Head and neck abscessation and thrombophlebitis following cheek tooth extraction in a pony

Abstract

Summary Due to their long hypsodont reserve crowns, extraction of equid cheek teeth can be difficult and result in more complications than the extraction of their shorter brachydont counterparts although the more recent resumption of oral extraction has greatly reduced such complications. The more common post‐extraction sequelae in equids include non‐healing alveoli due to retained dental or alveolar sequestrae which may lead to oromaxillary or oronasal fistula formation, chronic external sinus tract formation or osteomyelitis of the supporting bones. Collateral damage to adjacent teeth has also occasionally been reported during dental repulsion. Systemic complications following equine cheek tooth extraction have been infrequently described, including a small number of cases of exodontia‐related bacterial meningioencephalitis. This is surprising, as dental manipulation can lead to bacteraemia in many species, including horses. Infections at distant sites related to the spread of dental pathogens have been well described in humans and in small animals. This report describes deep abscessation of the masseter muscles followed by extensive thrombophlebitis of the jugular, facial and rostral cervical veins following oral cheek tooth extraction in a pony affected by pituitary pars intermedia dysfunction (PPID) that was successfully treated by abscess drainage and thrombectomy of the affected veins.

A long‐term study of equine cheek teeth post‐extraction complications: 428 cheek teeth (2004‐2018)

“…Painful nonhealing post extraction alveoli with areas of exposed dry, tan‐coloured alveolar bone, but without obvious alveolar infection occurred in two horses following oral extraction (n = 1) and Steinmann pin repulsion (n = 1) with quidding and bitting problems (n = 1), and quidding and swollen mandible (n = 1) present. These resembled ‘dry socket’ (alveolar osteitis) that occurs following brachydont exodontia, and recorded in a horse 13 . These lesions were initially diagnosed as sequestrated alveolar bone, but firm curettage showed the affected bone with a devitalised, discoloured alveolar ‘cortex’ to be fully attached to the underlying bones.…”

“…Because the most common post‐extraction problems managed by the authors including: alveolar sequestration with and without alveolar infection, alveolar infection with marked osteomyelitis of the supporting bones, retained dental fragments, ‘dry socket’ (alveolar osteitis) 13 and oro sinus/nasal fistulae (fistulae) were all associated with delayed or nonhealing of the alveolus, for statistical analyses these five disorders were combined together as a ‘non‐healing alveolus’ group. The low numbers of standard repulsions (n = 5) were combined with Steinmann pin repulsions (n = 41) for statistical analyses.…”

“…Due to the great length of equine cheek teeth reserve crowns (>9 cm long in younger horses), significant mechanical force is required for their exodontia that may also damage the alveolar and supporting maxillary and mandibular bones. Potential post‐extraction complications include delayed alveolar healing, including sequestration of alveolar bone with alveolar infection, osteomyelitis of the supporting bones, retention of dental fragments, persistent dental sinusitis, damage to adjacent teeth, adjacent soft tissue or bone damage and formation of oronasal, oro‐maxillary or oro‐cutaneous fistulae 3‐14 …”

Complications of Equine Cheek Teeth Extractions

“…The failure of dental sinusitis cases to resolve following exodontia may be related to one of the above described alveolar disorders, but is much more likely to be caused a residual sino-nasal problem (Dixon et al . 2019).…”

“…Such cases should have the affected alveolus examined and, if it contains sequestrae and/or is infected, or if it has a communication with the sinus, these disorders should be treated. However, the more likely causes for non-response of dental sinusitis are the presence of inspissated exudate or bone sequestrae in the affected sinuses or intercurrent nasal disease including nasal conchal bulla infections (Dixon et al . 2019(Dixon et al .…”