Long-Term Outcome of Horses Undergoing Unilateral Mandibular Condylectomy and Meniscectomy for Temporomandibular Joint Disease

Abstract

BackgroundThere are no reports describing the long-term outcome of sport horses undergoing unilateral mandibular condylectomy with meniscectomy (UMC) for treatment for severe temporomandibular joint (TMJ) disease (TMD). Whether horses undergoing UMC require a specialized diet, can return to riding with a bit, or return to intended function after surgery is unknown.ObjectiveTo determine the long-term outcome of horses undergoing UMC for treatment of severe TMD.Study DesignA multi-institutional, retrospective study.MethodsMedical records obtained from seven equine referral hospitals of horses with severe TMD that underwent UMC were reviewed. Details regarding the presenting complaints, results of clinical examination, findings of diagnostic imaging, surgical technique, and outcome (including long-term follow-up with an owner questionnaire) were recorded.ResultsEleven horses fit the inclusion criteria. Three had severe idiopathic osteoarthritis, and eight had confirmed septic osteoarthritis of the TMJ. The most common post-operative complications were drainage and peri-incisional swelling (n = 5). One horse developed a hematoma at the surgical site because the facial artery was inadvertently transected during the approach, causing the condylectomy to be postponed. All horses were discharged alive from the hospital, and 10 returned to their previous or intended use. All had complete resolution of clinical signs of TMD. One mare was retired from athletic use due to her genetic value as a broodmare. One horse was euthanized 2 years after UMC due to progressively worsening of clinical signs of temporohyoid osteoarthropathy (THO), which were not present before surgery. When available, owner satisfaction of the results of the procedure was excellent.Main LimitationsSample size; multiple institutions; owner bias.ConclusionsUnilateral mandibular condylectomy should not be considered a salvage procedure. Horses treated for severe TMD by UMC can return to their previous or intended level of athletic performance and do not require a specialized diet.

Abscesso em Articulação Temporomandibular por Streptococcus equi subsp. equi.

“…O tratamento indicado para casos de artrite séptica baseia-se na lavagem articular, antibioticoterapia sistêmica e intraarticular (White et al, 2022). No presente relato, apesar do exame radiográfico não indicar acometimento ósseo da articulação temporomandibular, foi possível na ultrassonografia se observar alterações articulares com a presença de uma estrutura anecóica circunscrita e, portanto, instituiu-se a aplicação de antibioticoterapia intra-articular.…”

Arthroscopic Management of Joint Problems in the Sport Horse

“…When evaluating the cartilage, the surgeon must be able to assess all the possible manifestations of articular pathology. Osteoarthrosis evolves from an early inflammatory process that, if uncared for, progresses to a degenerative one through a continuum of well described pathological changes [7]. These lesions progress from an early-stage synovitis characterized by hyperplasia, hyperemia, and hypertrophy of the synovial membrane.…”

“…One of the earliest changes occurring in the cartilage surface is discoloration and loss of shining (Figure 1) which heralds the initiation of degeneration. This is followed by "swelling" and softening of cartilage (Figure 2), sensed by the surgeon by using a palpator (Figure 3) which marks the initial loss of collagen network [7]. As the disease advances, the surgeon will observe surface fibrillation (Figure 4), partial thickness erosions (Figure 5), and full thickness erosions (Figure 6) in that order [7].…”

“…This is followed by "swelling" and softening of cartilage (Figure 2), sensed by the surgeon by using a palpator (Figure 3) which marks the initial loss of collagen network [7]. As the disease advances, the surgeon will observe surface fibrillation (Figure 4), partial thickness erosions (Figure 5), and full thickness erosions (Figure 6) in that order [7]. Osteophytes can be seen along the mid-to late-stage process, and these should have been seen on radiographs during pre-operative evaluation.…”

“…During the arthroscopic examination, the surgeon will encounter different types of visual representations of inflammation and chondromalacia, often part of a continuous process over time. Thus, this evolution leads to the following sequence of lesions on the articular surface from more incipient to more advanced [7] :…”