Extraction of cheek teeth using a lateral buccotomy approach in 114 horses (1999-2009)

Abstract

There are few published data regarding the success rates of cheek tooth (CT) removal by lateral buccotomy in the horse. A retrospective study of 114 horses admitted to 2 private equine referral hospitals over a 10 year period (1999-2009), which underwent CT removal via a lateral buccotomy. Hospital records were analysed and details including case details, presenting complaint and results of all diagnostic tests and surgical reports were documented. Information obtained during post operative reassessment was also available for analysis. Long-term follow-up information (>2 months) was obtained for 112 horses. Short-term complications (<2 months) occurred in 24/77 horses (31%) undergoing exodontia of the maxillary CT and 10/37 horses (27%) involving mandibular CT, with the majority arising from partial wound dehiscence and infection following 16 extractions (47%). All healed well by second intention. Other complications included both temporary (n = 6) and permanent (n = 3) facial nerve paralysis, myositis (n = 4) and the inadvertent establishment of an oroantral fistula (n = 4). One myositis case was subjected to euthanasia 24 h post operatively. Five horses had persistent sinusitis following surgery due to dental remnants (n = 2) and excessive packing material (n = 1) found in the sinuses. No inciting cause could be found in the remaining 2 horses. One further horse suffered a fatal cardiac arrest at induction of anaesthesia. Of all horses, 92% operated on had returned to their previous level of work after >2 months with no complications. Horses with CT removal by a lateral buccotomy have a reasonable prognosis for long-term outcome. Performing a lateral buccotomy is a justified treatment alternative for the surgical removal of equine CT following unsuccessful attempts by standing oral extraction, offering advantages over alternatives such as retropulsion, endodontic therapy and periapical curettage.