Oral Surgery Flashcards
In Bach 2014 paper “Bacterial Meningitis After Sinus Surgery in Five Adult Horses”, what was the onset of time to neurologic clinical signs from sinus surgery?
Vet Surg 2014
5–11 days after initial surgery and 4–11 days after last surgery in all 5 horses
In Bach’s 2014 paper, “Bacterial Meningitis After Sinus Surgery in Five Adult Horses”, what were the 4 pathways hypothesized to have caused meningitis secondarily to sinus surgery?
Vet Surg 2014
- osteitis/erosion of thin bones → fracture of cribiform plate
- vascular spread (hematogenous‐metastatic, thrombophlebotic)
- along cranial nerves (more common in ruminants - listeriosis), hypoth optic nerve in sphenopalatine sinus involvement
- direct bacterial inoculation caused by (iatrogenic) head trauma
In Mendez-Angulo’s paper “Extensive Rostral Mandibulectomy for Treatment of Ameloblastoma in a Horse” to what extent was the rostral mandibulectomy performed?
Vet Surg 2014
Caudal aspect of symphysis - The day after surgery, the remaining mandibular symphysis (<5 mm) fractured
In Gilsenan’s case series “Headshaking in 5 Horses After Paranasal Sinus Surgery”, what dose of gabapentin was effective in resolution of clinical signs in 2/5 horses?
Vet Surg 2014
5–10 mg/kg orally every 6–8 hours
What is the presumed MOA of neuropathic pain?
Gilsenan et al Vet Surg 2014
neuropathic pain are caused by spontaneous ectopic neuronal firing that may result from upregulation of sodium channels in injured nerves in various phases of repair
In the 2015 study by Langeneckert et al, “Cheek Tooth Extraction Via a Minimally Invasive Transbuccal Approach and Intradental Screw Placement in 54 Equids,” what was the success rate of MITSE?
Vet Surg 2015
81% (47/58)
In the 2015 study by Langeneckert et al, “Cheek Tooth Extraction Via a Minimally Invasive Transbuccal Approach and Intradental Screw Placement in 54 Equids,” what were the post-operative complications described by the authors?
- 4/58 (7%) animals w/ hemorrhage from trocar incision
- 3/58 procedures diffusion of local anesthetic caused temporary loss of facial nerve motor function
- 1/58 had oroantral communication
In the 2015 study by Langeneckert et al, “Cheek Tooth Extraction Via a Minimally Invasive Transbuccal Approach and Intradental Screw Placement in 54 Equids,” what was the most common intraoperative complication described by the authors?
Screw pullout
Mechanical lockage of the target tooth w/in the extraction path resulted in screw pullout in 13/32 procedures
Friable tooth material responsible for screw pullout in 19/32 procedures
In the 2015 study by Langeneckert et al, “Cheek Tooth Extraction Via a Minimally Invasive Transbuccal Approach and Intradental Screw Placement in 54 Equids,” MITSE was found to be favorable when compared to repulsion and invasive lateral buccotomy techniques for which reasons?
Repulsion:
- 3/14 (21%) of horses w/ repulsion of mandibular CT developed chronic draining tracts
- 6/30 (20%) of horses w/ entire apical repulsion of maxillary CT developed chronic nasal discharge w/ or w/o oroantral fistula formation (Prichard et al., 1992)
-vs. 2/33 (6%) of animals in this study
Invasive lateral buccotomy techniques:
- 3/112 (3%) of horses developed prolonged or permanent paralysis of the ventral buccal ramus of the facial nerve w/ drooping of the lower lip observed more than 2 months after surgery (O’Neill et al., 2011)
In Lorello’s 2016 paper “Clinical treatment and prognosis of equine odontoclastic tooth resorption and hypercementosis”, what was the mean age of diagnosis of EOTRH?
EVJ 2016
24 years (17-29 y range)
In Jansson’s 2016 paper “Conservative Management of Unilateral Fractures of the Mandibular Rami in Horses”, how many of the horses returned to their intended use?
Vet Surg 2016
23/24 (96%)
1 horse had dental problems and subsequent non healing fracture, later euth
In Jansson’s 2016 paper “Conservative Management of Unilateral Fractures of the Mandibular Rami in Horses”, how many horses were diagnosed with open fractures?
Vet Surg 2016
67%
9 of them developed cutaneous fistulas
In this intraoperative image from “True Cementomas (cementoblastomas) Associated with a Nonvital Left Maxillary Second Premolar in an 11-year-old Miniature Horse,” what muscle and nerve were retracted ventrally?
Leudke, Rawlinson, EVE 2016
Levator nasolabialis m
Infraorbital nerve
In Leudke’s 2016 paper ““True Cementomas (cementoblastomas) Associated with a Nonvital Left Maxillary Second Premolar in an 11-year-old Miniature Horse,” how is a cementoma histologically defined?
Rawlinson EVE 2016
Rare odontogenic tumors caused by abnormal proliferation of neoplastic or reactive cementoblasts that produce single or multiple nodular masses comprising sheets of mineralized cementum-like material
Differs from the Easley 2022 text that distinguishes reactive nodular hypercementosis from true cementomas as histologically different but clinically identical entities
What bone is fractured in the image below?
Grant “Iatrogenic fracture of the premaxilla during standing exodontia” EVE 2016
Premaxilla, bilaterally
In Nottrott’s 2018 JVD case report “Successful Treatment of a Persistent Oroantral Fistula via Transbuccal and Transnasal Endoscopic Debridement in a Horse”, what allowed the surgeons access to the sinuses transnasally? And which sinuses?
JVD 2018 issue 1
The absence of normal turbinate anatomy allows direct access into the maxillary and conchal sinuses on the right of the image.
What were the major outcomes of this ex vivo study in regards to ability to perform the techniques, access to the sinuses, and sinus drainage?
Bach et al. Surgical enlargement of the nasomaxillary aperture and transnasal conchotomy of the ventral conchal sinus: Two surgical techniques to improve sinus drainage in horses. Vet surg 2019
Sinonasal communications were successfully created in all cadavers and affected live horses.
Transnasal endoscopy of all sinuses except the middle conchal sinus was possible in heads 4–9 and in all clinical cases.
Drainage was increased (P = .028) through the surgically created sinonasal communications (combined TCVCSSENMAP) in heads 7–9
In Horbal’s 2016 paper “Gingival Fibrosarcoma in a Horse: A Case Report,” what treatments were performed?
JVD Dixon 2016
Repeated surgical debulking and intralesional cisplatin
In Horbal’s 2016 paper “Gingival Fibrosarcoma in a Horse: A Case Report,” after the final surgical and cisplatin treatments the mass was noted to have regressed how many months later and what was the maximum follow up?
JVD Dixon 2016
3 months
4 years later horse asymptomatic in full work
Last oral exam 8 months after final treatment, mare asymptomatic, no recurrence, gingival recession 107
In Morgan’s 2019 paper “Equine Odontogenic Tumors: Clinical Presentation, CT Findings, and Outcome in 11 horses,” what clinical presentation findings were noted in all horses?
Vet Radiol Ultra 2019
All masses nonpainful, firm, bony swellings palpated externally over dental arcades
Solitary mass 10/11 cases
In Morgan’s 2019 paper “Equine Odontogenic Tumors: Clinical Presentation, CT Findings, and Outcome in 11 horses,” what CT characteristics were present in all cases?
Vet Radiol Ultra 2019
All tumors associated with maxillary/mandibular bone expansion, alveolar and cortical bone lysis and cortical bone thinning
In Morgan’s 2019 paper “Equine Odontogenic Tumors: Clinical Presentation, CT Findings, and Outcome in 11 horses,” what were the only odontogenic tumors in this study found to contain enamel and be differentiable on CT examination?
Vet Radiol Ultra 2019
Complex odontomas
In Morgan’s 2019 paper “Equine Odontogenic Tumors: Clinical Presentation, CT Findings, and Outcome in 11 horses,” what do the short white arrows, long white arrow and white arrowheads represent?
Short white arrows: alveolar bone lysis
Long white arrow: cortical bone thickening
White arrowheads: Smooth periosteal reaction
In Rice’s 2018 paper “Standing intraoral extractions of cheek teeth aided by partial crown removal in 165 horses (2010-2016),” complete intraoral extraction was successful in what percent of horses and what percent of horses required additional intraoral extraction methods to complete extraction?
EVJ 2018 Rice
Complete intraoral extraction successful in 99.4% horses (164/165)
15% (25/165) required additional intraoral extraction methods
In Rice’s 2018 paper “Standing intraoral extractions of cheek teeth aided by partial crown removal in 165 horses (2010-2016),” what additional intraoral extraction method was performed most commonly?
EVJ 2018 Rice
MITSE 21/25 cases
tooth sectioning 4/25 cases
In Rice’s 2018 paper “Standing intraoral extractions of cheek teeth aided by partial crown removal in 165 horses (2010-2016),” what were the most common intraoperative complications and postoperative complications and rates respectively?
EVJ 2018 Rice
Most common intraoperative: fractured root tips 6.7% 11/165 horses
3.6% (6/165) horses developed postop complications - small alveolar sequestra 4/6 horses
In Caramello’s 2020 study “Equine cheek tooth extraction: Comparison of outcomes for five extraction methods,” which complication is highlighted by the arrows following lateral buccotomy extraction of 408?
EVJ 2020
Bone sequestra from damage to alveolar bone
In Caramello’s 2020 study “Equine cheek tooth extraction: Comparison of outcomes for five extraction methods,” in order from highest to lowest, what were the complication rates for the 5 extraction techniques?
EVJ 2020
Oral extraction - 20%
Repulsion by max trephine 42%
Lateral buccotomy 53%
Repulsion via mandibular trephine 54%
Repulsion via max bone flap 80%
In Caramello’s 2020 study “Equine cheek tooth extraction: Comparison of outcomes for five extraction methods,” which extraction technique significantly increased the odds of superficial incisional surgical site infection?
EVJ 2020
Max trephine retropulsion
In Caramello’s 2020 study “Equine cheek tooth extraction: Comparison of outcomes for five extraction methods,” which extraction technique significantly increased the likelihood of fistulation
EVJ 2020
Repulsion via max bone flap (also inc odds of sinusitis post-op, damage to surrounding teeth, delayed alveolar granulation)
In Caramello’s 2020 study “Equine cheek tooth extraction: Comparison of outcomes for five extraction methods,” which extraction technique significantly increased the odds of facial nerve neuropraxia?
EVJ 2020
Lateral buccotomy
In Pearce’s 2019 study “Extraction of 22 equine cheek teeth with displaced sagittal fractures using polymethylmethacrylate stabilization (2011-2016),” what was the success rate of this technique and what percent of cases had clinical signs on presentation?
EVE 2019
73% success rate
64% had clinical signs
In Pearce’s 2019 study “Extraction of 22 equine cheek teeth with displaced sagittal fractures using polymethylmethacrylate stabilization (2011-2016),” what complications were reported?
EVE 2019
2 maxillary nerve block complications
2 cases that did not have preoperative sinusitis developed postoperative sinusitis
In Kolos’ 2019 paper “Transnasal endoscopic treatment of equine sinus disease in 14 clinical cases,” what do A, B, C and D represent in the image below
EVE 2019
A. Nasal septum
B. Soft palate
C. Dorsal concha
D. Ventral concha
In Kolos’ 2019 paper “Transnasal endoscopic treatment of equine sinus disease in 14 clinical cases,” what concha should be fenestrated to access the rostral and caudal sinus groups respectively?
EVE 2019
Caudal sinus group: ventromedial wall of dorsal concha
Rostral sinus group: medial wall of ventral concha
In Kolos’ 2019 paper “Transnasal endoscopic treatment of equine sinus disease in 14 clinical cases,” what served as the craniocaudal landmark for fenestrations?
EVE 2019
caudal termination of nasal septum attachment to hard palate
In Kolos’ 2019 paper “Transnasal endoscopic treatment of equine sinus disease in 14 clinical cases,” complete resolution of clinical signs was reported in how many cases of dental and primary sinusitis respectively?
EVE 2019
dental sinusitis 7/10
primary sinusitis 3/4
In Wellman’s 2019 study “A Study on the Potential Role of Occlusal Fissure Fractures in the Etiopathogenesis of Equine Cheek Teeth Apical Infections,” standard CT identified how many occlusal fractures?
JVD 2019 issue 3
1 out of 39
In Wellman’s 2019 study “A Study on the Potential Role of Occlusal Fissure Fractures in the Etiopathogenesis of Equine Cheek Teeth Apical Infections,” how many occlusal fissure affected teeth had OFs going beyond 6mm depth?
JVD 2019 issue 3
33% (13/39)
In Kennedy’s 2020 study “A long-term study of equine cheek teeth post-extraction complications: 428 cheek teeth (2004-2018)”, what was the overall complication rate for extractions?
EVJ 2020
13.6%
In Kennedy’s 2020 study “A long-term study of equine cheek teeth post-extraction complications: 428 cheek teeth (2004-2018)” what was the overall success rate for oral extraction?
EVJ 2020
80%
In Kennedy’s 2020 study “A long-term study of equine cheek teeth post-extraction complications: 428 cheek teeth (2004-2018)” what was the complication rate for apically affected teeth vs those without?
EVJ 2020
18.3% with apical infection
5.4% without
In Kennedy’s 2020 study “A long-term study of equine cheek teeth post-extraction complications: 428 cheek teeth (2004-2018)” what was the most common complication and the relative # times they were recorded for repulsion vs MTE vs oral extraction?
EVJ 2020
32/58 (55%) complications were alveolar sequestra
Alveolar sequestration was recorded following 14.6% (6/41) of Steinmann pin repulsions, 10.3% (4/39) of MTEs and 6.4% (22/343) of oral extractions
In Limone’s 2020 case report “Transcutaneous Lateral Alveolar Ostectomy for Standing Surgical Extraction of Mandibular First Molar in an 8-Year-Old Miniature Horse,” what is demonstrated in the image below?
JVD 2020
Pulp exposures of pulp horns 1 and 3
In Limone’s 2020 case report “Transcutaneous Lateral Alveolar Ostectomy for Standing Surgical Extraction of Mandibular First Molar in an 8-Year-Old Miniature Horse,” what modification was made to Rawlinson’s previous description of transcutaneous lateral alveolar ostectomy?
JVD 2020
Buccal bones was only removed over the roots to the level of the furcation and not the reserve crown due to concern for mandibular fracture in a small patient
In Lores’ case report “Repair of an oronasal fistula with a two-layer closure method involving an autogenous fascia lata graft and oral mucosal flap in a pony” what was the first repair technique performed, and what technique ultimately got the fistula to resolve?
JAVMA 2020
1) The pony initially underwent a reconstructive surgical procedure that combined an alveolar bone flap (performed under standing sedation) with a sliding mucoperiosteal hard palate flap to repair the oronasal fistula (under GA)
2) a novel 2-layer flap closure method involving an autogenous fascia lata graft and oral mucosa flap (under GA)
In Pollaris’ 2021 article Fracture Resistance of Equine Cheek Teeth With and Without Occlusal Fissures: A Standardized ex vivo Model,” what factor was associated with decreased fracture resistance?
Frontiers 2021
Presence of fissure fractures
Especially for Type 1a and 1b in mandibular teeth and all types in maxillary teeth
no association with age
decreased fx resistance also with decreased mesio to distal length
In Pollaris’ 2021 article Fracture Resistance of Equine Cheek Teeth With and Without Occlusal Fissures: A Standardized ex vivo Model,” what were the strongest areas of fracture resistance in the healthy teeth tested?
Frontiers 2021
Fracture resistance sites were PH-2 for mand CT and PH-4 for maxillary CT
In Pollaris’ 2021 article Fracture Resistance of Equine Cheek Teeth With and Without Occlusal Fissures: A Standardized ex vivo Model,” what was signficant about fracture depth when healthy teeth were tested?
Frontiers
Experimentally induced crown fractures that extended below the simulated bone level were more frequently associated with pulp horn exposure
Degree of fracture depth was stat sig when comparing maxillary to mandibular CT (max>mand)
PH 5 likely to be above gum line, other PH locations not signficant
The white arrows are indicating deformation in what bone?
Vlaminck 2021 Frontiers
Diagnosis and Surgical Treatment of Idiopathic Primary Sino-Nasal Obstruction in Miniature Horse Breeds: Long-Term Follow-Up of Seven Cases
Frontal bone
In this image from Elzer’s 2020 paper “Standing Arthroscopic Treatment of Temporomandibular Joint Sepsis in a Horse,” which image left, middle or right shows moderate soft tissue swelling at the level of the TMJ?
JVD 2020
Left
middle: ostitis media
right: bilateral osteoproliferative changes consistent with THO
According to Elzer’s 2020 paper “Standing Arthroscopic Treatment of Temporomandibular Joint Sepsis in a Horse,” what compartment of the TMJ provides access for arthrocentesis and arthroscopic exploration?
JVD 2020
Larger dorsal compartment → caudolateral and rostrolateral synovial pouches
In this image, what anatomy were the tubes placed?
Through medioventral wall of dorsal conchal sinus
In Dixon’s 2021 paper “Equine “Idiopathic” and Infundibular Caries-Related Cheek Teeth Fractures: A Long-Term Study of 486 Fractured Teeth in 300 Horses” what was the most common type of fracture? What was the most commonly fractured teeth (max vs mand)?
Frontiers 2021
Maxillary pulp horn 1+2 (“slab”) fractures (n = 171/486) 35%
Triadan 08–10s were the most commonly (86%) fractured maxillary teeth.
The Triadan 08 and 09 positions were the most commonly (64%) fractured mandibular teeth
In Dixon’s 2021 paper “Equine “Idiopathic” and Infundibular Caries-Related Cheek Teeth Fractures: A Long-Term Study of 486 Fractured Teeth in 300 Horses” what were signficant findings related to infundibular-related fractures?
Frontiers
- Freq of INF-related fx differed signficantly with Triadan position (09s most common)
- More common in older horses (signficant)
- Unilateral nasal discharge more common with infundibular caries-related fractures (28/88 = 31.8%) than with all other types of maxillary teeth fractures (combined 60/284 = 21.1%).
In Dixon’s 2021 paper “Equine “Idiopathic” and Infundibular Caries-Related Cheek Teeth Fractures: A Long-Term Study of 486 Fractured Teeth in 300 Horses” what type of fracture was most associated with clinical signs of oral pain and bitting problems?
Frontiers 2021
Atypical mandibular cheek tooth fractures (ones through single pulp horns rather than typical “slab” fx through 1+2)
In Derham’s 2020 paper “Surgical treatment of a mandibular ameloblastic carcinoma with metastases to the mandibular lymph nodes in a pony,” what IHC antibody stains were used to confirm the presence of odontogenic epithelium?
EVE 2020
pancytokeratin
vimentin
In Derham’s 2020 paper “Surgical treatment of a mandibular ameloblastic carcinoma with metastases to the mandibular lymph nodes in a pony,” what technique to help stage the tumor had not been previously reported in horses?
EVE 2020
sentinel lymph node mapping
contrast uptake at mandibular lymph nodes bilaterally –> removed all mandibular lymph nodes
In Gergeleit’s 2020 study “Complications following mandibular cheek tooth extraction in 20 horses,” what was the overall prevalence of postoperative complications for mandibular cheek teeth extractions?
Fontiers 2020
6.6% (20/302)
In Gergeleit’s 2020 study “Complications following mandibular cheek tooth extraction in 20 horses,” what Triadan position teeth had the most complications and what was the mean age of horses that developed complications vs horses that did not?
Frontiers 2020
07s, 09s
complications younger (mean 7 years) vs those that did not (13 years)
In Gergeleit’s 2020 study “Complications following mandibular cheek tooth extraction in 20 horses,” intraoral extraction without additional techniques was successful in what percent of cases, and what was the relationship between surgical time, final extraction method and severity of complications?
Frontiers 2020
55% intraoral extraction successful
No direct correlation between surgical time, final extraction method and severity of complications
In Gergeleit’s 2020 study “Complications following mandibular cheek tooth extraction in 20 horses,” what was the most prevalent complication, and what was the median healing time?
Frontiers 2020
Alveolar bone sequestration with delayed alveolar healing 90% (18/20)
3 months (range 2-5 months)
In White’s 2022 article “Long-Term Outcome of Horses Undergoing Unilateral Mandibular Condylectomy and Meniscectomy for Temporomandibular Joint Disease” what was the most common diagnosis, post-op complication, and outcome?
Frontiers 2022
8/11 septic osteoarthritis of the TMJ
5/11 drainage and peri-incisional swelling
10/11 returned to intended use
3/11 severe idiopathic OA
other complications included hematoma from facial artery damage intra-op
1 horse was euthanized 2 years after UMC due to progressively worsening of clinical signs of temporohyoid osteoarthropathy (THO), which were not present before surgery (neuro signs)
In Verwilghen’s 2022 paper “Equine Suture Exostosis: A Review of Cases from A Multicenter Retrospective Study” what were the 4 etiology groups identified?
Vet Sciences 2022
45/105 developed following sino-nasal surgery
23/105 following trauma
7/105 with underlying sinus pathology
25/105 idiopathic
In Verwilghen’s 2022 paper “Equine Suture Exostosis: A Review of Cases from A Multicenter Retrospective Study” how many cases had bone sequstrum identified?
Vet Sciences 2022
28 cases out of 105 (27%)
In Verwilghen’s 2022 paper “Equine Suture Exostosis: A Review of Cases from A Multicenter Retrospective Study” how many cases were following sinus surgery, and what % were flaps vs trephines?
Vet Sciences 2022
43% (45/105) were following sinus surgery
56% (25/45) were flap surgeries
44% (20/45) were trephinations
From the 25 flap surgeries, 11 were performed with an oscillating saw, two with chisel and in 12 the method was not reported
Trephines ranged from 5mm to 24mm in diameter
In Górski’s paper “Application of Hyperbaric Oxygen Therapy (HBOT) as a Healing Aid after Extraction of Incisors in the Equine Odontoclastic Tooth Resorption and Hypercementosis Syndrome” what theoretically are the positive effects of HBOT on healing?
Vet Sciences 2022
Increased oxygen concentration reaches the diseased tissues, even those with poor blood supply, supporting aerobic mechanisms of action of neutrophils killing anaerobic bacteria, stimulated the angiogenesis process, reduces tissue swelling, and stimulates the proliferation of fibroblasts
This allows for the acceleration of wound healing and shortens the recovery time after surgical procedures
Case report…dumb
Where do compressive forces and tensile forces generally apply to an incisor tooth?
James EOTRH Review JVD 2022 issue 4
Compressive stresses were predominant on the labial aspect of the alveolar crest and the palatal/lingual aspect of the root tip.
Tensile stresses were predominant on the palatal/lingual aspect of the alveolar crest
The maximum stress in the PDL around the crestal bone and the palatal and lingual aspects of the root apex coincides with the position of initial resorptive lesions in the incisors of affected cases.
In Christiansen’s paper “Standing equine cheek tooth extraction: A multivariate analysis of the effect of antibiotics on the risk of post-operative complications” what was the overall outcome/conclusions?
EVJ 2022
Antibiotics were not associated with the risk of complications in 264 horses that underwent standard oral extraction
MTE was associated with a significantly greater risk of any complications, regardless of whether standing oral was combined with antibiotics or not and significance – relative risk 2.32 for MTE
Age was sig assoc with development of complications
MTE not stat sig when additional comparisons made - take with a grain of salt
Age seen as a confounding factor as horses that for abx were typically younger in this cohort
In Townsend’s study “Evaluation of the long-term oral consequences of equine exodontia in 50 horses” what was the rate of dental drift per year?
Townsend TVJ 2008
rate of dental drift was calculated as 15.7% of extraction space/year (range 4–50%)
NOT associated with the age at extraction (P = 0.78) or frequency of dental care since extraction (P = 0.48).
There was a significant negative relationship between the rate of dental drift and the duration of time since extraction (P = 0.008)
In Townsend’s study “Evaluation of the long-term oral consequences of equine exodontia in 50 horses” what was the prevalence of overgrowth of the opposite tooth?
Townsend TVJ 2008
98%
In Hopfgartner’s study “Comparison of equine paranasal sinus trephination complications and outcome following standing computed tomography, radiography and sinoscopy guided approaches for the treatment of sinusitis” what were the outcomes related to imaging groups?
Hopfgartner Vet Surg 2024
Disease duration was sig longer in cases where CT was used for diagnostics versus cases with no CT imaging
Short-term postoperative complications occurred in 30.1% and were higher in groups using preoperative CT imaging (p = .01), with hemorrhage being the most common surgical complication
Post hospital complications occurred in 45.8% (105/223) of all cases and did not differ significantly between imaging groups
No difference in case resolution among imaging groups
In Hopfgartner’s study “Comparison of equine paranasal sinus trephination complications and outcome following standing computed tomography, radiography and sinoscopy guided approaches for the treatment of sinusitis” what were the outcomes related to disease groups in terms of long and short term complications?
Hopfgartner Vet Surg 2024
Disease duration was also significantly longer in primary sinusitis versus secondary sinusitis cases
Long-term complications were more common in the secondary sinusitis (99/182; 50.6%) than the primary sinusitis (13/41; 31.7%) group
Short term post-op complications more common in primary than secondary sinusitis
In Pujol’s 2020 study “Suspected primary mycotic rhinitis and paranasal sinusitis in seven horses (2013-2019),” what was the mean number of debridement sessions necessary to remove any necrotic material, and what was the range of time needed to observe complete regression of mycotic plaques?
EVE 2020
mean 4 debridement sessions
1-5 months
In Pujol’s 2020 study “Suspected primary mycotic rhinitis and paranasal sinusitis in seven horses (2013-2019),” what fungal species was most commonly identified?
EVE 2020
Aspergillus spp
In Pujol’s 2020 study “Suspected primary mycotic rhinitis and paranasal sinusitis in seven horses (2013-2019),” complete longterm clinical resolution was noted in what percent of cases?
EVE 2020
83%
In Zetterstrom’s 2021 case report “Meningitis after tooth extraction and sinus lavage in a horse,” what clinical signs were associated with the development of bacterial meningitis?
Journal of Eq Vet Sci 2021
Hyperthermia, tachycardia, signs of neck pain
First case report of a horse surviving following diagnosis of suspected bacterial meningitis following treatment of bilateral secondary sinusitis due to apical dental infection
In Jehle’s 2022 study “Trephination versus minimally invasive transnasal approaches for the diagnosis and treatment of sinus disease in horses,” access to the affected paranasal sinuses was possible via natural openings in what percent of cases?
Vet Sci 2022
44%
No surgical access required
In Jehle’s 2022 study “Trephination versus minimally invasive transnasal approaches for the diagnosis and treatment of sinus disease in horses,” this study was the first to demonstrate what endoscopic technique?
Vet Sci 2022
transendoscopic fenestration of the maxillary septal bulla
In Jehle’s 2022 study “Trephination versus minimally invasive transnasal approaches for the diagnosis and treatment of sinus disease in horses,” what was the most common complication?
Vet Sci 2022
Hemorrhage
occurred in all minimally invasive procedures
In Stemmet’s 2022 case report “Unilateral, Rostral Maxillary Sinusitis Resulting from Displacement and Retention of an Alveolar Plug in a 4-Year-Old Horse,” what structure is shown below?
JVD 2022
Maxillary septal bulla
In Brown’s 2022 study “Clinical, diagnostic and histological findings involving cheek teeth hypercementosis in nine horses,” what is the definition of nodular reactive hypercementosis vs peripheral reactive hypercementosis?
JVD 2022
Nodular hypercementosis: Proliferation of cementum embedded in periodontal tissues but not visibly attached to tooth root
Peripheral hypercementosis: Proliferation of cementum attached to margin of tooth
In Brown’s 2022 study “Clinical, diagnostic and histological findings involving cheek teeth hypercementosis in nine horses,” how many cases of peripheral vs nodular reactive hypercementosis were diagnosed respectively?
JVD 2022
Peripheral 6/9 cases
Nodular 3/9 cases
In Brown’s 2022 study “Clinical, diagnostic and histological findings involving cheek teeth hypercementosis in nine horses,” how many horses developed complications and what were the most common complications?
JVD 2022
5/9 cases
Oronasal fistula 2/5
Recurrent sinusitis 2/5
Serous drainage for 7 days from mandibular repulsion site
In Godoy’s 2023 study “Treatment of a mandibular diastemal fracture using locking compression plate and cerclage wire in a mare,” what factors were thought to contribute to the successful outcome?
JVD 2023
Implant resistance, fracture stability and proper feed intake
switched to pelleted feed
In Hunt’s 2023 paper “Intraoral formation of a rigid obturator for the treatment of dental fistulae and draining tracts in the horse,” what materials were used to create the rigid obturator?
Rice, Henry JVD 2023
Inorganic borate-based biologically active fiber (RediHeal) placed in debrided alveolus
Flowable bis-acryl-based composite resin (ProTemp)
In Hunt’s 2023 paper “Intraoral formation of a rigid obturator for the treatment of dental fistulae and draining tracts in the horse,” complete resolution of clinical signs was noted in what percent of horses, and confirmed healing was observed in what percent of horses?
Henry, Rice JVD 2023
Complete resolution of clinical signs 95.5% (21/22) horses
Confirmed healing PPOC 68% (15/22)
In Hunt’s 2023 paper “Intraoral formation of a rigid obturator for the treatment of dental fistulae and draining tracts in the horse,” rigid obturator placement complications were noted in what percent of horses?
Rice, Henry JVD 2023
32% (7/22)
All complications resolved following repair or replacement of RO
In Leps’ 2024 study “Dental sectioning for intraoral equine cheek teeth extractions: 29 cases,” what percent of teeth were extracted via sectioning?
Frontiers 2024
6.3% (29/461) teeth
In Leps’ 2024 study “Dental sectioning for intraoral equine cheek teeth extractions: 29 cases,” were more maxillary or mandibular cheek teeth sectioned and what percent of teeth/cases developed complications?
Frontiers 2024
maxillary 27/29
24% complication rate
In Dixon’s 2005 study “Standing oral extraction of cheek teeth in 100 horses,” what was the overall success rate and what was the success rate when a fracture was present?
EVJ 2005
intraoral extraction 90%
fracture present 83%
In Razman’s 2011 study “Extraction of fractured cheek teeth under oral endoscopic guidance in standing horses,” what was the overall success rate?
Vet Surg 2011
87%
In Dubois’ 2019 study “Assessment of clinical and computed tomographic findings for association with the outcome of intraoral cheek tooth extraction in horses and ponies,” what was the intraoral extraction success rate?
JAVMA 2019
67% (60/89 teeth)
Determination of success was obtained by examination of extracted tooth fragments, endoscopic examination of alveolus or probing of alveolus (not rads) → if a small amount of root was present in alveolus deemed unsuccessful
In Dubois’ 2019 study “Assessment of clinical and computed tomographic findings for association with the outcome of intraoral cheek tooth extraction in horses and ponies,” following multivariable analysis, what was the only CT factor that was stat sig associated with a lower extraction success rate and what was that success rate?
Dixon JAVMA 2019
Fractured teeth
54% intraoral success rate
In Dixon’s paper “Empyema of the nasal conchal bulla as a cause of chronic unilateral nasal discharge in the horse: 10 cases (2013-2014)” how many cases has concurrent sinus disease, and how many cases were primary vs dental sinusitis?
Dixon EVJ 2015
7/8 had concurrent sinusitis
1 primary sinusitis, 6 dental sinusitis
the one case with no concurrent sinusitis was a dyplastic and infected 207 causing VCB empyema
In Gergeleit’s paper, “Complications Following Mandibular Cheek Tooth Extraction in 20 Horses”, which mandibular Triadan tooth was most commonly affected by post-op alveolar sequestration in young horses?
Gergeleit Frontiers 2020
Triadan 07
What instrument is shown here?
Dixon EVJ 2021
Trephines
In Dixon’s paper “A long-term study of sinoscopic treatment of equine paranasal sinus disease: 155 cases (2012-2019)” what was the most common reason for follow-up treatment being needed?
Dixon EVJ 2021
Bone sequestra (9/47 cases)
In Dixon’s paper “A long-term study of sinoscopic treatment of equine paranasal sinus disease: 155 cases (2012-2019)” what was the % response to first tx alone, and the overall response rate?
Dixon EVJ 2021
First response: 69.7%
Overall response: 96.1%
Where is this catheter located?
Dixon EVJ 2021
VCS
In Dixon’s 2012 paper “Equine paranasal sinus disease: A long-term study of 200 cases(1997–2009): Treatments and long-term results of treatments” what was the overall success rate of all cases? What was the success for dental sinusitis tx?
Dixon EVJ 2012
Overall: 87%
Dental sinusitis: 82%
In Monck’s 2020 paper “Biomechanical comparison of locking compression plate fixation and a novel pedicle screw external fixation to repair equine mandibular fractures,” how was the pedicle screw with wires (PDW) construct created?
Easley, Vet Surg 2020
4 titanium 4.5mm self-tapping pedicle screws and a 5.5mm titanium rod to each hemimandible
Placed 2cm from fracture site and 2cm from each other
Screws inserted with handheld screwdriver into pre-drilled holes
Bilateral inderdental wires added along tension side of fracture with 18G wire, wires passed between 306/307, 406/407 and wound through incisors
In Monck’s 2020 paper “Biomechanical comparison of locking compression plate fixation and a novel pedicle screw external fixation to repair equine mandibular fractures,” which construct had greater bending stiffness and needed more force to fail?
Easley, Vet Surg 2020
Locking compression plates
LCP construct failed at 57% load of intact mandibles, PDW failed at 32%
LCP 55% as stiff as intact mandibles, PDW 31% as stiff
Statistical both constructs strengths differed from intact mandibles, but not stat sig compared to each other
In Monck’s 2020 paper “Biomechanical comparison of locking compression plate fixation and a novel pedicle screw external fixation to repair equine mandibular fractures,” how many of the PDW and LCP interfered with tooth roots?
Easley, Vet Surg 2020
PDW: 0/6
LCP: 2/6
In Monck’s 2020 paper “Biomechanical comparison of locking compression plate fixation and a novel pedicle screw external fixation to repair equine mandibular fractures,” how did the LCP and PDW constructs compare to those previously evaluated by Peavey et al?
Easley, Vet Surg 2020.
LCP performed better than the dynamic compression plate and other constructs evaluated by Peavey
PDW performed similarly to constructs evaluted by Peavey et al
In Peavey’s 2003 study “Fixation technique influences the monotonic properties of equine mandibular fracture constructs,” what constructs were evaluated and which was deemed the most stable?
Vet Surg 2003
dynamic compression plate (DCP), external fixator (EF), external fixator with interdental wires (EFW), acrylic intraoral splint with interdental wires (ISW) to repair an osteotomy created 1cm caudal to mental foramen
DCP was most stable
What do the green arrows represent in the image below?
Easley 2022
The entrances into the dorsal (discotemporal) and ventral (discomandibular) joint compartments
What muscles do A, B, C and D represent in the image below?
A.) levator nasolabialis
B.) Levator labii superioris
C.) Buccinator
D.) Depressor labii inferioris
What is the preferred view for evaluating blind wolf teeth?
Easley ch 28 exodontia
Le30V-RtDO
Which two teeth are considered not accessible via MIB?
Easley ch 28 exodontia
Mandibular 10 and 11, even with distraction of the mandibles
approaches to the mandibular 09s and 10s are more difficult than for the rostral mandibular teeth, but not impossible
challenges with max 10 and 11 due to thick masseter muscle, but not impossible
What is the oral extraction complication rate?
Easley ch 29
3.5-20%
What complication risks should you consider when extracting wolf tips?
Easley ch 29
Wolf tooth extractions can risk separated root tips or greater palatine artery laceration.
What % of repulsion extraction cases may require further follow up?
Easley ch 29
70%
What complications should be considered with repulsion of cheek teeth?
Easley ch 29
Inaccurate punch placement can result in damage to adjacent teeth and/or supporting bones.
Skin incisions may discharge for a few weeks following surgery due to oral bacteria contamination.
Disruption of the alveolar apex can result in fistula formatio
like…why do it…
What important anatomy do you need to consider when performing a lateral buccotomy? What issues can you recognize if they’re damaged?
Easley ch 29
Damage to the dorsal buccal nerve causes lower lip paresis.
Damage to the ventral buccal nerve causes ipsilateral nostril and upper lip paresis.
Laceration of the parotid duct can result in saliva leakage through the surgical site.
MIB approach througn the masseter muscle risks damaging what structure?
Easley ch 29
Deep facial vessels
In Rice’s 2018 paper “Standing intraoral extractions of cheek teeth aided by partial crown removal in 165 horses (2010–2016)” what depth was recommended for the coronectomy cut?
Rice EVJ 2018
To the level of the crestal bone
What is the healing time for oral epithelium after cheek tooth extraction?
VCNA 2020 Earley and Galloway
Oral epithelium migrates at a rate
of 0.3 to 0.5 mm per day, and mucosal epithelialization from the gingival margin
should be significant within 2 weeks and complete within 1 month.
How does the apex of a cheek tooth extraction heal over time?
VCNA 2020 Earley and Galloway
In the apical two-thirds of the alveolus the blot clot is replaced by osteoid. The osteoid fully mineralizes into woven bone by the beginning of the second month, and remodeling into cortical and trabecular bone is complete by 6 months.
According to Easley’s 2022 textbook, which is the larger recess in the discotemporal and discomandibular joint compartments respectively?
Chp 16
Discotemporal: caudal recess
Discomandibular: rostral recess
What compartment of the TMJ is being aspirated in the image below
Easley 2022, Chp 16
Discomandibular (caudal approach)
What is the name of the instrument shown below?
Easley 2022, Chp 28
Reverse fulcrum forcep
In the Schwieder case report “Dentigerous cysts with exostosis of the temporal bone in horses – A new variant diagnosed by computed tomography” what type of dentigerous cyst was diagnosed in this report?
EVE 2019
Neither a ‘dermoid type’ nor a ‘dentigerous type’
It was a dentigerous cyst with no dental tissue, and additional exostosis (boney prolif noted)
In the Schwieder case report “Dentigerous cysts with exostosis of the temporal bone in horses – A new variant diagnosed by computed tomography” where did the exostosis originate from anatomically?
The arrow an arrowhead show the contrast enhancing cyst and tract from retrograde injection
The asterisk shows the exostosis
EVE 2019
An exostosis (arrow) derives from the supramastoid crest (asterisk) near the external acoustic meatus (arrowhead)
What direction should a parotid duct catheter be inserted due to the course of parotid duct?
Easley 2022, Chp 28
Dorsal to ventral
opening points dorsally but duct courses ventrally
According to Easley’s 2022 textbook, where is it best to make a partial coronectomy on a tooth whose roots curve distally?
Chp 28
Distal aspect of the tooth
In Sacks case report “Fixation of chronic suture exostosis in a mature horse” what surgery was performed and what duration length to resolution was reported?
Sack EVE 2013
The periosteum was elevated and the callus around the suture between the frontal and nasal bones was removed revealing a distinct 2 mm gap between the bones.
Unilock plate was placed on each side and fixed with 3 mm locking screws; Four screws were placed proximal and 4 distal to the suture on each side
Epiphora diminished after surgery and was completely resolved 6 months later. The horse returned to normal use and the owner was satisfied with the outcome
There was no radiographic evidence of periosteal reaction or callus 6 months post operatively and the connection between implant and bone appeared stable
What patient factors are major considerations for if a tooth is a candidate for intraoral sectioning?
Easley 2022, Chp 28
Patient age/length of tooth
Small patients like minis and ponies’ mouths may not accommodate long sectioning burs
11s –> can be very challenging to section due to caudal angulation (45 degree NSK head may be needed)
When sectioning teeth, what cut is made in blind fashion since it cannot be monitored radiographically?
Easley 2022, chp 28
Mesial-distal/sagittal cut of maxillary cheek teeth
In Dixon’s 2005 study “Standing oral extraction of cheek teeth in 100 horses (1998-2003),” what percent of horses overall developed postoperative complications and what percent of horses with apical cheek teeth infections developed intraoperative and postoperative complications?
EVJ 2005
Overall postoperative complications: 8%
Apically infected cheek teeth complications: 23%
In Dixon’s 2005 study “Standing oral extraction of cheek teeth in 100 horses (1998-2003),” what was the stat sig association between apical infected cheek teeth postoperative complication rates for teeth extracted intraorally in this study vs via repulsion Dixon 2000?
EVJ 2005
Complications stat sig lower for intraoral vs repulsion (49%)
What is the timeline of tensile strength loss in Monocryl (Poligecaprone 25) suture?
JVD 2014 issue 3
Tensile strength is 50 % at 7-days, 20-25 % at 14 -days, and 100 % at 21-days.
Absorbable sutures lose all measureable tensile strength and degrade in how many days?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
60 days
What are the advantages of using poligecaprone 25 (monocryl)?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Very low tissue drag
most pliable of all absorbable sutures
Good knot security
very good ease of handling
very high initial tensile strength and strength:size ratio –> can use smaller sutures
rapid loss of tensile strength –> 50% at 7 days, 20-25% at 14 days, 100% at 21 days
completely absorbed at 120 days
What is Polyglactin 910 and when is there no detectable tensile strength left?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Vicryl, 28 days
How are ALL synthetic sutures degraded?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Hydrolysis, which results in more predictable absorption times
What are the pros and cons to chromic gut?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Good handling ability and knot security
Poor tissue response –> moderate to severe inflammation, especially cats; premature resorption in tissue that is infected, inflamed, or very vascular; can induce allergic reaction in cats especially ones with stomatitis!
What are the two phases that suture absorption occurs in chromic gut?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Collagenolysis and proteolytic enzyme digestion and absorption
How long do non-absorbable sutures maintain their tensile strength? When do they need to be removed?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Non-absorbable sutures maintain tensile strength for greater than 60 days.
Non-absorbable suturesneed to be removed in 7 to 21days
What is Polyglecaprone 25?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Monocryl
Absorbable MONOfilament
What has the longest complete absorption in absorbable suture?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
PDS at 182 days
What are sutures that are contraindicated in the mouth?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Nonabsorbable sutures like nylon and polypropylene, and PDS
Poliglecaprone maintains what percent of its tensile strength for 7 days and when is it completely degraded by?
Pegg “Clinical Evaluation of Intraoral Suture Patterns Using Poliglecaprone 25 in Greyhound Dogs,” JVD 2022
maintains 50-60% of tensile strength through 7 days
Completely degraded by hydrolysis after 91-119 days
What is Polyglactin 910?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
Vicryl
Absorbable MULTIfilament
What is Polydioxanone?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
PDS
absorbable MONOfilament
What is the tensile strength loss timeline and complete absorption of Polyglactin 910?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
50% - 14 days
20% - 21 days
60-90 days complete or 56-70 days - depends on the source cited
Vicryl
What is the tensile strength loss timeline and complete absorption of Poliglecaprone 25?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
60-70% - 7 days
30-40% - 14 days
Complete - 90-119 days
Monocryl
timeline differs by source - another says 50% - 7 d.20% - 14 d. in this paper
What is the tensile strength loss timeline and complete absorption of Polydioxanone?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
74% - 14 days
58% - 28 days
Complete - 182-283 days
PDS
4-0 and smaller:
60% - 14 d
40% - 30 d
35% - 45 d
What needle does this represent?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
A: 1/2 circle, cutting needle
What needle does this represent?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
B: 3/8 circle, reversecutting needle
What needle does this represent?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
C: 1/2 circle, taper needle
What needle does this represent?
JVD 2014, Issue 3. “Suture material and needle options in oral and periodontal surgery” Domnick
D: 5/8 circle, taper-cut needle
What was the dental drift rate found in Townsend’s 2008 study “Evaluation of the long-term oral consequences of equine exodontia in 50 horses,” and how did it compare to the experimentally determined drift rate found by Vlaminck 2006, 2008?
Dixon Vet J 2008
15.7% extraction space per year
Vlaminck 39-41% following experimental repulsion of maxillary 08s or 09s
In Townsend’s 2008 study “Evaluation of the long-term oral consequences of equine exodontia in 50 horses,” what percent of horses had no appreciable extraction space at re-examination?
Dixon Vet J 2008
18% cases
4-23 years post-extraction
In O’Neil’s 2011 study “Extraction of cheek teeth using a lateral buccotomy approach in 114 horses,” what percent of cases had procedure related complications and what was the most common complication?
EVJ 2011
30% horses
Partial wound dehiscence most common (47% complications)
3% cases permanent facial nerve paralysis
In Kennedy’s 2020 study “A long-term study of equine cheek teeth post-extraction complications: 428 cheek teeth (2004-2018)” what factors were stat sig associated with an increased risk of developing a post-extraction alveolar disorder in the cases that were managed by the authors?
Dixon EVJ 2020
Extraction of mandibular 06s, 07s, 08s
Teeth with apical infections
Repulsion or minimally invasive transbuccal extraction
In Christiansen’s 2022 study “Standing equine cheek tooth extraction: A multivariate analysis of the effect of antibiotics on the risk of post-operative complications,” what was the overall complication rate for standing oral extraction vs minimally invasive trans-buccal extraction?
EVJ 2022
Oral extraction 16.7%
MTE 36.6%
In Christiansen’s 2022 study “Standing equine cheek tooth extraction: A multivariate analysis of the effect of antibiotics on the risk of post-operative complications,” what was the association of antibiotic use with risk of complications for oral extractions vs MTE extractions?
EVJ 2022
Antibiotics were not stat sig associated with the development of complications for standing oral extractions
MTE without antibiotics was associated with sig greater risk of complications when compared to standing oral extraction with or without antibiotics
In Christiansen’s 2022 study “Standing equine cheek tooth extraction: A multivariate analysis of the effect of antibiotics on the risk of post-operative complications,” what was the association of age with the development of complications?
EVJ 2022
Younger age stat sig associated with the development of complications
According to Easley’s 2022 textbook, drainage cannot be established for what group of sinuses with endoscopically guided balloon trans-nasal sinoplasty?
Chp 34
Rostral group because the sino-nasal ostium is too small/acute
In the image below from Easley’s 2022 textbook, what does the white arrow, A, B, and C represent?
Chp 35
White arrow: infraorbital canal
A: caudal maxillary sinus
B: rostral maxillary sinus
C: Ventral conchal sinus
In the image below from Easley’s 2022 textbook, what do D, E, F and G represent?
Chp 35
D: Dorsal conchal bulla
E: Dorsal conchal sinus
F: Rostral aspect of ethmoid mass
G: Frontal sinus
According to Easley’s 2022 textbook, the skin incision of a sinus flap should be how much larger than the osteotomy site?
Chp 35
1cm with slightly curved corners
According to Easley’s 2022 textbook, what are the landmarks for the caudal incision of the frontonasal sinusotomy flap?
chp 35
2cm medial to medial canthus to dorsal midline of skull at the a level halfway between the medial canthus of the eye and the supra-orbital fossa
According to Easley’s 2022 textbook, what are the landmarks for the rostral incision of the frontonasal sinusotomy flap?
Chp 35
10cm rostral to caudal incision just medial to an imaginary line drawn between the medial canthus of the eye and the nasoincisive notch to dorsal midline of skull
Lateral incision connecting the caudal and rostral incisions may need to deviate dorsally to avoid the nasolacrimal duct
According to Easley’s 2022 textbook, what are the landmarks for the caudal incision for the maxillary sinusotomy flap?
Chp 35
Just dorsal to the facial crest to just below a line between the medial canthus and the infraorbital foramen at a level 1-2cm rostral to the medial canthus of the eye
According to Easley’s 2022 textbook, what are the landmarks for the rostral incision for the maxillary sinusotomy flap?
Chp 35
Just dorsal to the facial crest to just below a line between the medial canthus and the infra-orbital foramen at the rostral aspect of the facial crest.
According to Easley’s 2022 textbook, what size fenestration of the ventral conchal or dorsal conchal rostromedial walls is recommended to promote fistula formation and sinus drainage?
Chp 35
> 3cm
In Tremaine’s 2001 study “A long-term study of 277 cases of equine sinonasal disease Part 1: details of horses, historical, clinical and ancillary diagnostic findings,” what were the 5 most common causes of sinonasal disease?
Dixon EVJ 2001
Primary sinusitis 24%
Dental sinusitis 22%
Sinus cysts 13.4%
Sinonasal neoplasia 8%
Progressive ethmoid hematoma 7.6%
In Tremaine’s 2001 study “A long-term study of 277 cases of equine sinonasal disease Part 1: details of horses, historical, clinical and ancillary diagnostic findings,” what stat sig associations were present between sinonasal disease etiology and the two most common clinical signs nasal discharge and facial swelling respectively?
Dixon EVJ 2001
Malodorous nasal discharge sig less frequently associated with primary sinusitis
Facial swelling stat sig more associated with sinus cysts and sinonasal neoplasia than dental sinusitis
In Tremaine’s 2001 paper “A long-term study of 277 cases of equine sinonasal disease Part 2: treatments and results of treatments,” what sinonasal disease had the best long-term outcome with complete remission of clinical signs?
Dixon EVJ 2001
Sinonasal mycosis 92%
In Tremaine’s 2001 paper “A long-term study of 277 cases of equine sinonasal disease Part 2: treatments and results of treatments,” what percent of cases had a good long-term outcome with complete remission of clinical signs for primary sinusitis, dental sinusitis, sinus cysts and sinonasal neoplasia?
Dixon EVJ 2001
Primary sinusitis 84%
Dental sinusitis 78%
Sinus cysts: 82%
Sinonasal neoplasia 12%
In Tremaine’s 2001 paper “A long-term study of 277 cases of equine sinonasal disease Part 2: treatments and results of treatments,” what percent of dental sinusitis cases required more than one treatment?
Dixon EVJ 2001
70%
Name this IDS wiring technique
Wiggs ch 13
Ivy loop
Name this IDS wiring technique
Wiggs ch 13
Stout
Name this IDS wiring technique
Wiggs ch 13
Essig
Name this IDS wiring technique
Wiggs ch 13
Risdon
What interdental wiring technique is shown?
Verstraete Ch 31
Ivy Loop
What interdental wiring technique is shown?
Verstraete Ch 31
Stout loop
What interdental wiring technique is shown?
Verstraete Ch 31
Risdon wiring with secondary wires anchoring around individual teeth
What interdental wiring technique is shown and what type of fractures is it best used for?
Verstraete Ch 31
Essig interdental wiring
Reduction and stabilization of luxated canine teeth with alveolar bone fracture
What wiring technique is shown here, outline in Easley ch 33
Easley ch 33
Obwegeser pattern
What are the most common injury of the equine head?
Easley ch 33
Incisive bone and rostral mandible
What are type 1 and type 2 external fixators
Easley ch 33
Type 1 fixation involves applying a sidebar on one side of the head only
Type 2 fixation systems comprise a construct with sidebars on both sides of the head
When applying external fixation, how many pins should be placed?
Easley ch 33
two pins on either side of fracture ideally at a slight angle to each other
When monitoring patients with external fixators, what common radiographic signs will be seen around the pins?
Easley ch 33
Some osteopenia and discharge is expected and should resolve quickly after fixator removal.
What is the least mechanically effective placement location for fixation of a mandibular fracture with an LCP or DCP?
Easley ch 33
Ventral
Ventrolateral is stronger; the best is along the tension side, but teeth in the way obvi
Which side of the mandible is the tension side and which is the compression side?
Easley ch 33
Tension - oral
Compression - ventral
What is the prognosis for vertical ramus fractures?
Easley ch 33
The prognosis for vertical ramus fractures that do not involve the temporomandibular joint are favourable, although fibrosis within the masseter may be a rare cause of dysmastication or reduced ability to open the mouth.
What depth of a tongue laceration needs repair?
Easley ch 33
Transverse, dorsal tongue laceration should be repaired if 25% or more of the vital tongue remains attached.
In Perkin’s 2009 study “Sinoscopic treatment of rostral maxillary and ventral conchal sinusitis in 60 horses,” the ventral chonchal bulla (maxillary septal bulla) was able to be fenestrated via a conchofrontal portal in what percent of horses?
Dixon Vet Surg 2009
95%
Following fenestration, hemorrhage prevented examination of the RMS and/or VCS in 21%
In Nagy’s case report “Mandibular Condylectomy and Meniscectomy for the Treatment of Septic Temporomandibular Joint Arthritis in a Horse” what had occured on this post-op CT?
Nagy Vet Surg 2006
Remodeling of a pseudocondyle, more cranial than caudal and mostly medially
In Perkin’s 2009 study “Sinoscopic treatment of rostral maxillary and ventral conchal sinusitis in 60 horses,” sinoscopy was diagnostically useful in what percent of horses overall and disease resolved following sinoscopic treatment and longer term sinus lavage in what percent of cases?
Dixon Vet Surg 2009
Diagnostically useful in 67% horses
Resolved in 43% horses
What three sinuses drain via the sinonasal ostium?
O’Leary, Dixon. A review of equine paranasal sinusitis. Aetiopathogenesis, clinical signs and ancillary diagnostic techniques. EVE 2011.
The sphenopalatine, ethmoid and caudal maxillary sinuses
The sinonasal ostium communicates directly with the caudal maxillary sinus
What sinuses drain into the nasal cavity via the naso-maxillary opening?
O’Leary, Dixon. A review of equine paranasal sinusitis. Aetiopathogenesis, clinical signs and ancillary diagnostic techniques. EVE 2011.
Rostral maxillary and ventral conchal
In Dixon’s 2012 study “Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): ancillary diagnostic findings and involvement of the various sinus compartments,” what was the association of fluid lines on rads with different etiologies of sinusitis?
EVJ 2012
Fluid lines sig less common with chronic primary sinusitis than subacute primary sinusitis, sig less with sinus cysts than primary sinusitis combined
In Dixon’s 2012 study “Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): ancillary diagnostic findings and involvement of the various sinus compartments,” what sinus compartment was most frequently invovled and what sinus compartments were least frequently invovled overall?
EVJ 2012
Caudal maxillary sinus 78%
Least: sphenopalatine and ethmoidal 6%
What structures risk damage during surgical approach to the TMJ or coronoid process?
Magri EVE 2021
risks injury to the superficial temporal artery, the transverse facial artery and vein, and the transverse facial branch of the auriculotemporal nerve
In Magri’s case series “Coronoidectomy as a treatment for mandibular immobility caused by fracture of the coronoid process in three horses” how was the coronoid process accessed and removed?
Magri EVE 2021
Incision dorsally through skin into the supraorbital fossa
Did not do zygomatectomy
In Frietman’s case report “A minimally invasive partial condylectomy and temporal bone resection for the treatment of a suspected chronic synovial sepsis of the temporomandibular joint in a 3.5-year-old paint horse gelding” what surgical approach was used?
Frietman Vet Quarterly 2018
Arthroscopic approach to TMJ (meniscomandibular and meniscotemporal compartments) and debridement of meniscus and bone
Bone debridement until healthy subchondral bone was reached
Diseased tissue: There were signs of chronic synovitis,
characterised by synovial hyperaemia, synovial
hyperplasia and multiple synovial adhesions
What do A, B, C and D represent in the image below?
Froydenlund, Dixon, Reardon. Anatomical and histological study of the dorsal and ventral nasal conchal bullae in normal horses. Vet Rec 2015.
A. Dorsal conchal sinus
B. Ventral conchal sinus
C. Dorsal conchal bulla
D. Ventral conchal bulla
In Froydenlund’s 2015 study “Anatomical and histological study of the dorsal and ventral nasal conchal bullae in normal horses,” which bulla was larger and contained more septae, cellulae and drainage apertures?
Dixon Vet Rec 2015
Dorsal conchal bullae
In Froydenlund’s 2015 study “Anatomical and histological study of the dorsal and ventral nasal conchal bullae in normal horses,” what was the median number of drainage apertures from the dorsal and ventral conchal bullae respectively and what part of the bullae did they drain from?
Dixon Vet Rec 2015
DCB 2 (range 0-6) with all draining from ventral aspect into middle meatus
VCB 1 (0-3) with all draining from dorsal and/or dorsolateral aspects into middle meatus
In Froydenlund’s 2015 study “Anatomical and histological study of the dorsal and ventral nasal conchal bullae in normal horses,” what was the relationship between the bullae and the adjacent paranasal sinuses?
Dixon Vet Record 2015
No communications were identified between the bullae and the immediately adjacent paranasal sinuses
In Froydenlund’s 2015 study “Anatomical and histological study of the dorsal and ventral nasal conchal bullae in normal horses,” what was the histologic appearance of the bullae?
Dixon Vet Record 2015
Bullae consisted of ciliated, pseudostratified, columnar epithelium over glandular submucosa often overlying turbinate bone and variably hyaline cartilage
In Liuti’s 2015 study “An anatomical study of dorsal and ventral nasal conchal bullae in normal horses: Computed tomographic anatomical and morphometric findings,” what was the association between bullae size and age and head size?
Dixon EVJ 2015
In both dorsal conchal bulla and ventral conchal bulla, there were significant differences in sizes between the different age groups (smaller in younger animals)
Measures of bullae size and volume were significantly associated with head size
In Liuti’s 2015 study “An anatomical study of dorsal and ventral nasal conchal bullae in normal horses: Computed tomographic anatomical and morphometric findings,” what teeth were most commonly associated with the rostral and caudal limits of dorsal and ventral conchal bullae respectively?
Dixon EVJ 2015
Dorsal conchal bullae rostral 07s, caudal 10s
Ventral conchal bullae rostral 07s, caudal 09s
In Liuti’s 2017 study “Computed tomographic assessment of equine maxillary cheek teeth anatomical relationships, and paranasal sinus volumes,” what was the relationship between 06s and 07s, 08s, 09s, 10s and 11s with the sinuses respectively?
Vet Rec 2017
06s and 07s were not in contact with any sinus lumen in any age group
All 08s partially or fully within RMS
09s fully within RMS in all except 2 young (age 1.5-2 years) cases fully in CMS
10s variably in RMS or CMS
11s consistently in CMS
In Liuti’s 2017 study “Computed tomographic assessment of equine maxillary cheek teeth anatomical relationships, and paranasal sinus volumes,” what was the relationship between the dorsal conchal sinus and age?
Reardon, Dixon Vet Record 2017
Dorsal conchal sinus larger than frontal sinus in group 2 (aged 6-15 years) and group 3 (aged > 15 years) but not in group 1 (aged < 6 years)
DCS 2-3 times larger than VCS in all age groups
In Liuti’s 2017 study “Computed tomographic assessment of equine maxillary cheek teeth anatomical relationships, and paranasal sinus volumes,” the clinical crown and apices of 11s were how much more rostral in the oldest age group vs the young age group?
Reardon, Dixon Vet Record 2017
2.48cm, 2.83cm
Mesial drift with age
What do A, B and C represent from the images below from Bach’s 2019 study “Surgical enlargement of the nasomaxillary aperture and transnasal conchotomy of the ventral conchal sinus: two surgical techniques to improve sinus drainage in horses?”
Simhofer Vet Surg 2019
A: Caudal maxillary sinus
B: Bullae of the maxillary septum
C: Dorsal concha
In Bach’s 2019 study “Surgical enlargement of the nasomaxillary aperture and transnasal conchotomy of the ventral conchal sinus: two surgical techniques to improve sinus drainage in horses,” sinonasal communication was successfully created in how many horses and sinusitis resolved in how many live horses?
Simhofer Vet Surg 2019
Sinonasal communications successfully created in all cadavers and affected live horses
Sinusitis resolved in all affected horses with follow up of 3-25 months
Drainage was stat sig increased through the surgically created sinonasal communications with combined TCVCS and SENMAP in heads 7-9
What characteristics of a joint tap are indicative of sepsis vs inflammation? What is the definitive way to diagnose?
Auer and Stick ch 79
Sepsis: > 4 g/dL total protein, >90% neutrophils, >30,000 total cell count
Definitive dx from synovial culture
Normal TP less than 2.5 g/dL, normal neutrophil % is less than 10%
In Fenner’s 2019 study “Paranasal sinus cysts in the horse: complications related to their presence and surgical treatment in 37 cases,” complications of surgical site healing occurred in what percent of cases and full remission was obtained in what percent of cases?
EVJ 2019
Complications 32%
Full remission 78.6% cases
In Fenner’s 2019 study “Paranasal sinus cysts in the horse: complications related to their presence and surgical treatment in 37 cases,” cysts recurred in what percent of cases?
EVJ 2019
19%
What structure is marked by the white star below?
Pouyet. Validation of a 2-mm videoendoscope for the evaluation of the paranasal sinuses with a minimally invasive technique. Vet Surg 2019.
Rostral lacrimal tubercle
a boney prominence palpable just rostral and slightly dorsomedial to the medial canthus. Insertion of orbicualr muscle
What do C, D, E and F represent in the image below?
Pouyet. Validation of a 2-mm videoendoscope for the evaluation of the paranasal sinuses with a minimally invasive technique. Vet Surg 2019.
C: Maxillary septal bulla
D: Infraorbital canal
E: Frontomaxillary opening
F: entrance to the sphenopalatine sinus
In Pouyet’s 2019 study “Validation of a 2-mm videoendoscope for the evaluation of the paranasal sinuses with a minimally invasive technique,” what differences were seen for visualization of the structures within the caudal maxillary sinus when the frontal sinus vs caudal maxillary sinus approaches were compared?
Vet Surg 2019
No difference for visualization
When is mandibular symphysiotomy considered?
Easley ch 32
To access hard and soft palate
To what landmark can a commisurotomy be performed?
Easley ch 32
Rostral masseter
Avoid damaging parotid duct and facial a+v
What muscle and skin flap transposition should be used for a sinocutaneous fistula involving conchofrontal and maxillary sinuses respectively?
Easley ch 32
CFS: temporalis muscle
RMS/CMS: levator nasolabilais or levator labii superioris muscle
Which needle placement is to access the ventral NCB and dorsal NCB from an extranasal approach?
Pouyet EVE 2022 “Extra-nasal approach to access the dorsal and ventral conchal bullae in horses”
For the DNCB, the needle is inserted half-way between the infra-orbital foramen and the dorsal aspect of the nasal
bone, with the needle oriented perpendicular to the bone surface.
For the VNCB, the needle is inserted at a point located at 30% of the distance between the infra-orbital foramen and the dorsal aspect of the nasal bone, with a minimum of 1.5 cm above the infra-orbital foramen and the needle
oriented approximately 40° downwards. The needle was placed at least 1.5 cm above the infra-orbital foramen to minimise nasolacrimal duct damage.
In Dixon’s paper “Swellings of the angle of the mandible in 32 horses (1997–2011)” what trauma phenotypes were discussed at this location in the mandible?
Dixon TVJ 2013, also Ch 13 Easley
Most appear to be traumatic in origin but gross fractures are uncommon
What fracture repair technique is depicted here?
Beard EVE 2009 “Fracture repair techniques for the equine mandible and maxilla”
Also ch 13 Easley
U bar
What pathology is most common with swelling at each of the following mandibular regions?
Dixon 2014 Swellings at angle of mandible, also Ch 13 Easley
1 - Rostral, masses
2 - body, apical infections
3 - angle, traumatic mandibular periosteitis
What should be done differently for maxillary sinus flaps in young horses?
Easley ch 35
Maxillary flaps in young horses and ponies should be restricted to the CMS as more rostral flaps risk damaging the dental apices and provide very limited or no access to the rostral sinus group
Which sinusotomy approach gives better access to the ventral conchal sinus?
Easley ch 35
Frontonasal
Disorders affecting which sinus are most likely to result in neurological syndromes such as blindness and trigeminal nerve dysfunction?
Easley ch 15
Sphenopalatine sinus
These sinuses are in close association with cranial nerves II-VI and some major blood vessels. Recent anatomical and imaging review confirmed that, unlike the other sinuses, the median septum, separating left and right sides of the SPSs is often eccentric or absent
When can crown amputation be considered for diseased canine teeth? What finding intra-op would suggest it is not appropriate?
Easley ch 28
External replacement resorption (ankylosis)
There should be no visible pulp chamber present in the ideal candidate for crown amputation, but if bleeding is noted from the pulp chamber after amputation, surgical extraction of the entire tooth should be performed.
What is the working and set time of Protemp?
Easley ch 28
working time: 40 sec
setting time: 1 min 40 sec
What speculum is depicted, and what procedure is it recommended to use during?
Easley ch 28
Modified Gunther Speculum
MIB extraction techniques
In Vlaminck’s 2021 paper “Diagnosis and surgical treatment of idiopathic primary sino-nasal obstruction in miniature horse breeds: long-term follow-up of seven cases,” what were the short and longterm outcomes?
Frontiers 2021
Incisions healed and clinical signs resolved within 3 weeks
Long-term outcome following median period of 19 months very good in all cases with resolution of clinical signs
In Verwilghen’s 2022 paper “Equine suture exostosis: a review of cases from a multicenter retrospective study,” what 4 etiology patterns were identified?
Pearce, Staszyk Vet Sci 2022
Following sino-nasal surgery, following trauma, underlying sinus pathology, idiopathic
Following sino-nasal surgery most prevalent 45/105 cases
In Hopfgartner’s 2024 study “Comparison of equine paranasal sinus trephination complications and outcome following standing computed tomography, radiography and sinoscopy guided approaches for the treatment of sinusitis,” what was the most common cause of sinusitis and what percent of cases were secondary sinusitis?
Vet Surg 2024
Dental sinusitis most common cause 60.7%
Secondary sinusitis made up 82% of all cases
In Hopfgartner’s 2024 study “Comparison of equine paranasal sinus trephination complications and outcome following standing computed tomography, radiography and sinoscopy guided approaches for the treatment of sinusitis,” what percent of cases developed post hospital complications, what was the most common one and what was its association with imaging group?
Vet Surg 2024
46%
Most common complication: recurrence of disease 37%
Did not stat sig differ between imaging groups
Long-term complications more common in secondary sinusitis group 50.6% vs primary sinusitis 32%
In Hopfgartner’s 2024 study “Comparison of equine paranasal sinus trephination complications and outcome following standing computed tomography, radiography and sinoscopy guided approaches for the treatment of sinusitis,” what percent of cases resolved following initial trephination surgery and what percent had final resolution after follow up medical or surgical treatment?
Vet Surg 2024
Following initial trephination surgery 57% of cases resolved with no sig difference between imaging groups
Final resolution after follow up medical or surgical treatment increased to 95% and was NOT different between imaging groups or between primary or secondary sinusitis
According to Easley’s 2022 textbook, what plug material is least likely to loosen for obturator of an oroantral fistula?
chp 32
PMMA
According to Easley’s 2022 textbook, transposition with what two muscles can be utilized to obliterate an oromaxillary fistula?
Chp 32
Levator nasolabialis m.
Levator labii superioris m.
What muscle has been exteriorized to treat the maxillary fistula that communicates with the oral cavity (white arrow)?
Easley 2022, chp 32
Levator labii superioris m.
originates beneath the orbit at the junction of the lacrimal, maxillary and zygomatic bones
Transposition of what muscle(s) can be used to resolve a sinocutaneous fistula involving the conchofrontal or rostral and caudal maxillary sinuses respectively?
Easley 2022 textbook, Chp 32
Conchofrontal: Temporalis m.
Maxillary sinuses: levator nasolabialis m., levator labii superioris m.
Describe the course of the parotid duct.
Easley 2022, Chp 32
Duct exits gland 2-3cm rostral to linguofacial vein, crosses tendon of insertion of sternomandibularis m., travels rostrally ventral to facial vein, at vascular notch follow rostral border of masseter m, perforates cheek at buccal ostium adjacent to 07s/08s
How much saliva does a 500kg horse produce in 24 hours?
Easley 2022, Chp 32
40L
primarily from parotid salivary glands
Involvement of what neurovascular structures makes removal of the parotid salivary duct difficult to impossible?
Easley 2022 textbook, Chp 32
Maxillary vein, internal and external carotid arteries, facial, glossopharyngeal, hypoglossal nerves, vagosympathetic trunk
What structure is isolated in this image and what is it coursing over?
Easley textbook 2022, Chp 32
Parotid salivary duct
Tendon of the sternomandibularis m.
In Hawkes’s 2008 article “Treatment of oromaxillary fistulae in nine standing horses (2002-2006),” how fistulae were associated with diastemata, fractured cheek teeth and a central defect in a worn cheek tooth respectively?
Easley, Dixon EVJ 2008
Diastemata 7/9
Fractured cheek tooth 1/9
Central defect in worn cheek tooth 1/9
In Hawkes’s 2008 article “Treatment of oromaxillary fistulae in nine standing horses (2002-2006),” how were the defects treated?
Easley, Dixon EVJ 2008
PMMA packed in diastemata or dental defect following debridement 6/9 cases
PMMA packed in alveolus following extraction 3/9 cases
In Dixon’s 2000 study “Equine dental disease part 4: a longterm study of 400 cases: apical infections of cheek teeth,” how many horses had primary apical infections of their cheek teeth?
EVJ 2000
162/400
40%
In Dixon’s 2000 study “Equine dental disease part 4: a longterm study of 400 cases: apical infections of cheek teeth,” infections of the caudal maxillary cheek teeth with secondary paranasal sinusitis had complete response to initial treatment in what percent of cases?
EVJ 2000
33%
In Tucker’s 2016 paper “Radiographic, computed tomographic and surgical anatomy of the equine sphenopalatine sinus in normal and diseased horses” what were the clinical signs associated with disease of this sinus? What were the causes?
Tucker EVJ 2016
CS: exophthalmos, blindness, unilateral epistaxis or unilateral nasal discharge
Diagnoses included neoplasia (7), progressive ethmoidal haematoma (4), sinus cyst (2) and empyema (1)
In Tucker’s 2016 paper “Radiographic, computed tomographic and surgical anatomy of the equine sphenopalatine sinus in normal and diseased horses” what were the limitations for endoscopic access? What was the most superior imaging modality?
Tucker EVJ 2016
The palatine portion of the sphenopalatine sinus was consistently accessible sinoscopically and the sphenoidal portion was accessible in 6/10 cadaver heads.
The borders of the sphenopalatine sinus were NOT identifiable on plain radiographs –> CT is superior
According to Brinkshulte’s 2014 paper on sinonasal communication, what were the variations in the rostral sinonasal channel (RSC) and the caudal sinonasal channel (CSC)?
Brinkschulte 2014 BMC
RSC: 52% go to rostral max sinus only; 42% go to rostral max sinus and Ventral conchal sinus; 5% go to VCS only
CSC: all go to caudal max sinus
In Brinkschulte’s 2014 study on sinonasal communications, what variation in location of the nasomaxillary aperture was noted?
Brinkschulte 2014 BMC
< 15yo – located at the 09 or 10
> 15 yo – located at the 10 or 11
Makes sense with mesial drift
In Brinkschulte’s 2013 paper on sinus anatomy and volumes, that sinus was noted to sometimes be contacted but the palatal roots of cheek teeth?
Vet Rad US 2013 Brinkschulte
Ventral conchal sinus
In Brinkschulte’s 2013 paper on sinus anatomy and volumes, what variation in rostral aspect of the maxillary septum was noted?
Vet Rad US 2013 Brinkschulte
47% at the 09
44% at the 10
2.8% at the 08 (n=1)
5.6% at the 11 (n=2)
The septum continued caudo-dorsally and merged with the dorsal spiral lamellae of the ventral conchal sinus.
THO is most common in what breed?
Easley ch 32
QH
