With King under standing sedation, Ludwig, assisted by intern veterinarian Antonio Beck Jr., removed the fragments of the fractured tooth, and the resulting cavity was flushed, dried, and packed with a dental impression material plug. King’s mouth was then carefully rinsed to remove any lingering debris. Ludwig and Beck then turned their attention to King’s sinuses.
When the sinusotomy was completed, an endoscope was passed through the opening into the left sinus, which revealed a scattered accumulation of purulent material. A sample of this material was collected for bacterial culture and sensitivity.
The Equine Medical Center’s in-house laboratory processed the sample by growing the bacteria to identify the specific organism causing King’s infection and to determine which antibiotics would be most effective in treating it.
The front portion of King’s largest paranasal sinus, which is associated with the roots of the upper cheek teeth, was found to be completely filled with hay and grain, and there was contamination of this feed material throughout the rest of the left side of King’s sinuses. The feed material was removed, and the sinuses were flushed with a sterile saline solution. Medical-grade Manuka honey was administered to the left-sided sinuses for antimicrobial purposes.
King’s surgical site was temporarily closed with staples to allow for continued access for future lavage, and a head bandage was applied before he was taken back to his stall.
During hospitalization, King was given antibiotics and received regular sinus lavages, which resulted in a gradual decrease in the amount of purulent material and accumulated feed within his sinuses and the associated fistula or infection tract.
After six days of hospitalization, King’s dental plug was removed, the area was gently debrided, and a new dental plug was fitted. King was ready to return home for continued care.
King recently visited the Equine Medical Center for a recheck appointment. Endoscopic evaluation of the site of the fractured tooth showed that the area was significantly healed. The dental plug was removed, and the area flushed, revealing healthy granulation tissue with a small fistula or tract in the center; a huge improvement since his hospitalization.
Although there was no obvious sign of nasal discharge, an endoscope was passed into King’s sinuses to check the healing progress. A thorough lavage with sterile saline was performed, and some debris was retrieved, which was suspected to be residual rather than an active infection.
Regular dental care should be an integral part of a horse’s general health program and should reflect the individual needs of each unique horse to ensure their long-term health and comfort. Identifying dental issues and treating them appropriately prevents serious health problems.
Ludwig has a special interest in soft tissue surgery and, in particular, the treatment of dental and sinus issues.
“Our ability to quickly diagnose these diseases with a combination of radiographs, CT scans, and endoscopy allows for targeted and specific surgical treatments, resulting in enhanced disease resolution and a faster recovery for our patients,” Ludwig said.
There are a multitude of different dental and sinus diseases that can affect horses, and Ludwig is happy to treat them all at the Equine Medical Center.
link