Mandibular Condylectomy and Meniscectomy for the Treatment of Septic Temporomandibular Joint Arthritis in a Horse

“…), luxations (Hurtig et al . ; Hardy and Shiroma ), and septic and nonseptic arthritis (Carmalt and Wilson ; Nagy and Simhofer ), rather than the more vague TMJ disorder.…”

Section: Can This Evidence Be Applied In My Case Population/clinical mentioning

confidence: 99%

TMJpathology: is it real?

Witte

2015

Equine Veterinary Education

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Clinical scenario: can poor athletic performance or behavioural problems, such as quidding, headshaking or dysphagia, be attributed to temporomandibular joint disorder (TMJ)? P (population) = adult horses with poor-/under-performance or behavioural problems and no other localising signs I (intervention/indicator) = clinical history and diagnostic testing (diagnostic imaging, arthrocentesis or intrasynovial anaesthesia, surgery) C (comparator/control) = N/A O (outcome) = diagnosis of poor performance attributable to the TMJ Search strategy Quantity of evidencePubMed result: 32 papers, including 12 single case reports or case series, 11 experimental studies of imaging (radiography, computed tomography, ultrasonography, magnetic resonance imaging), diagnostic (arthrocentesis) or surgical (arthroscopic) techniques (8 such studies used only cadaveric material, 7 used healthy live horses and 4 studies used both cadavers and live horses), 4 editorials or invited reviews, 2 experimental kinematic studies (1 technique validation and 1 measuring impact of dietary change), 2 studies of molecular biology (1 study of the correlation of TMJ cytokine profiles with dental pathology scores, and 1 of the cytokine response of TMJ compared to metarcarpophalangeal joints). Quality of the evidenceAn absence of systemic reviews, controlled clinical trials, case-control studies or large case series means that definitive evidence of TMJ disorder in horses is limited. This search used broad search terms, and only found mention of TMJ disorder amongst editorials and review articles. The experimental studies of diagnostic approaches are robust and provide good evidence for the benefits of advanced imaging modalities for this complex structure. Experimental evidence regarding the cytokine response in the TMJ indicates that this joint may show different cytokine dynamics to other diarthrodial joints (Carmalt et al. 2011), and does not definitively support the possibility of putative TMJ disorder contributing to the cluster of vague clinical signs listed. Dental pathology has been postulated as one cause of TMJ disorder; however, TMJ articular pro-inflammatory cytokine concentrations did not correlate with age and dental pathology score in one study (Carmalt et al. 2006). Can this evidence be applied in my case Clinical messageConfirmed reports of TMJ disorder in horses are absent, but this may be due to the diagnostic challenge that results from nonspecific signs. It is clear from this search that diagnostic techniques have progressed and should allow more specific diagnoses to be made. It is hoped that robust (multi-centre) case series will follow. Author's declaration of interestsNo conflicts of interests have been declared.

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“…Vor allem die knöchernen Strukturen können computertomographisch exzellent dargestellt werden (Morrow 2000, Rodríguez et al 2008 Die mandibuläre Kondylektomie wurde bereits Anfang des zwanzigsten Jahrhunderts beschrieben (Röder 1903). Sie wurde später auch an gesunden Pferden (Barber et al 1985), beim adulten Pferd mit Kiefergelenksarthrose (Merz et al 2006) und bei einem jungen Pferd mit akuter, septischer Kiefergelenksentzündung (Nagy und Simhofer 2006) bzw. mit einer Kiefergelenksankylose (Patterson et al 1989) durchgeführt.…”

Section: Abb 3 a Bunclassified

“…Als ursäch-lich wird der temporäre Stabilitätsverlust durch den chirurgischen Eingriff angesehen. Eine solche Deviation ist bei dem beschriebenen Trakehnerwallach und auch bei dem von Nagy und Simhofer (2006) …”

Section: Abb 3 a Bunclassified

Unilateral mandibular condylectomy in an adult warmblood gelding

Bienert‐Zeit¹,

Rötting²

2011

PHK

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EinleitungKiefergelenkserkrankungen werden beim Pferd selten beschrieben. Dies liegt möglicherweise an den diagnostischen Herausforderungen dieser anatomisch anspruchsvollen Region (Schumacher 2006). Septische, meist traumatisch bedingte Erkrankungen und Luxationen bzw. Subluxationen des Gelenkes werden genannt (Devine et al. 2005) und haben in der Regel einen akuten klinischen Verlauf. Aseptische Entzündungen des Kiefergelenkes und Arthrosen verlaufen eher schleichend und können mit Zahnerkrankungen vergesellschaftet sein (May 1996, Baker 2002, Merz et al. 2006. Im Folgenden wird der Fall einer aseptischen Kiefergelenksentzündung mit hochgradiger Arthrose und deren Untersuchung, Therapie und Verlauf geschildert. Nach Kenntnisstand der Autoren ist eine derartige Kiefergelenkserkrankung ohne Beteiligung der Zähne beim adulten Pferd noch nicht beschrieben. Unilateral mandibular condylectomy in an adult warmblood gelding A 17-year-old Trakehner gelding was admitted with poor general condition, profound weight-loss and masticatory problems. The horse was examined clinically, radiographically, ultrasonographically and with computed tomography. An advanced, degenerative arthrosis and aseptic infection of the right temporomandibular joint (TMJ) was diagnosed. Mandibular condylectomy, with the horse anesthetized, was performed successfully. The operation resulted in resolution of the clinical signs within a few days and complete return of masticatory function within two months. The incision healed by first intention. Six months postoperatively the gelding had regained to normal body weight and was being used for riding. In conclusion, mandibular condylectomy can be used for treatment of advanced aseptic arthrosis of the TMJ in horses with excellent longterm results. Kasuistik

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Mandibular Condylectomy and Meniscectomy for the Treatment of Septic Temporomandibular Joint Arthritis in a Horse

Abstract: Mandibular condylectomy, including meniscectomy, is an acceptable treatment option for advanced TMJ septic arthritis and allowed return of normal masticatory function.

Cited by 44 publications

References 22 publications

Does temporomandibular joint pathology affect performance in an equine athlete?

Does temporomandibular joint pathology affect performance in an equine athlete?

TMJpathology: is it real?

Unilateral mandibular condylectomy in an adult warmblood gelding

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