BackgroundFractures of the paracondylar process of the occipital bone may cause headshaking, neck pain and neurologic deficits. The condition is being recognised more frequently with increasing availability of computed tomography. However, to date only limited information is available as to presentation, treatment, surgical approach and outcome.ObjectivesTo describe the clinical signs, imaging findings, treatment, surgical approach and outcome in three horses diagnosed with paracondylar process fracture.Study designRetrospective case series.MethodsClinical records and diagnostic images of affected cases were reviewed.ResultsTwo cases had ventral nonunion fractures-one of these presented with neck pain, headshaking and behavioural changes, while in the other the fracture was a suspected incidental finding in a case of poor performance. A third case with a more dorsal fracture presented with acute facial nerve paralysis. Diagnosis was by computed tomography in all cases, although imaging of ventral fractures by radiography was found to be feasible. Where clinical signs could be associated confidently with the fracture, conservative management resulted in improvement but not complete resolution. Repeated recurrence of clinical signs after prolonged periods of remission necessitated surgical removal in one case, which was readily accomplished with the aid of ultrasound guidance, and led to rapid resolution of clinical signs without significant post-operative complications. The surgical approach is described.Main limitationsLimited follow-up was available.ConclusionsParacondylar process fracture should be considered as a differential diagnosis for headshaking, neck pain, poor performance and facial paresis, and is a justification for performing computed tomography in such cases. A multi-disciplinary approach is beneficial due to the potential for orthopaedic, neurologic, ophthalmologic and behavioural clinical signs, with additional need for expertise in diagnostic imaging and pain management. Surgical fragment removal should be considered for ventral fractures.

Suture exostosis is an intriguing and not uncommon pathology that has to be included in the differential diagnosis for horses with swelling of the head. Although several singular case reports have been published, no large case series is available. The aim of this study is to report a multicentric retrospective collection of suture exostosis cases. Data concerning horses with suture exostosis in the facial region were collected retrospectively. Information regarding breed, age, gender, history, imaging findings, initiated treatment, response to treatment and follow up was recorded. One hundred and five cases of various breeds were reported. Analysis revealed the cases could be grouped into four entities: 45 developed following sino-nasal surgery, 23 following trauma, seven with underlying sinus pathology and 25 idiopathic. Treatment consisted of sequestra removal, plate fixation, antimicrobial and anti-inflammatory drugs or no treatment. Whereas initial localized pain fades within few days or weeks, resolution or reduction of the swelling was obtained in most cases after 3 months to 1.5 years. The etiopathogenesis of suture exostosis seems to consist of different entities. Identification of an underlying cause, particularly the presence of a bone sequester and infection is important to speed up resolution and before concluding an idiopathic case. When performing sinusotomies, it is important to provide as little trauma as possible to the surgical site in order to prevent suture exostosis as a complication.

BACKGROUNDSagittal fractures of equine cheek teeth are commonly observed during oral examination. There are few reports on the apical and endodontic pathology associated with such fractures seen during computed tomographic (CT) examination.OBJECTIVESTo document the prevalence of CT changes indicative of apical disease in equine cheek teeth which have suffered a sagittal fracture involving the clinical +/- reserve crown.STUDY DESIGNRetrospective case series.METHODSCT examinations of equine heads with sagittal fractures of cheek teeth present were reviewed: 81 teeth from 49 horses were identified to have a sagittal cheek tooth fracture. The images were evaluated for apical pathology including gas (in the endodontic system and periapically), widened periodontal space, periapical sclerosis, apical clubbing, cementoma/hypercementosis, lamina dura loss, associated sinusitis and sinus mucosal swelling. An apical infection grading system was created to give each tooth a score. Hounsfield units were used to measure the density of the endodontic, apical and periapical regions. The fracture length ratio was recorded. Statistical analysis was performed using a generalised estimating equation to evaluate predictors of apical infection and associations between clinical signs and CT abnormalities.RESULTS87 sagittal fractures (56 buccal, 17 palatal/lingual and 14 midline) from 81 teeth were recorded (74 maxillary and 7 mandibular). Apical infection was diagnosed in 73% (37/51, P = 0.05) of buccal, 55% (6/11, P =0.07) of palatal/lingual, 100% (13/13) of midline, 100% (6/6) with multiple fractures and 96% (23/24, P =0.008) of fractures involving infundibula. There was no significant relationship between apical infection and the presence of clinical signs associated with dental pathology (P = 0.4). There was no significant association between fracture length ratio and apical infection (P = 1.0). Midline sagittal fractures were significantly associated with sinusitis when compared to all other maxillary fractures (OR 5.92, 95% CI 186 1.67-20.83, P=0.006). Loss of the lamina dura was not significantly associated with apical infection (P=0.5) MAIN LIMITATIONS: Maxillary tooth bias and subjective grading system.CONCLUSIONSA large proportion of fractured cheek teeth have evidence of apical infection on CT examination and therefore warrant treatment.

Cheek teeth diastemata are the most common cause of quidding in the horse. They most commonly affect the most distal mandibular interdental spaces (09/10s and 10/11s) and they begin with impaction of food material, which may progress to gingivitis and periodontitis. They are diagnosed during a thorough oral examination, given under sedation. The initial assessment should include removal of the food from the diastema, which is also therapeutic. Many cases may be resolved by removing the impacted food and with good quality routine dentistry. Other proposed treatments include packing or stenting of diastemata, removing teeth from occlusion, diastema widening and extraction of cheek teeth.

SummaryThis case report describes the successful surgical management of a sinonasal angiomatous polyp involving the dorsal conchal bullae, dorsal conchal sinus, ventral conchal sinus, ventral conchal bullae and ventral conchal recess of the left nasal cavity resulting in a secondary sinusitis and compression of the nasal passage.

Summary Background There is limited information about bacterial isolates that are present on the equine midline incision during and following exploratory laparotomy. Objectives To investigate the bacterial species cultured from the ventral midline pre‐, intra‐ and post‐ laparotomy, whether particular bacterial isolates are associated with the development of surgical site infections (SSIs) and to report the antimicrobial resistance phenotypes of these isolates. Study design Prospective cohort study. Methods The ventral midline of 31 horses undergoing exploratory laparotomy was sampled for bacterial culture at set time‐points pre, intra and post‐operatively. Inclusion criteria were that horses must have undergone exploratory laparotomy within 90 min of the initial colic examination upon hospital admission and must not have been placed in a stable prior to surgery. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration. Results Seven horses (22.6%) developed a SSI. None of the variables tested were associated with the altered risk of SSI. The prevalence of a positive bacterial culture from the incision increased progressively over time and a variety of bacteria were isolated. A positive intra‐operative culture was not a predictor of SSI; and when a SSI did occur, it was due to a different bacterial isolate. MRSA and ESBL‐producers were identified in the post‐operative period in one and four different horses respectively, but none of these developed a SSI. Main limitations Sampling was limited to hospitalisation and no culture results were available for horses developing SSI following hospital discharge. Conclusions A variety of bacterial species may be isolated from equine laparotomy incisions peri‐operatively without development of SSI. SSI does not appear to be solely related to bacterial contamination of the incision peri‐operatively and other mechanisms such as bacteraemia merit further investigation.

Equine grass sickness (EGS) is a frequently fatal disease of horses, responsible for the death of 1 to 2% of the U.K. horse population annually. The etiology of this disease is currently uncharacterized, although there is evidence it is associated with Clostridium botulinum neurotoxin in the gut. Prevention is currently not possible, and ileal biopsy diagnosis is invasive. The aim of this study was to characterize the fecal microbiota and biofluid metabolic profiles of EGS horses, to further understand the mechanisms underlying this disease, and to identify metabolic biomarkers to aid in diagnosis. Urine, plasma, and feces were collected from horses with EGS, matched controls, and hospital controls. Sequencing the16S rRNA gene of the fecal bacterial population of the study horses found a severe dysbiosis in EGS horses, with an increase in Bacteroidetes and a decrease in Firmicutes bacteria. Metabolic profiling by 1H nuclear magnetic resonance spectroscopy found EGS to be associated with the lower urinary excretion of hippurate and 4-cresyl sulfate and higher excretion of O-acetyl carnitine and trimethylamine-N-oxide. The predictive ability of the complete urinary metabolic signature and using the four discriminatory urinary metabolites to classify horses by disease status was assessed using a second (test) set of horses. The urinary metabolome and a combination of the four candidate biomarkers showed promise in aiding the identification of horses with EGS. Characterization of the metabolic shifts associated with EGS offers the potential of a noninvasive test to aid premortem diagnosis.

BACKGROUND:Paranasal sinus cysts (PSC) are a common cause of equine secondary sinusitis. The outcome and associated complications have not been frequently reported. OBJECTIVES:To review the associated clinical signs, associated morbidities and outcomes of horses treated for PSC. STUDY DESIGN:Retrospective multicentre case series. METHODS:Retrospective analysis of case records and telephone follow up survey. RESULTS:Subjects were 37 horses 1-24 years old that were presented with nasal discharge (n = 31), facial swelling (n = 25) and epiphora (n = 19). Radiography and computed tomography allowed identification of the cyst-induced changes including concomitant tissue destruction (n = 31), leading among other things to local nerve damage causing headshaking (n = 6) and unilateral blindness (n = 1). Radiographic changes to adjacent dental apices were present in 10 horses. Horses over 10 years old showed more of the named associated problems. Post-operative complications included surgical site infection (SSI) (n = 11), nasofrontal suture periostitis (n = 6) and sequestration (n = 1) following removal of the PSC via osteotomy. The long-term response to treatment was available for 28 cases with 22 horses (78.6%) fully cured, 4 (14.3%) partially cured and 2 (7.1%) not responding to treatment. In 7 horses (18.9%) there was recurrence of the cyst post-operatively. MAIN LIMITATIONS:Due to the study being a multicentre retrospective case series with collection of data over an extended period, there may be inconsistency in data recording and absence of reporting of some findings. CONCLUSIONS:Overall, the diagnosis and treatment of sinus cysts is relatively straightforward and carries a good prognosis. In long-standing cases complications secondary to the expansive growth of cysts will dramatically affect the prognosis for full recovery due to pressure-induced changes to facial bones, cheek teeth and nerves. These secondary complications mainly occurring in older horses may be due to a combination of a relatively longer period of affection and the inflexibility of older horses' bones. Cyst recurrence following treatment can occur in up to 19% of cases.

Paranasal sinusitis is the most common cause of a unilateral nasal discharge. External clinical signs such as nasal discharge and lymphadenopathy are common to both primary sinusitis and many causes of secondary sinusitis creating a diagnostic challenge. The complex anatomy coupled with relative inaccessibility precludes direct examination so a clinician must rely on carefully performed diagnostic tests. Upper respiratory endoscopy should be used to eliminate other causes of unilateral nasal discharge such as guttural pouch empyema. Detailed oral examination should be used to eliminate occlusal dental problems and radiography used to determine precise sinus involvement and apical dental pathology. Should these tests yield equivocal results, advanced head imaging such as computed tomography (CT) may provide a definitive diagnosis and further anatomical information. Direct sinus endoscopy through trephination can be both diagnostic for inspissated material, and therapeutic by allowing lavage to be performed.

Reasons for performing studyOro-dental disease can have a significant impact on equine welfare.ObjectivesTo determine the prevalence of oro-dental disease and to identify risk factors for oro-dental disorders and poor body condition scores (BCS) in a working horse population in Egypt.Study designCross-sectional survey.MethodsOro-dental examination was performed on 450 working horses in 2 Egyptian provinces. Horse and management historical data were collected and horses were assigned to no/mild, moderate and severe dental disease categories based on findings on examination. Multivariable logistic regression and generalised additive models were used to identify risk factors for oral mucosal injuries and very poor/poor BCS, and to explore the relationship between age and different oro-dental disorders.ResultsOro-dental disease was common, with 45.3% and 8.4% of horses considered to have moderate and severe oro-dental disease, respectively. None of these horses had previously undergone any form of proper dental examination and treatment by trained personnel. Oral mucosal injuries (64.2%) and sharp enamel points (79.8%) were most common. Oral mucosal injuries were significantly associated with increasing age (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.01-1.1, P = 0.03), focal dental overgrowths (OR 2.4, 95% CI 1.4-4.0, P = 0.002) and sharp enamel points (OR 6.3, 95% CI 3.5-11.0, P<0.001). Very poor and poor BCS were significantly associated with severe dental disease (OR 2.6, 95% CI 1.2-5.8, P = 0.02), horses aged 16-30 years (OR 3.5, 95% CI 1.7-7.0, P = 0.001), height (OR 0.9, 95% CI 0.9-0.97, P = 0.001) and packed cell volume (OR 0.9, 95% CI 0.85-0.95, P<0.001).ConclusionsThere is a need for education of working horse-owners in Egypt about the importance of oro-dental disease and for greater availability of veterinarians with suitable training and equipment to perform dental prophylaxis and treatment. Even simple dental prophylaxis could have a significant impact on the health and welfare of this population of working horses.

Reasons for performing study: Surgical site infection (SSI) is an important cause of post operative morbidity following laparotomy. Objectives: To investigate risk factors for SSI, including effect of season and surgery performed outside normal working hours, and to report bacterial isolates and antimicrobial resistance patterns. Study design: Retrospective cohort study. Methods: Data were obtained from horses that had undergone exploratory laparotomy over a 3‐year period (2010–2013) in a UK hospital population. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration that developed during hospitalisation. Multivariable logistic regression was used to identify associations between pre‐, intra‐ and post operative variables and altered likelihood of SSI. Results: Surgical site infection developed in 73/287 (25.4%) horses during hospitalisation. Horses of greater bodyweight (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.0002–1.005, P = 0.03), increased packed cell volume (≥48%) on admission (OR 3.03, 95% CI 1.32–6.94, P = 0.01), small intestinal resection (OR 2.27, 95% CI 1.15–4.46, P = 0.02) and post operative colic (OR 2.86, 95% CI 1.41–5.79, P = 0.003) were significantly associated with increased likelihood of SSI in a multivariable model. SSI was also significantly more likely to occur during winter (OR 3.84, 95% CI 1.38–10.70, P = 0.01) and summer (OR 5.63, 95% CI 2.07–15.3, P = 0.001) months in the model. Three‐layer closure of the incision was protective (OR 0.31, 95% CI 0.16–0.58, P<0.001) compared to 2‐layer closure. There was no effect of surgery being performed outside normal working hours (P = 0.5). The most common bacterial isolates were Escherichia coli (59.5%), Enterococcus spp. (42.4%) and Staphylococcus spp. (25.4%). Penicillin resistant isolates accounted for 92% (96/104) of isolates while 18% (21/119) of isolates were gentamicin resistant. Conclusions: Laparotomy during winter and summer months was associated with increased likelihood of SSI but there was no effect of surgery performed outside normal working hours. This information assists in identifying horses at high risk of SSI and informing development of preventive strategies.

The increasing availability of video-endoscopy has allowed direct sinus endoscopy to be performed through much smaller portals than traditional sinus trephination techniques. This has advantages of healing faster and with a better cosmetic result. Knowledge of the intra-sinus anatomy and the correct trephine sites is essential to perform direct sinus endoscopy.

Improved recognition of equine geriatric conditions has resulted in a surge in our aged population with a concurrent escalation of many age-related dental pathologies. Prevention of these disorder is the ultimate aim but early identification and appropriate management can increase an animal's oral comfort and maximise its masticatory ability. There is only a finite amount of tooth available for eruption in the horse and therefore as the teeth become worn and less efficient as a grinding unit, dietary modification becomes a paramount consideration to accommodate this. Geriatric animals have differing requirements for restraint and sedation with treatment of coexisting disorders also an important requirement.

A 12‐month‐old bull with chronic respiratory stridor and dysphagia was presented. Endoscopic evaluation of the upper airway revealed a large swelling of the dorsal pharynx, partially obstructing the airway. The swelling was investigated further with the bull anaesthetised. A hand was advanced through the mouth to the level of the mass while an endoscope was placed via the nasopharyngeal route to visualise the swelling. Needle aspiration revealed thick purulent material. The wall of the abscess was digitally broken down, and the endoscope was advanced into the cavity of the abscess to allow flushing with normal saline. Immediately following surgery, there was a noticeable reduction in respiratory noise. Two days following surgery, appetite had returned to normal, and by four days following surgery, minimal respiratory noise was present at rest. Four months after being discharged, the owner reported the animal to be completely normal.