingual process (LP) of the basihyoid bone. Surgical resection of the fractured LP was performed. The mare recovered uneventfully and symptoms improved 10 weeks post‐operatively.     

CONGENITAL MEGAESOPHAGUS WITH HYPERTROPHIC OSTEOPATHY IN A 6-YEAR-OLD DOG

Congenital megaesophagus is often sufficiently debilitating to a young puppy to result in an owner's request for euthanasia. If medically managed, some puppies may develop a functional esophagus and mature normally; in others, the dilation may persist, but nutritional support may be sufficient to allow skeletal maturation. Hypertrophic osteoarthropathy or hypertrophic osteopathy is well recognized in many animal species. Pulmonary neoplasia is most commonly associated with development of the secondary bone changes, but numerous other causes exist. The chronic changes of hypertrophic osteopathy were identified in a 6-year-old German Shepherd that was debilitated by persistent congenital megaesophagus. To the investigators' knowledge, a relationship between long-term esophageal dilatation and hypertrophic osteopathy has only been reported once in a human patient.     

Plasma Concentrations of a Type II Collagen-derived Peptide and Its Nitrated Form in Growing Ardenner Sound Horses and in Horses Suffering from Juvenile Digital Degenerative Osteoarthropathy

Several breeds of draft horses suffer from degenerative digital osteoarthropathy, resulting in a reduced active lifespan. A group of 30 Ardenner horses was followed, in standardized conditions, from 15 to 28 months of age to detect the early manifestations of the disease. The severity of the disease was assessed according to a personal grading system including clinical and radiographic items. Coll 2-1, a peptide of the helical region of type II collagen, and its nitrated form (Coll 2-1 NO₂) were assayed in blood plasma collected at 452 ± 18 days, 504 ± 20 days, 558 ± 18 days, 613 ± 19 days, 675 ± 19 days, 752 ± 21 days and 852 ± 19 days of age. At the end of the follow-up period, 53.3% of Ardenner horses were affected by a degenerative digital osteoarthropathy. A significant effect (p < 0.05) of time, sex and pathology was observed for Coll 2-1 NO₂. Variations of Coll 2-1 were not significant except for the time effect. The elevation of Coll 2-1 NO₂ in the pathological group could indicate an inflammatory process during the growth of the affected horses, as nitration of tyrosine is mediated through reactive oxygen/nitrogen species and/or myeloperoxidase activity. Coll 2-1 NO₂ appears to be an interesting early marker of cartilage degradation and oxidation in degenerative osteoarthropathy.