Case Study - Murphy
Murphy a 31-year-old horse presented with an acute case of unilateral (one-sided) nasal discharge from his right nostril. After a thorough examination it was determined that Murphy was suffering from a sinusitis. Signs of sinusitis can include; unilateral nasal discharge, dull sound on percussion of skull, facial swelling, tearing of eyes, abnormal inspiratory noises.
Horses have large air-filled sinuses which produce mucus and help to accommodate the horse’s cheek teeth, without adding excessive weight. Infections can be primary (invading bacterial infection from upper respiratory tract) or secondary (tooth root infections, bone fracture, sinus cyst).
To identify the underlying cause of Murphy’s sinusitis radiographs of his skull were taken. Radiographs showed a fluid line (green arrows) and evidence of apical infection of 2 of Murphy’s cheek teeth 108 & 109 on his right side (bolded red text). This along with his clinical signs of nasal discharge and dull sinuses made secondary sinusitis the most likely diagnosis.
Murphy visited the IEC clinic for removal of 2 of his affected teeth as well as trephination and flushing of his nasal sinuses. Murphy was given a standing sedation and pain relief throughout the procedure. The extraction technique required the use of periodontal spreaders to break down the ligaments attached to the teeth. The spreaders were gradually increased in size until the tooth was sufficiently separated from the neighbouring teeth. Next the tooth was grasped using specialised dental forceps and gently manipulated until it became loosened at which point it was able to be removed. The tooth was examined to ensure that all root tips were present, and the second tooth was removed using the same technique.
Right Lateral Skull Radiograph. Showing the Modified Triadan numbering system (red numbers). Teeth 108, 109, 110 have signs of apical infection, warranting removal. A fluid line (green arrows) illustrates fluid/pus in the sinus cavity.
Extracted Teeth. Murphy's extracted 108 & 109 cheek teeth. Notice the shortened roots due to his age. Younger horses often have much longer root tips making extraction of teeth more difficult.
Murphy visited the IEC clinic for removal of 2 of his affected teeth as well as trephination and flushing of his nasal sinuses. Murphy was given a standing sedation and pain relief throughout the procedure. The extraction technique required the use of periodontal spreaders to break down the ligaments attached to the teeth. The spreaders were gradually increased in size until the tooth was sufficiently separated from the neighbouring teeth. Next the tooth was grasped using specialised dental forceps and gently manipulated until it became loosened at which point it was able to be removed. The tooth was examined to ensure that all root tips were present, and the second tooth was removed using the same technique.
Following the successful extraction of his affected premolar and molar the cavity was flushed and radiographs were taken to identify any fragments left behind. There was one small root fragment found that later fell out. In order to fully flush Murphy’s sinuses a small hole (trephination) was drilled into his skull above the frontal sinus. A sterile giving set was inserted into the hole and 500 mL of sterile saline was flushed through the sinus.
Post operatively Murphy was placed on a course of antibiotics, daily flushing of the socket, and hexa-rinse flushes to help avoid infection. Currently Murphy is doing very well! He has a new lease on life and can’t get enough of his food. He will come back to have one more tooth removed in 3 months after fully healing from his first procedure.
Ensuring your horse gets a yearly dental examination can help prevent development of dental related sinusitis. Contact us to get your horse booked in for their next dental exam!
Thank you to Dr. Nikita McAdams, Carolyn Hartley, and Illawarra Equine Centre
Trephination. Murphy with a small trephination into his right frontal sinus.
Post Operative Recovery. Murphy 4 weeks post-op.
The socket healed well and he is eating without issues!
References:
Barakzai, S. 2014. Radiology of equine cheek teeth and sinus disorders. In Practice. 36, pp. 466-472. Retrieved from <http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.842.4579&rep=rep1&type=pdf>
Freeman, D.E. 2003. Sinus Disease. Vet Clin Equine 19, pp. 209-243. Retrieved from <https://www.vetequine.theclinics.com/article/S0749-0739(02)00062-7/fulltext>
University of Florida. Equine Sinus Conditions. Retrieved from <https://largeanimal.vethospitals.ufl.edu/hospital-services/surgery/sinus-conditions/>