Outcomes after medical and surgical interventions in horses with temporohyoid osteoarthropathy

Abstract

The survival prognosis in horses with THO is good to excellent in those submitted to surgical intervention, and fair in those treated with medical therapy alone.

Ceratohyoidectomy in standing sedated horses

“…Clinical signs of THO resolved in all clinical surgically treated horses in the context of this study, and horses returned to their previous levels of performance. This is in agreement with findings reported in previous studies in which CHE was performed under general anesthesia with 65% to 80% of horses returning to performance following surgery . Important intraoperative hemorrhage can occur during the CHE procedure .…”

“…With horses placed in dorsal recumbency under general anesthesia, pooling of blood in a deep incision can complicate accurate placement of hemostatic forceps, and hematomas may form during or after the recovery from anesthesia. This may explain the requirement for a blood transfusion because of profuse hemorrhage in one horse operated on in dorsal recumbency in a previous study by Espinosa and colleagues . Furthermore, in that same study in horses operated on under general anesthesia, three horses developed dyspnoea after surgery and required a tracheostomy.…”

“…In a recent study, six of 27 (22%) horses that underwent CHE under general anesthesia experienced complications. These included poor recovery from anesthesia in one case, dyspnoea requiring temporary tracheostomy in three cases, dysphagia in two cases, and intraoperative hemorrhage in three cases, one of them requiring a blood transfusion.…”

“…Cranial nerves may be affected, and this manifests as signs of central facial paralysis with secondary corneal ulcers (facial nerve), vestibular syndrome with varying degrees of ataxia (vestibulocochlear nerve), and dysphagia and/or signs of oesophageal dysfunction (vagal nerve). [1][2][3][4][5] If the petrous temporal bone fractures, middle or inner ear infections may propagate around the brain stem and result in meningoencephalitis. 6,7 Acute exacerbation of ataxia and of the previously mentioned cranial nerve deficits and even seizures and acute death have been described during manipulation of the tongue and larynx (eg, nasogastric tubing, dental procedures).…”

Shear mouth secondary to temporohyoid osteoarthropathy

“…A recent retrospective study comparing treatment interventions demonstrated a significantly improved survival prognosis in those horses that were subject to surgery over those that were treated medically (Espinosa et al 2017). Several surgical options for the treatment of THO are described; these include a partial stylohyoid ostectomy (PSHO) and a CHO (Divers et al 2006;Freeman and Hardy 2012;Oliver and Hardy 2015).…”