Safia Z. Barakzai

Summary: Background: A recent systematic review reported insufficient evidence to conclude on a preferred treatment for equine sarcoids. Diode laser excision of sarcoids is now one of the most common first‐line treatments in UK practices but there is limited evidence of its long‐term efficacy. Objectives: This study aimed to evaluate the overall recurrence rate of sarcoids, the recurrence rate at the site of surgical excision (SSE) and at different anatomical sites (DAS) after diode laser excision in clinical practice. Study Design: Retrospective case series. Methods: Medical records for horses that underwent surgical excision for clinically diagnosed sarcoid lesions using a diode laser between 2018 and 2023 by a single experienced ECVS diplomate were retrospectively reviewed. Horses that were already receiving additional sarcoid treatment at the time of surgery, histological exclusion of sarcoids or those that were unavailable for follow‐up were excluded. Signalment, lesion type, size and location, histology results, surgical complications, recurrence of sarcoid(s) at the SSE and at DAS and time of recurrence were recorded and analysed. Results: One hundred and twenty‐four horses with 218 lesions were included with a median follow‐up of 32 months [6.0–71.2]. The recurrence rate for an individual sarcoid at the SSE was low (6.4%), and the overall recurrence rate per horse (at least one recurrence anywhere) was 20.5%. Obtaining histological tumour‐free margins (TFM) was associated with a significant decrease in recurrence rate at SSE (0.0% vs. 11.5%, Fisher test: p = 0.01). Main Limitations: Retrospective study design, not all lesions were confirmed histologically. Conclusion: Diode laser removal is an effective treatment for equine sarcoids, with an overall low recurrence rate observed. Recurrence at the SSE was significantly reduced if TFM were obtained on the excised lesion. Careful selection of lesions and sufficient margins appear to be important for treatment success.

Summary: Background: The paracondylar process is of clinical interest due to its proximity to anatomical structures involved in vital functions. There are limited reports describing abnormalities affecting the paracondylar process (PCP), with traumatic fractures being the most prevalent pathology. Affected horses can present with a variety of signs including headshaking, facial paralysis and/or poor performance. In almost all cases reported in the literature to date, computed tomography has been used to diagnose a PCP fracture. Objectives: The aim of this study was to develop a radiographic technique for imaging the PCP, to determine the optimum radiographic projection angle and trial its use in standing sedated horses. Study design: Cadaveric‐simulated clinical case and pilot study conducted in 10 standing sedated horses. Methods: Three tangential radiographs of the left and right paracondylar processes at 5°, 15° and 20° to the transverse plane and 20° to the dorsal plane were obtained in 10 standing sedated horses. Three blinded observers independently ranked each of the three images for clarity of viewing the PCP. The radiographic projection allowed imaging of the ventral portion of the PCP while avoiding superimposition of other osseous structures. A simulated PCP fracture in a cadaver could be recognised using this technique. Results: The highest grades were obtained for radiographs with a 5° angle from the transverse plane, and the lowest grades were obtained for a 20° angle. Main limitations: Complex anatomy of the PCP with superimposition of osseous and soft tissue structures. Conclusions: The radiographic technique for the PCP can be safely performed in standing, sedated horses. It is suitable for implementation in general veterinary practice before considering referral for advanced imaging techniques in horses presenting with headshaking or facial paralysis.

Background: The paracondylar process is of clinical interest due to its proximity to anatomical structures involved in vital functions. There are limited reports describing abnormalities affecting the paracondylar process (PCP), with traumatic fractures being the most prevalent pathology. Affected horses can present with a variety of signs including headshaking, facial paralysis and/or poor performance. In almost all cases reported in the literature to date, computed tomography has been used to diagnose a PCP fracture. Objectives: The aim of this study was to develop a radiographic technique for imaging the PCP, to determine the optimum radiographic projection angle and trial its use in standing sedated horses. Study design: Pilot study conducted in 10 standing sedated horses. Methods: Three tangential radiographs of the left and right paracondylar processes at 5º, 15º and 20º to the transverse plane were obtained in 10 standing sedated horses. Three blinded observers independently ranked each of the three images for clarity of viewing the PCP. The radiographic projection allowed imaging of the ventral portion of the PCP while avoiding superimposition of other osseous structures. Results: The highest grades were obtained for radiographs with a 5º angle from the transverse plane, and the lowest grades were obtained for a 20º angle. Main limitations: Complex anatomy of the PCP with superimposition of osseous and soft tissue structures. Conclusions: The radiographic technique for the PCP can be safely performed in standing, sedated horses. It is suitable for implementation in general veterinary practice before considering referral for advanced imaging techniques in horses presenting with headshaking or facial paralysis.

Background: Reported complication rates after dental repulsion for equine exodontia are high (up to 80%), but repulsion methods have changed notably in the last 20 years. Objectives: Describe the outcome for 20 cases after dental repulsion using small diameter repulsion pins. Study design: Retrospective case series. Methods: Records of horses that underwent cheek tooth repulsion were reviewed (2014–2023). Inclusion criteria included: mandibular or maxillary cheek tooth extraction where oral extraction failed and repulsion was used to complete extraction, and where clinical follow up information was available. Repulsions were carried out under sedation with a regional nerve block or under a short general anaesthetic, using a small diameter repulsion pin (3–5 mm). Intra‐operative radiographs facilitated instrument placement. The alveolus was packed with polymethyl methacrylate post‐extraction. Horses were re‐examined at 4–6 weeks post‐operatively. Results: Twenty cases were included. Patients had a mean age of 10.3 years old (range 5–16 years). The majority (75%) of teeth had pre‐existing dental fractures. Maxillary ( n = 15) and mandibular cheek teeth ( n = 5) were all successfully repulsed, with 16 cases performed with the horse standing and 4 with the horse under general anaesthesia. Intra‐operative complications included damage to the mandibular bone ( n = 1). Short‐term complications ( n = 2) included superficial surgical site infection, and dehiscence of one sinus flap. Long‐term complications included the recurrence of sinusitis ( n = 1) and small intra‐alveolar fragments causing persistent bitting problems in another patient. Main limitations: Retrospective study design, small number of cases. Conclusions: When oral extraction fails, cheek tooth repulsion using small diameter repulsion pins is an effective extraction technique. The total intra‐ and post‐operative complication rate was 25%, which is comparable to previously published complication rates for repulsion using Steinmann pins and also those encountered after trans‐buccal screw extraction.

Background: There is no objective information reporting the effect of unilateral laser ventriculocordectomy (VeC) on arytenoid abduction or stability. Objectives: To evaluate arytenoid stability and abduction in horses with severe recurrent laryngeal neuropathy (RLN) before and after unilateral laser VeC. Study design : Prospective study in clinically affected client-owned horses. Methods: Sample size calculations indicated ≥7 horses were required. Horses with grade C or D exercising laryngeal function that underwent unilateral laser VeC were included. Exercising endoscopy was performed before and ≥6 weeks after left-sided laser VeC. Arytenoid stability at maximal exercise was calculated by measuring the left-to-right quotient angle ratio (LRQ) of the corniculate processes at the points of maximal arytenoid abduction (expiration) and maximal arytenoid collapse (inspiration). For each horse, means of measurements obtained for four breaths pre- and post-operatively were used for statistical analysis. Results: Eight horses were included: 5 grade C and 3 grade D laryngeal function. The difference in LRQ between inspiration and expiration was lower post-operatively (median 0.039; interquartile range [IQR] 0.032-0.047) compared to pre-operatively (median 0.158; IQR 0.083-0.249; p=0.01) confirming the left arytenoid was more stable following unilateral laser VeC. The degree of improvement was significantly greater for grade D horses compared to grade C horses (p=0.04). The LRQ measured on maximal abduction was also lower post-operatively (median 0.467; IQR 0.444-0.506) compared to pre-operatively (median 0.578; IQR 0.554-0.655; p=0.02) indicating the left arytenoid was less abducted following surgery. Main study limitations: The sample size was small, no racehorses were included and post-operative assessment was conducted at a variable time after surgery. Conclusion: Unilateral laser VeC in grade C and D RLN-affected horses results in slightly reduced left arytenoid abduction but increased arytenoid stability.

Background: There is no objective information reporting the effect of unilateral laser ventriculocordectomy (VeC) on arytenoid abduction or stability. Objectives: To evaluate arytenoid stability and abduction in horses with severe recurrent laryngeal neuropathy (RLN) before and after unilateral laser VeC. Study design: Prospective cohort. Methods: Eight horses with grade C or D exercising laryngeal function that underwent unilateral laser VeC were included. Exercising endoscopy was performed before and ≥6 weeks after left‐sided laser VeC. Arytenoid stability at maximal exercise was calculated by measuring the left‐to‐right quotient angle ratio (LRQ) of the corniculate processes at the points of maximal arytenoid abduction (expiration) and maximal arytenoid collapse (inspiration). For each horse, means of measurements obtained for four breaths pre‐ and post‐operatively were used for statistical analysis. Results: The difference in LRQ between inspiration and expiration was lower post‐operatively (median 0.039; interquartile range [IQR] 0.032–0.047) compared with pre‐operatively (median 0.158; IQR 0.083–0.249; p = 0.01) confirming the left arytenoid was more stable following unilateral laser VeC. The degree of improvement was significantly greater for grade D horses compared with grade C horses ( p = 0.04). The LRQ measured on maximal abduction was also lower post‐operatively (median 0.467; IQR 0.444–0.506) compared with pre‐operatively (median 0.578; IQR 0.554–0.655; p = 0.02) indicating the left arytenoid was less abducted following surgery. Main limitations: The sample size was small, no racehorses were included and post‐operative assessment was conducted at a variable time after surgery. Conclusion: Unilateral laser VeC in grade C and D RLN‐affected horses results in slightly reduced left arytenoid abduction but increased arytenoid stability.

Summary: Case 1, Guttural pouch tympany: An 8‐month‐old Arabian filly presented with a history of longstanding bilateral fluctuant parotid region swelling and acute onset dyspnoea, tachypnoea, inspiratory stridor and right mucopurulent nasal discharge. Endoscopy and drainage (mucopus from the right, air from the left) of the GPs resulted in temporary reduction in the bilateral parotid region swelling. Marked dyspnoea recurred 48 h later, with accompanying external GP distention. A diagnosis of bilateral (R > L) GP tympany with secondary guttural pouch empyema of the right GP was therefore made. An indwelling Foley catheter was positioned in the right GP, but the filly dislodged the catheter daily and after 5 days, surgery was performed. Case 2, Persistent guttural pouch empyema: An 18‐year‐old pony gelding had chondroids found in the right GP 6 months previously and was diagnosed with a ‘strangles’ ( Streptococcus equi var. equi ) infection. Over subsequent months, multiple medical and surgical treatments were attempted but empyema kept recurring. After 6 months, it became difficult to introduce an endoscope into the right pouch, due to stenosis of the auditory tube. A laser salpingopharyngostomy procedure was recommended. Both horses underwent endoscopically guided salpingopharyngeal fistulation in the midline dorsal nasopharyngeal recess using a diode laser under standing sedation after topical application of local anaesthetic. A fistula approximately 1.5 × 2 cm was created (Figure 1) and then the median septum between the left and right pouches was resected caudally with the laser creating a large fenestration between the two pouches. No complications of surgery occurred. In Case 1, external GP distension resolved immediately following surgery. Re‐examination at 6 weeks post‐operatively showed continued patency of the fistula and resolution of secondary empyema. The foal remained asymptomatic thereafter until it was lost to follow‐up. Case 2 had resolution of nasal discharge. A final follow‐up endoscopy 3 months post‐operatively revealed both pouches to be clear, and the salpingopharyngeal fistula to still be patent. Telephone follow‐up 6 months post‐surgery revealed that the pony had no recurrence of clinical signs.

Summary: Investigation of horses that continue to make noise or perform poorly after upper respiratory surgery is greatly enhanced by postoperative exercising endoscopy in most cases. This review paper discusses dynamic abnormalities of the equine upper respiratory tract that occur after the most commonly performed upper respiratory tract surgeries.

Background: There is little objective information concerning the intra‐ and post‐operative complications or the long‐term outcome of sinoscopic treatment of equine sinus disorders. Objectives: To document the long‐term outcome, including intra‐operative complications, reasons for treatment failure and other complications, in horses undergoing standing sinoscopic treatment of sinus disorders. Study design: Retrospective clinical study. Methods: Records of sinus disease cases presented to The University of Edinburgh Veterinary School between January 2012 and July 2019 were reviewed. Follow‐up information was obtained from clinical records and a telephone questionnaire. Results: Long‐term follow up for 155 cases treated sinoscopically showed that 108/155 (69.7%) fully responded to their initial treatment. Concurrent intranasal lesions were identified in 37.4% of cases. Sinusotomy was later required in 10 cases to improve surgical access or sinonasal drainage. Reasons for failure to fully respond to the initial treatment (n = 47) included: intra‐sinus bone sequestra (n = 9), inspissated exudate (n = 6) or insects (n = 2); similar material and/or infected conchal bullae in the middle meatus (n = 7); persistent oro‐maxillary fistulae (n = 4), misdiagnosed dental apical infections (n = 4); impaired sinonasal drainage (n = 4), progressive ethmoid haematoma regrowth (n = 3) and undiagnosed causes (n = 5). Further treatment of 43 of these cases (67% as outpatients) showed 34/43 cases fully responding to their second treatment. Only 4/155 cases (2.6%) required sinonasal fenestration. In the long term, 149/155 cases (96.1%) showed full and 2/155 cases (1.3%) showed partial improvement. Sinoscopy portal wound infection occurred in nine cases. Main limitations: The length of time between treatment and obtaining follow‐up information in some cases. Advances in knowledge and techniques over the duration of the study. Conclusions: Sinoscopic treatment is a minimally‐invasive technique causing minimal morbidity and was successful in 96.1% of cases. Meticulous care should be taken to ensure that bony sequestrae and inspissated exudate are fully removed from the sinuses and nasal cavity during sinoscopic treatments.

Summary: Background: Unilateral ventriculocordectomy (VeC) is frequently performed, yet objective studies in horses with naturally occurring recurrent laryngeal neuropathy (RLN) are few.Objectives: To evaluate respiratory noise and exercising overground endoscopy in horses with grade B and C laryngeal function, before and after unilateral laser VeC.Study design: Prospective study in clinically affected client‐owned horses.Methods: Exercising endoscopy was performed and concurrent respiratory noise was recorded. A left‐sided laser VeC was performed under standing sedation. Owners were asked to present the horse for re‐examination 6–8 weeks post‐operatively when exercising endoscopy and sound recordings were repeated. Exercising endoscopic findings were recorded, including the degree of arytenoid stability. Quantitative measurement of left‐to‐right quotient angle ratio (LRQ) and rima glottidis area ratio (RGA) were performed pre‐ and post‐operatively. Sound analysis was performed, and measurements of the energy change in F1, F2 and F3 formants between pre‐ and post‐operative recordings were made and statistically analysed.Results: Three grade B and seven grade C horses were included; 6/7grade C horses preoperatively had bilateral vocal fold collapse (VFC) and 5/7 had mild right‐sided medial deviation of the ary‐epiglottic fold (MDAF). Right VFC and MDAF was still present in these horses post‐operatively; grade B horses had no other endoscopic dynamic abnormalities post‐operatively. Sound analysis showed significant reduction in energy in formant F2 (P = 0.05) after surgery.Main limitations: The study sample size was small and multiple dynamic abnormalities made sound analysis challenging.Conclusions: RLN‐affected horses have reduction in sound levels in F2 after unilateral laser VeC. Continuing noise may be caused by other ongoing forms of dynamic obstruction in grade C horses. Unilateral VeC is useful for grade B horses based on endoscopic images. In grade C horses, bilateral VeC, right ary‐epiglottic fold resection ± laryngoplasty might be a better option than unilateral VeC alone. The Summary is available in Portuguese ‐ see Supporting Information