Single-stage orthognathic correction of campylorrhinus lateralis in foals using transection and fixation: Surgical description and outcome of four horses.

Research Overview

• This study describes a single-stage surgical technique to correct a congenital facial deformity called campylorrhinus lateralis (wry nose) in foals and evaluates the long-term functional and cosmetic outcomes in four horses.

Background

• Campylorrhinus lateralis (wry nose): A rare congenital deformity characterized by lateral deviation of the nasal bones and maxilla, resulting in airway obstruction and severe malocclusion (class 4).
• Clinical significance: The condition causes respiratory difficulty and impairs normal feeding in affected foals.
• Existing treatments: Various surgical approaches have existed, but contemporary data on single-stage transection and fixation using bone grafts and the long-term results are limited.

Study Objective

• To describe the surgical technique involving transection and fixation, including rib grafting when required.
• To report complications and long-term outcomes in foals treated with this procedure.

Methods

• Study design: Retrospective case series involving four foals diagnosed with wry nose.
• Preoperative assessment:
  • Physical examination.
  • Oral examination to assess malocclusion.
  • Radiographic imaging and CT scans (when available) to evaluate bone deformities.
• Surgical procedure:
  • Temporary tracheostomy and laryngotomy to secure airway during surgery.
  • Resection of malformed nasal septum to facilitate correction.
  • Osteotomy (bone cutting) and fixation of nasal bones using plates and screws for stability.
  • Orthognathic transection and fixation of premaxilla and maxilla using pins and wires to realign jaw bones.
  • Bone grafting from rib performed in one case to support bone healing and structure.
  • Resection of alar folds (nose flaps) when indicated to improve airway patency.
• Follow-up: Minimum 12 months postoperative monitoring with clinical exams and owner feedback.

Results

• All four foals presented with respiratory distress due to the deformity.
• Successful stabilization was achieved:
  • Premaxillary bones stabilized with pins and wires.
  • Nasal bones stabilized with plates and screws.
  • Rib graft used in one horse to augment fixation.
• Complications observed:
  • All horses developed a plate-associated infection, a known risk in implants but manageable.
  • One horse developed an oronasal fistula (an abnormal connection between oral and nasal cavities).
• Long-term outcomes at follow-up:
  • All horses had improved respiratory function and no longer exhibited distress.
  • Normal grazing and mastication behaviors were restored.
  • Body condition was maintained well.
  • Three horses returned to their intended athletic activities.
  • All owners reported satisfaction with both functional and cosmetic results.

Conclusions and Implications

• This small case series demonstrates that a single-stage transection and fixation surgical approach can effectively correct wry nose in foals.
• Despite post-operative complications like infections, the overall functional outcomes were positive with restored airway patency and feeding ability.
• The use of bone fixation hardware and, in select cases, rib grafting, provided sufficient stability for healing and bone remodeling.
• Owners were consistently satisfied with the cosmetic appearance, indicating the procedure also addresses aesthetic concerns.
• Limitations include the small number of cases and retrospective study design, suggesting a need for further research to generalize findings.

Summary

• The study provides a detailed description of a surgical technique addressing a challenging congenital facial deformity in foals.
• The single-stage transection and fixation method offers a feasible solution that balances surgical complexity with recovery and long-term function.
• This research helps fill a gap in veterinary surgical literature regarding management and outcomes of wry nose using modern fixation techniques.