Oral Extraction and Nasal Retrieval of a Fragmented Maxillary Fourth Premolar Tooth in a Horse Using Endoscopic Guidance: A Case Report

Summary

# Editorial Summary A 9-year-old Warmblood mare presented with a 14-month history of purulent nasal discharge that was ultimately traced to a comminuted fracture of the left maxillary fourth premolar with secondary oronasal fistulation. Conventional oral extraction removed the primary crown, but fragmented root pieces remained inaccessible from the oral cavity; rather than pursuing extensive external surgical approaches, the clinicians employed endoscopic guidance to retrieve these fragments transnasally through the existing fistulous tract using bronchoesophageal forceps, followed by surgical debridement and alveolar occlusion with polyvinyl siloxane. This minimally invasive technique eliminated the need for more traumatic external approaches such as facial osteotomy, which carry higher risks of complications including facial nerve involvement and delayed healing. For equine practitioners managing complicated premolar fractures with secondary oronasal fistulae, this case demonstrates that careful diagnostic imaging and endoscopic guidance can enable fragment retrieval whilst preserving tissue integrity and reducing postoperative morbidity. The strategic approach to alveolar management—particularly the use of polyvinyl siloxane to prevent food impaction—offers a practical framework for similar cases where complete oral access proves impossible.

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Key Findings

• •Endoscopic-guided transnasal retrieval successfully removed inaccessible root fragments through an existing oronasal fistula in a 9-year-old mare
• •Minimally invasive combined oral and transnasal approach avoided need for extensive external surgical approaches
• •Polyvinyl siloxane occlusion of the alveolus prevented postoperative food contamination

Conditions Studied