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Temporohyoid Osteoarthropathy / pharyngeal collapse - update

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  • Temporohyoid Osteoarthropathy / pharyngeal collapse - update

    Temporohyoid Osteoarthropathy (say this three times fast)

    Besides being a mouthful, it is a likely diagnosis for my mare, and I'm wondering if anyone has experience with this disorder. Here are a couple of links to articles for anyone who is curious about this.

    http://www.roodandriddle.com/news/my...thropathy.html
    http://www.thehorse.com/articles/296...opathy-studied

    Background: Horse has a history of refusal to take the bit and resisting any sort of poll flexion. Desperate training measures led to the discovery of a breathing abnormality (restricted airway) and exercise intolerance when ridden with poll flexion. This has grown worse over the past several months.

    She shows no neurological symptoms, except for very occasionally aspirating her food (but she is a little piggy, so that my explain that). Various veterinary exams led to a remote dynamic endoscopy last week, followed by endoscopy of the guttural pouches.

    The airway obstruction was found to be the result of pharyngeal collapse, for which there is no treatment. No big deal, because I can still ride her on a loose rein.

    The guttural pouch endoscopy revealed abnormalities on the right side, with the stylohyoid bone enlarged and covered with emphysema (not to be confused with empyema) and masses of emphysema throughout the guttural pouch. Basically these are gas bubbles throughout the tissue that look sort of like bubbly tumors. Speculation is a stylohyoid fracture.

    We also found low WBC count but no sign of infection anywhere (she did have a cold or flu back in October). We are treating with NSAIDs and antibiotics. Not sure what the next step is--probably another CBC and a follow-up endoscopy.

    If the diagnosis is correct, the recommendation is for a CT scan followed by ceratohyoidectomy. While medicating we are waiting for the full endoscopy report from the CSU vets. They find my mare very "interesting" -- I do not like when vets find things to be interesting...
    Last edited by LarkspurCO; Feb. 3, 2013, 01:39 AM.

  • #2
    Temporohyoid Osteoarthropathy - neurologic disorder characterized by acute onset of cranial nerve dysfunction with bony proliferation of the tempohyoid joint and proximal stylohyoid bone, ultimately leading to fusion of the tempohyoid bone. Fusing of this bone will predispose a horse to fracture along the base of the skull or the shaft of the stylohyoid bone and may be secondary to normal tongue and laryngeal movement.

    Treatment usually consists of relieving inflammation and eliminating infection caused by corneal ulcers - drugs often used are a combination of Bute and Trimethoprim sulfra. This treatment is showed to only benefit a small percentage of the affected horses.

    It is very painful for the horse, and very degenerative.

    Usual protocol is to euthanize after 6 months of treatment, if no clinical improvement is found.

    I'm sorry I can't bring you any satisfaction, and I can only imagine what a hard time this must be for you.

    Jingles*
    www.facebook.com/lusitanos4sale

    Comment

    • Original Poster

      #3
      Thank you for the feedback. Her condition is not at all dire at this point, with the only clear symptom being pharyngeal collapse. If the diagnosis is confirmed, the ceratohyoidectomy would help prevent future neurologic complications by relieving pressure on the temporohyoid joint. Or so they say.

      Comment


      • #4
        Sending jingles and prayers for your girl. I pray that the surgery will work for her. I am sorry that both of you are going through such a tough time.
        When in Doubt, let your horse do the Thinking!

        Comment


        • #5
          I have no idea but want to wish you both well and ask, what specific symptoms brought you to finding this once you began exploring her issues? Might be helpful for us all to make note. Hugs.
          "Kindness is free" ~ Eurofoal
          ---
          The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

          Comment

          • Original Poster

            #6
            Specifically, we were looking for an explanation for her loud breathing noise. We thought it might be roaring but my vet did a standing endoscopy and didn't see anything interesting.

            He then arranged the remote dynamic endoscopy with another client and the vets from CSU. I was going to take her in for a treadmill endoscopy but CSU had just acquired a dynamic respiratory scope, which is a much better tool. It is a special scope designed to be used while the horse is ridden or driven and is considered state-of-the art for diagnosing breathing abnormalities.

            The scope is made by Optomed:
            http://www.optomed.fr/article.php?rubrique=27

            After I rode her and they saw the pharyngeal collapse, the vets suggested scoping her guttural pouches to rule out abnormalities. That is when they found the weirdness in the right guttural pouch. They were actually very encouraged in that her symptoms are very mild. A follow-up endoscopy will help determine the next step. That will probably happen next month some time.

            Comment


            • #7
              Originally posted by SCMSL View Post
              Treatment usually consists of relieving inflammation and eliminating infection caused by corneal ulcers - drugs often used are a combination of Bute and Trimethoprim sulfra.
              Could you explain the link between corneal ulcers and THO? I would think inflammation caused by the ulcer would not be close enough to affect the temporohyoid joint.

              Comment


              • #8
                Of the options for my neurological mare, that would have been the preferable one.

                After surgery several vets said the outcome from TOP is very good. I ended up going down a much worse road. Wish you the best of luck for treatment and recovery!

                Comment

                • Original Poster

                  #9
                  Originally posted by Eventer13 View Post
                  Could you explain the link between corneal ulcers and THO? I would think inflammation caused by the ulcer would not be close enough to affect the temporohyoid joint.
                  It is the other way around. Facial paralysis leads to decreased tear production, which leads to corneal ulceration.

                  Comment

                  • Original Poster

                    #10
                    Originally posted by SendenHorse View Post
                    Of the options for my neurological mare, that would have been the preferable one.

                    After surgery several vets said the outcome from TOP is very good. I ended up going down a much worse road. Wish you the best of luck for treatment and recovery!
                    I'm sorry to hear that. What surgery did she have?

                    Comment


                    • #11
                      Thanks for sharing more of the details, you never know when you might need to know to look for something like that. FWIW, I had a client whose horse was diagnosed with it many years ago, before I met her.
                      "Kindness is free" ~ Eurofoal
                      ---
                      The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

                      Comment


                      • #12
                        Could you explain the link between corneal ulcers and THO? I would think inflammation caused by the ulcer would not be close enough to affect the temporohyoid joint.
                        Corneal ulcers are found in about 80% of horses with Temporohyoid Osteoarthropathy.
                        www.facebook.com/lusitanos4sale

                        Comment

                        • Original Poster

                          #13
                          The other thing I would add is that she travels with a slight head tilt, with her nose to her right side, and she is more resistant flexing her neck to the left than to the right.

                          A little more on how we got to this point...

                          Her resistance to contact and neck flexion never made sense, because she was so easy to train and is so willing to do anything else you ask her. She became so resistant that she would bear down against the bit -- any bit -- with all her strength to avoid the contact.

                          Last spring and summer I took her to two clinics with a trainer I highly respect, and at the end of those sessions the only thing we figured out was that for some reason she hated dressage, and the problem was with the horse and not with me.

                          After that, I decided to go back to riding her on a loose rein until I could figure it out. As her breathing problem became more noticeable and nothing turned up in a physical exam, I knew something more had to be going on.

                          Comment

                          • Original Poster

                            #14
                            Well I just heard from my vet who heard from CSU and they are wanting to rescope her soon while she is on the antibiotics and he says they are "very concerned" about her developing neurologic problems. Crap.

                            Comment


                            • #15
                              Well I just heard from my vet who heard from CSU and they are wanting to rescope her soon while she is on the antibiotics and he says they are "very concerned" about her developing neurologic problems. Crap.
                              Don't despair yet. These things are rarely straight forward and your mare may yet have another trick in the hat.

                              Keep up posted, and hope everything goes well with the scope!
                              www.facebook.com/lusitanos4sale

                              Comment


                              • #16
                                Thinking good thoughts for your girl.

                                And truly, thanks for sharing this info. We never can know who it might help.

                                Hang in there.
                                "Kindness is free" ~ Eurofoal
                                ---
                                The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

                                Comment


                                • #17
                                  I have a mare that has it. At the time she was diagnosed the surgery was fairly new and had a good chance of causing tongue paralysis so I didn't do it and chose to retire her instead. (the risk of skull fracture and resulting ataxia being key factor... that and the fact that she couldn't or wouldn't pick up the right lead and panicked if she thought I might ask.) She spent 6 months on antibiotics which cured the ear infection and facial paralysis and has been a pasture puff for almost 10 years.

                                  Comment

                                  • Original Poster

                                    #18
                                    I thought I would post a quick update on my mare.

                                    After a few weeks of antibiotics and NSAIDs, I took her to CSU for another scope and exam with the internal medicine doc.

                                    The condition of the guttural pouch has improved, and the doctor did not see any reason to biopsy one of the suspicious looking areas that was found on the first exam.

                                    The emphysema is still present but looks a little better, and the tissue underneath the bubbly areas looks healthy. The temporohyoid joint is now mobile, but the joint still appears somewhat abnormal -- it is covered with emphysema and difficult to see clearly.

                                    Enlarged lymph nodes in the throat, reluctance to flex at the poll and overall neck stiffness were observed. A head x-ray was taken to check for tumors -- normal.

                                    A rebreather test prompted a longer than normal recovery, but no abnormal lung sounds were detected.

                                    Cause of the pharyngeal collapse is still unknown.

                                    So...in the absence of anything to freak out about right now, we decided to take her off the meds and give her some more time. The plan is to put her back to work and rescope in a month to see if she improves. The doc also would like to have the resident chiropractor/acupuncturist examine her then.

                                    (All of this is fine with me because my other horse is going for a bone scan in two weeks.)

                                    Meanwhile, she seems to feel fine but is a little pissed off about no longer getting her her nightly medicine -- cup of sweet feed and applesauce with Uniprim and Previcox.

                                    I rode her today and she was her usual peppy self, happy to work in spite of the airway obstruction. As long as she can keep her head down with her throatlatch open she is happy. She canters with her head between her knees -- nice little rolling canter and not too bad to sit, for a horse standing on her head.

                                    Comment


                                    • #19
                                      I'm so happy for you Larkspur, glad she's feeling better!
                                      www.facebook.com/lusitanos4sale

                                      Comment


                                      • #20
                                        Such good news!!!!
                                        "Kindness is free" ~ Eurofoal
                                        ---
                                        The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

                                        Comment

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