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In this Issue:
HELPFUL HINTS BY BERNARD FLETCHER DVM
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Dental Disease Process and Fistulas
Discharging tracts related to dental infec¬tions are quite commonly seen and it can be difficult to diagnose the primary source of the infection. As stated previously, there can be many variations from the normal scenario with dental fistulas, and a clear understanding of the structures of the head is a necessity when dealing with such cases. It is important to remember that not all abscesses located on the mandible, maxilla, and incisive bone are caused by dental infections. Diagnosis of the causative agent of the abscess is done by clinical exam, probing, and radiographs.
WHAT IS YOUR EVALUATION? BY KENDELL METCALF DVM & BRIANA J. BURGE
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Nasal drainage from 106
Upon initial examination, the reported swelling appears to originate from the api¬cal root of premolar 106. The mass is ex¬tremely painful when palpated. The area is firm to touch and heat is present. Mod¬erate, bilateral TMJ sensitivity is noted, as well as atrophy of the temporalis muscle. The mandible is deviated from the maxilla – a shift from right to left. The horse’s right eye suffers from excessive drainage and a corneal ulcer is found. Radiographs are requested for further diagnosis.
SPECIAL REPORT BY NICK MOORE DVM
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Clinical Anatomy of the Equine Parana¬sal Sinuses
The equine paranasal sinus complex is composed of an elaborate system of air filled cavities located within various bones of the skull. These structures are suscep¬tible to a wide range of disease processes and are therefore of significant importance to the equine dental practitioner. While the focus of this discussion will revolve around the relationship between dental and sinonasal disease, one must not lose sight of the fact that many non-dental related si¬ nus problems exist – these will be covered very briefly only to highlight their potential significance in sinonasal disorders.
CASE REPORT BY NICK MOORE DVM
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Rostral Maxillary Sinus Bridge
This is quite unusual, and explains why an upper eight apical caudal root infection would drain outside the maxillary sinus in such a young horse. Location of the rostral maxillary sinus in relationship to the last premolar varies with each individual. In young horses, the location of the sinus is normally more anterior and the position of the caudal upper eight alveous communi¬cates with the rostral maxillary sinus.
REPORT UPDATE BY B.W. FLETCHER DVM
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Severe Contamination of the Maxillary Sinuses
A 23-year-old Quarter horse gelding was presented with a swollen maxilla below the right eye with two purulent drain tracts. Information from the owners indicated that the swollen maxilla had been present for several years. The drainage from the fistulous tracts was copious and purulent, and had a very foul odor. An oral exam revealed that the 111 was missing and that an orosinus fistula was present in that location resulting in severe contamination of the maxillary sinuses with material from the oral cavity.
FINDINGS IN THE FIELD BY JOHN PETERS, DR. GRIMES, & BRIANA BURGE
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Nasal Discharge Caused from Premolars
Lateral radiographs reveal areas of radiolucency of the 106 and 206 apical roots. Metal plates and wire are also found throughout the maxilla, reportedly from an injury - now two years ago. It may be safe to assume the fractured maxilla is the cause of the infected, underdeveloped premolars.
HOW TO ARTICLE BY BERNARD FLETCHER DVM & NICK MOORE DVM
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Repulsion of Fragmented Cheek Teeth with a Steinmann Pin in the Standing Horse
The goal of this procedure is to minimize the time needed to remove fractured cheek teeth that would be almost impossible to extract orally. This technique allows for successful standing cheek-tooth repulsions with minimal surgical exposure and com¬plications, thus avoiding the added costs and risks associated with general anesthe¬sia. Light sedation and local anesthesia are all that is required to perform this procedure. In cases with large abscess formations and advanced sinus disease, a traditional sinus flap may still be indicated to help debride necrotic and infected tis¬sue, but using the Steinmann pin tech¬nique will allow for a much smaller communication with the oral cavity.
