Objective: Subject of this article is an overview of the literature to the possible diagnoses of the cardinal symptom "swelling of the lower jaw" concerning mandibular fracture and dental diseases except for tumours, which have been described in part 1. In addition, five case studies of this disease complex are documented. Material and methods: The five cases were treated at the equine clinic of the Freie Universitat Berlin in the last ten years. Results: There are many differential diagnoses for the cardinal symptom "swelling of the lower jaw". Both only slightly impairing diseases (e. g. bumps) as well as extremely acute periodontitis can occur. Conclusions and clinical relevance: With the cardinal symptom "swelling of the lower jaw" extensive diagnostic procedure is necessary. Besides the general and the clinical examination, radiography and endoscopic exploration of the oral cavity provide most information.

Zusammenfassung: Gegenstand und Ziel: Die Arbeit gibt einen Literaturüberblick über die möglichen Diagnosen zum Leitsymptom “Umfangsvermehrung am Unterkiefer” hinsichtlich Unterkieferfraktur und Zahnerkrankungen, mit Ausnahme der Tumoren,die im ersten Teil der Publikation beschrieben wurden. Anschließend werden fünf Fallbeispiele aus diesem Teilkomplex und deren Diagnostik dokumentiert. Material und Methoden: Für die Fallberichte wurden Patienten aus den letzten 10 Jahren der Klinik für Pferde der Freien Universität Berlin ausgewählt. Ergebnisse: Das Leitsymptom „Umfangsvermehrung am Unterkiefer” umfasst viele unterschiedliche Differenzialdiagnosen. Wenig beeinträchtigende Erkrankungen (z. B. Bumps) kommen ebenso vor wie klinisch hochgradig akute Periodontitiden. Viele Zahnerkrankungen entstehen aus Störungen des Zahndurchbruchs und -wechsels. Klinische Relevanz und Schlussfolgerung: Das Leitsymptom „Umfangsvermehrung am Unterkiefer” erfordert eine umfangreiche Diagnostik. Neben der allgemeinen und klinischen Untersuchung liefern die Röntgenuntersuchung und die Endoskopie der Maulhöhle die meisten Informationen. Ausschlaggebend sind ferner das Alter des Patienten und eventuelle Probleme bei der Futteraufnahme.

A sequestrum is dead osseous tissue, round about seperated from the vital bone (demarcation). In horses particularly the extremities are affected, because of the lack of protective soft tissue covering the osseous skeleton. Otherwise bone sequestration can be seen on all locations with a cutaneous plane, where just skin covers the skeleton. The most important cause beside an open trauma is a mated trauma as well as haematogenous infection of the bone. The clinical findings are bad healing wounds with changing loss of function over a longer peroid of time. In the most cases there's no refer to a trauma in the anamnesis. Consequently the diagnosis requires an ectensive clinical examination (wound healing, injury of tendons, ligaments and joints) as well as an extended and repeated radiological examination of these patients. Surgical therapy as sequestrectomy is the therapy of choice. In sporadic cases a sequestrum is immured by periostal reactions or it is resorbed.

The present study was undertaken to investigate the fine radiographic structure of osteochondral fragments obtained by surgical removal from 41 fetlock and 54 hock joints in equines using the "Feinfokus" radiographic technique. This technique allows high resolution magnified (6x) radiographs of the isolated intraarticular osteochondral fragments to be taken. This procedure thereby enables the radiographic differentiation of histopathologically verified soft tissue, calcified cartilage, spongy and sclerotic bone components of the osteochondral fragments. It was also endeavoured to find a correlation between the occurrence of the osteochondral fragments in these joints and the age, breed, sex and the intraarticular localization. Intraarticular fragments in the fetlock joints were found to have a nonspecific breed predilection, whereas these chips in the hock joint were predominantly found in trotters and warm-blooded breeds. On examination of the "Feinfokus" radiographic images, sclerotic areas were observed in the osteochondral fragments in 14% and 25% in the fetlock and hock joints, respectively. The degree of sclerification tended to increase directly with the age of the horse, with some exceptions, in the fetlock as well as in the hock joints. However, on the basis of the limited sample size of the sclerified osteochondral fragments (n = 20) investigated in this study, this finding can only be considered as being suggestive of a trend. Sclerified intraarticular bony osteochondral fragments were found to have a greater average size than spongy fragments. A correlation could neither be found between the occurrence of these sclerified bony fragments and the sex or breed of the horse, nor with its intraarticular localization.

In 1997 and 1998 the fetlock and tibiotarsal joints of 130 warmblooded foals were examined radiologically. The foals were x-rayed monthly until they were weined, regarding especially the beginning and development of osteochondral changes and osteochondrosis dissecons.First signs of osteochondral variations, such as irregularities and low density of bone margins, were seen in an early age of under one month in the fetlock and tibiotarsal joint. "Joint mice" developed from those early changes, in the dorsal aspect of the fetlock joint during the fourth month of life, in the palmar/plantar aspect of the fetlock joint between the second and fourth month, at the distal part of the tibia in the fourth month, and at the lateral talus in the fourth month, too. In single cases, joint bodies developed earlier. They were not seen in neonatal foals. In the region of the proximal sesamoid bones isolated ossification centres were seen.

Section or perforation of the equine oesophagus is a rare injury. Typical causes of such injuries would be, for instance, fa Ils, insertion of foreign bodies, careless use of stomach tubes and other traumas. Spontaneous rupture of the oesophagus can a Iso be ca used by long term constipation or transfer of infection from surrounding tissue. We distinguish between open and covered perforation.Treatment normally consists of immediate surgical intervention with drainage. Post operatively, dip feed, wound hygiene, antibiotics and tetanus prophylactic may be indicated.In two case histories, the cause of two ruptures of the oesophagus is examined and the respective diagnosis and symptomes and the therapy for these injuries, which ore completely heeled, are described.

Arthroscopy was introduces as the first minimal-invasive, endoscopic surgical technique for joint diseases 20 years ago. Disadvantages of the large surgical access by arthrotomy are great trauma of the soft tissue, higher risk for infection, complications in wound healing, long reconvalescence and higher risk for secondary osteoarthrosis. By the time arthroscopy replaced arthrotomy more and more. In equine orthopedic surgery minimal-invasive techniques should be more applied to improve wound healing by a minimal access and with that a short reconvalescence. The minimal access makes an optimal localisation necessary which often implies a great technical expense. In bone and joint surgery the x-ray control with the aid of a c-arch during surgery is a valuable supposition for minimal-invasive techniques. With the c-arch where the x-ray tube is connected with a monitor the surgeon is able to examine the different regions of the limbs in different projections during surgery. The radiographs can immediately be evaluated on the monitor. Hence an optimal localisation of the access and a visible control and correction of single surgical steps become possible. The main indication for the C-arch-technique in bone and joint surgery results from the pathological finding of radiological presentation. Primary indication is the radiologically isolated bone chip in joints or in the surrounding tissue. Further possibilities for application of the C-arch-technique are extirpation of bony fragments, internal fixation of bony fragments, surgical therapy for cystic bone lesions with cancellous bone grafting after drilling the lesion and surgical fixation of a joint with drilling of the joint space and implantation of cancellous bone grafts.

In commenting and interpreting radiographs for prepurchase or lameness exams isolated ,,joint-chips" always have been stumbling-blocks. The confusion of terms results from attempts for explanation by clinicians and pathologists. The clinical importance of isolated ,,joint-mice" is not always clear. However radiological mass examinations on yearlings up to 3- to 4-year-old horses have shown that ,,corpora libera" can already be seen during the breeding and raising period (Hertsch et al. 1996).In the working horse the ,,joint-chips" can be seen together with joint effusion, lameness, positive flexion tests or radiographically isolated abnormal bodies within the joint cavity. Besides the radiographic finding has to be an appropriate and objective description and must be distinguished from the diagnosis which is the interpretation of the pathological and clinical condition (Zeller 1977, Hertsch 1992 a). Surgical methods to remove ,,joint-mice" started with the extirpation of the proximal fragment of proximal sesamoid bone fractures from Churchill (1956) 40 years ago.The arthrotomy was alternated 20 years ago by the arthroscopy as endoscopic technique to demonstrate (Knezevicz 1977) and remove cartilaginous and bony fragments from the joint cavity (Mc llwraith 1984).Hertsch (1992b) describes another technique to remove fragments from the coffin joint. With the help of x-ray examination with a C-arch the fragment in the area of the extensor process can be removed under continuous joint rinsing. This technique is also practicable in the fetlock- and stifle-joint.The combination of the mentioned techniques for the extirpation of joint-fragments, probably in addition with flexible endoscopes, as minimal-invasive surgical technique is very much future-oriented.

Podotrochlosis in the thoracic limbs in horses is known as a cause for lameness for more than 200 years.Turner (1829) named this disease ,,navicular joint disease" and defined the syndrome as an inflammation of the synovial membrane between the deep digital flexor tendon and the flexor surface of the navicular bone, causing abrasion and different degrees of destruction of the navicular bone, the deep digital flexor tendon and the navicular bursa.100 years later Oxspring (1935) developped a technique for radiographic examination of the navicular bone, thus improving the diagnostic techniques.In the following 50 years detailled studies on pathological anatomy (Delius 1982, Hertsch et al. 1982 Poulos 1983) helped to distinguish and interpret the radiological findings. The conclusion is that the navicular-lameness has to be differentiated according the involved anatomical structures (Hertsch 1983, Pool et al. 1989).Up to a few years the diagnosis podotrochlosis-syndrome was made on unspecific symptoms as course of the lameness, clinical findings on the hoof and the fore limbs, positiv digital nerve block and radiological findings on the navicular bone (Langfeldt und Hertsch 1988).Ten years ago Schott (1989) published a technique for compartment pressure measurement as direct measurement of the intra-articular pressure in the coffin joint as contribution to the pathogenesis and therapy of navicular and coffin joint lameness. With this relation the diagnostic value of the anesthesia of the coffin joint and the navicular bursa (Dyson 1993, Pleasant et al. 1997) for differentiation of the podotrochlosis-syndrome (Hertsch et ai. 1982) was evaluated again.Although the pathogenesis of the navicular-lameness has not been totally clarified and different theories can be found in different methods for treatment (Turner 1996), only the trouble and effort to find an aetiological and differentiating diagnosis can lead to an adequate successful therapy and leave the neurectomy of the digital nerves as the last expedient.

Fractures concerning the extensor process of the pedal bone are differentiated in1. base fracture (extensor process fracture of the distal phalanx, chip fracture of the extensor process, strain or avulsion fracture of the extensor process)horizontal, angular, covered, open2. apex fracture3. marginal prominence fracture4. apex fracture including marginal prominence.Following differential diagnoses have to be defined1. isolated ossification center2. metaplasia of the joint capsule/of the extensor tendon3. osteochondrotic arthropathy.The documented case shows one possible etiology of a base fracture through the extensor process in a foal with congenital club feet. The applied successful surgical therapy was the desmotomy of the subcarpal check ligament of the deep digital flexor tendon.

In this study, x-rays of the front toes and hock joints of 4.186 three- to eight-year-old auction horses of the breeding associations Bayern, Hannover, Hessen, Holstein, Oldenburg, Westfalen and the breeders of Trakehner horses are evaluated. The horses have been examined radiographically within the limits of elite horse sales in the years of 1982 until 1990. On disposal are x-rays of each front toe in the lateromedial and the dorsopalmar (Oxspring) view and radiographs of the hock in different views. The x-rays are evaluated with the aid of a detailed scheme for radiographic criteria that registers 45 locations and criteria and makes it possible to investigate the frequency of radiographical findings in the whole population as well as in relation to sex, age and height of the horses by coding. The results of this study demonstrate that in sound horses radiological deviations of the distal limbs and hock joints from the norm are prevalent and exclusive. The radiograph admits no concluding accessment of the state of health of the horse. With regard to the variety of radiographic changes in clinical inconspicuous, selected horses, the clinical relevance of these findings is called in question and the priority of the exact clinical examination is emphasized in the diagnosis and prognosis of diseases of the distal limbs and hock joints of horses.