Extraction of cheek teeth using a lateral buccotomy approach in 114 horses (1999-2009).
Authors: O'Neill H D, Boussauw B, Bladon B M, Fraser B S
Journal: Equine veterinary journal
Summary
# Editorial Summary Between 1999 and 2009, O'Neill and colleagues reviewed 114 cases of cheek tooth extraction performed via lateral buccotomy at two private equine referral hospitals, documenting complications, healing outcomes and long-term performance using hospital records and follow-up data obtained more than two months post-operatively. Short-term complications occurred in roughly 29% of cases overall (34 of 114 horses), with wound dehiscence and infection being most common, though all resolved through secondary intention healing; other notable complications included temporary or permanent facial nerve paralysis (9 cases), myositis (4 cases), and oroantral fistulae (4 cases), with only one case requiring euthanasia and one fatal perioperative event. Despite these complications, 92% of horses returned to their previous level of work without ongoing issues beyond the two-month mark, with long-term follow-up available for 112 horses. This evidence supports lateral buccotomy as a justified surgical option for cheek tooth removal following failed conservative extraction attempts, particularly when weighed against alternative interventions such as retropulsion, endodontic therapy and periapical curettage. For practitioners managing horses with problematic cheek teeth, these findings suggest that referral for buccotomy may offer better long-term functional outcomes than some alternative approaches, though informed consent regarding the 27–31% short-term complication rate remains essential.
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Practical Takeaways
- •Lateral buccotomy is a viable surgical alternative for cheek tooth extraction when standing oral extraction has failed, with reasonable long-term success despite significant short-term complication risk
- •Expect wound complications in approximately 1 in 3 maxillary cases; most resolve with second-intention healing, but monitor closely for infection and dehiscence
- •Most horses (92%) return to work successfully after >2 months, making this a justified surgical option despite permanent complications occurring in a small percentage of cases
Key Findings
- •Short-term complication rate was 31% in maxillary extractions (24/77 horses) and 27% in mandibular extractions (10/37 horses), with majority from wound dehiscence and infection following 16 extractions (47%)
- •Permanent facial nerve paralysis occurred in 3 horses, temporary in 6 horses; 4 horses developed oroantral fistulae and 5 developed persistent sinusitis
- •92% of all operated horses returned to previous level of work after >2 months with no complications, indicating good long-term prognosis despite short-term complication rates