Ceratohyoidectomy for Management of Unilateral and Bilateral Temporohyoid Osteoarthropathy: Long-Term Outcome in 33 Equids.

Overview

• This study examines the long-term outcomes of two surgical treatments—unilateral and bilateral ceratohyoidectomy—in horses affected by temporohyoid osteoarthropathy (THO), a condition causing neurological problems due to inflammation or degeneration of the temporohyoid joint.
• The research evaluates the effectiveness, complications, and return to work or improvement rates in 33 horses treated with these surgeries, providing insights into whether bilateral surgery offers benefits over unilateral surgery.

Background

• Temporohyoid Osteoarthropathy (THO): It is a progressive degenerative and inflammatory disease affecting the temporohyoid joint in horses.
• Neurological Implications: THO can lead to mild neurological signs impacting horse performance or severe acute neurological deficits such as facial nerve paralysis or vestibular dysfunction (balance issues).
• Diagnostic Advances: Traditionally, surgery was performed on one side (unilateral) based on clinical symptoms. However, improved imaging techniques have revealed that both sides (bilateral) can be affected, prompting re-evaluation of treatment strategies.

Study Objective

• To report findings, surgical complications, and long-term outcomes of unilateral versus bilateral ceratohyoidectomy procedures in a cohort of 33 equids diagnosed with THO.
• To assess whether bilateral surgery offers advantages over unilateral surgery in terms of clinical improvement and survival.

Methods

• Retrospective analysis of 33 horses diagnosed with THO undergoing either unilateral or bilateral ceratohyoidectomy.
• Evaluation of clinical signs reduction, post-surgical complications, survival rates, and return to previous levels of work/exercise.
• Statistical assessment of variables such as age, duration of clinical signs, and surgical method with outcomes.

Key Findings

• Survival: 84% of horses survived to long term after surgery.
• Improvement: 86% of treated cases showed clinical improvement.
• Complete Resolution: 38% of horses completely resolved clinical signs.
• Return to Work: 62% of horses returned to their previous levels of exercise.
• Work Level Adjustment: 77% returned to work at the same or a lower intensity level.
• Unilateral vs. Bilateral: No significant difference was found in outcomes between unilateral and bilateral ceratohyoidectomy procedures.
• Risk Factors: Older horses and those with longer duration of clinical signs before surgery had reduced likelihood of improvement or returning to work.

Clinical Implications

• Bilateral ceratohyoidectomy is a viable treatment option since it does not show inferior outcomes compared to unilateral surgery.
• Early diagnosis and intervention are important for optimizing recovery and return to function.
• Clinicians should consider both sides for surgical treatment due to the possibility of bilateral disease, especially as diagnostic imaging technologies improve.
• Age and duration of symptoms should be factored into prognosis and therapeutic planning, as they impact the chance of favorable outcomes.

Conclusion

• This study supports ceratohyoidectomy as an effective surgical treatment for managing temporohyoid osteoarthropathy in horses.
• Both unilateral and bilateral procedures yield comparable long-term outcomes, with most horses experiencing improvement and survival with return to work.
• Earlier treatment and considering bilateral disease extent may help improve surgical success.