Standing Arthroscopic Treatment of Temporomandibular Joint Sepsis in a Horse

Abstract

A 15-year-old Thoroughbred gelding was presented for investigation of fever, right temporomandibular region swelling, and progressive pain when opening the mouth. Right temporomandibular joint (TMJ) sepsis was diagnosed based on synovial fluid analysis, sonographic imaging, and standing robotic cone-beam computed tomography. Concurrent otitis media and temporohyoid osteoarthropathy (THO) were also noted. The horse was treated with arthroscopic debridement and lavage during standing sedation followed by local and systemic antimicrobial therapy. There were no complications associated with the surgical procedure and the gelding’s clinical signs resolved. Arthroscopy of the TMJ can be accomplished in the standing horse and should be considered when arthroscopic exploration or debridement of this joint is indicated. This is also the first case report of concurrent otitis media, TMJ sepsis, and THO; due to their close anatomic relationship, it is possible that septic otitis media could lead to pathology in the TMJ and temporohyoid joint, as described in humans.

The Equine Temporomandibular Joint: Comparisons Between Standard and Needle Arthroscopic Examination of Cadaver Specimens and Standing Horses

“…The secondary objective of the study was to validate the technique and assess the feasibility, of examination of the TMJ in living, standing, horses using these arthroscopic systems. Standing surgery of the equine TMJ has been reported ( 11 ), and routine standing arthroscopic surgery has been reported as an alternative to that performed under general anesthesia in the TMJ and fetlock ( 24 , 25 ). The NAS was initially reported as a diagnostic imaging modality in the equine stifle ( 26 ).…”

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

“…The belief that lameness, or specific ill-behaviors, such as head-tossing, bit refusal, lameness, or unwillingness to travel in a specific direction ( 5 , 7 , 8 ), are caused by pain in the TMJ has resulted in a variety of empirical or holistic treatments, such as massage therapy, acupuncture, chiropractic adjustments, or dietary supplementation ( 9 ). Reported clinical signs displayed by horses with TMD include difficulties with mastication (quidding or hyporexia); pain when opening the mouth; effusion or swelling of the TMJ; headshaking; head tilt; and refusal to accept a bit when being ridden ( 8 , 10 – 14 ). Despite these reports, some studies have shown that horses with acute inflammation of the TMJ do not reliably quid, despite experiencing a change in the mechanics of mastication.…”

“…Conditions affecting the TMJ of horses most commonly reported include septic arthritis ( 14 , 16 – 18 ), osteoarthritis ( 7 ), fracture of the mandibular condyle ( 17 ), and luxation or subluxation of the joint ( 19 ). Treatment of horses for non-septic arthropathy of the TMJ usually includes systemic administration of a non-steroidal anti-inflammatory drug ( 20 ) or intra-articular injection of a corticosteroid, hyaluronic acid ( 21 ), or biological therapy ( 8 , 22 ).…”

Management of Septic Arthritis of the Temporomandibular Joint in Dogs

“…Affected individuals typically exhibit periauricular pain, pain when opening and closing the mouth, swelling, redness, and occasionally purulent discharge (6,(8)(9)(10). Diagnosis of TMJ septic arthritis requires a physical examination and advanced diagnostic imaging, namely CT, cone-beam CT (CBCT), and, occasionally, MRI.…”

“…Although the management of TMJ septic arthritis has been described in human, in many reports, and in animals, in some reports, to the knowledge of the authors, a detailed description of the management of this condition in dogs has not been described in the English peer-reviewed literature in the past 10 years (1,9,12,18,19). Therefore, we sought to report our experience in the diagnosis and management of TMJ septic arthritis and report the outcome in four dogs.…”