Treatment of oromaxillary fistulae in nine standing horses (2002-2006).
Authors: Hawkes C S, Easley J, Barakzai S Z, Dixon P M
Journal: Equine veterinary journal
Summary
# Editorial Summary: Treatment of Oromaxillary Fistulae in Standing Horses Oromaxillary fistulae—abnormal communications between the oral cavity and paranasal sinuses—are rarely documented outside the context of cheek tooth extraction, yet older horses can develop these lesions through alternative pathways including diastemata, fractured teeth, and dental wear defects. Between 2002 and 2006, Hawkes and colleagues identified nine cases (median age 22 years) at two referral centres, with seven fistulae associated with cheek tooth diastemata, one with a fractured tooth, and one with a central wear defect. Following careful sinus lavage to remove impacted food and exudate, six cases achieved successful closure through polymethylmethacrylate (PMMA) sealing of the diastema or defect, whilst the remaining three cases requiring dental extraction were managed with PMMA alveolar packing—all nine horses treated successfully in the standing position. This work demonstrates that oromaxillary fistulae in the absence of apical infection respond well to conservative standing treatment focused on addressing the underlying dental pathology and securing the oral defect, shifting clinical management away from extraction-dependent approaches and highlighting the importance of diastemata assessment in aged horses presenting with sinusitis.
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Practical Takeaways
- •Older horses presenting with sinusitis should be systematically evaluated for cheek tooth diastemata and oromaxillary fistulae, as these may be causally related
- •Oromaxillary fistulae of non-apical origin can be successfully managed standing-sedated using conservative techniques (sinus lavage and PMMA sealing) without tooth extraction in most cases
- •PMMA is an effective material for sealing diastema defects or alveolar sockets in standing horses and avoids the complications associated with general anaesthesia in aged patients
Key Findings
- •Nine cases of oromaxillary fistula were identified in aged horses (median 22 years) between 2002-2006, predominantly associated with cheek tooth diastemata (7/9 cases)
- •Six cases were successfully treated in standing horses by removing sinus contents and sealing diastema or dental defect with polymethylmethacrylate (PMMA)
- •Three cases following dental extraction were successfully treated with PMMA alveolar packing
- •All cases were successfully treated in the standing horse without general anaesthesia when apical infection was absent