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

Abstract

To report use of mandibular condylectomy for treatment of advanced degenerative joint disease of the temporomandibular joint (TMJ) caused by sepsis. Clinical case report. Two-year-old Noriker filly. Computed tomography (CT) was used to confirm advanced degenerative joint disease of the left TMJ and for follow-up after mandibular condylectomy and removal of necrotic meniscus. Painful swelling (3 weeks duration) with drainage located just caudal to the left lateral canthus of the eye was associated with atrophy of the left masseter muscle, masticatory problems, and inappetence. There was incisor malocclusion with a 1.4 cm resting lateral mandibular deviation to the right and inability to open the mouth more than a few centimeters. Left mandibular condylectomy combined with meniscectomy and thorough debridement of the septic left TMJ resulted in resolution of clinical signs and complete return of function. Streptococcus zooepidemicus, intermediately resistant to penicillin and subsequently to enrofloxacin, was isolated from the wound. Regeneration of a mandibular "pseudocondyle" was evident on CT at 4 months. At 4 months and 1 year the filly had maximal mouth opening >10 cm and no malocclusion. Mandibular condylectomy can be used to facilitate management of septic TMJ arthritis. There was no radiologic or clinical evidence of TMJ ankylosis >1 year after meniscal removal. Mandibular condylectomy, including meniscectomy, is an acceptable treatment option for advanced TMJ septic arthritis and allowed return of normal masticatory function.