Arthrodesis of the Distal Interphalangeal Joint in a Horse Using Stainless Steel Baskets and Transarticular 4.5-mm Cortical Screws

The distal interphalangeal joint was successfully arthrodesed in a 7-monthold horse using two 13-mm stainless steel baskets that were packed with autogenous cancellous bone and held in place with transarticular 4.5-mm cortical screws. The baskets were placed midway between the extensor process of the distal phalanx and the collateral ligament on the corresponding side of the joint. The screws were directed from the abaxial side of the middle phalanx, axially and distally through the basket and across the joint space, into the distal phalanx. Bony fusion of the distal interphalangeal joint occurred through the region occupied by the baskets as well as through the central region of the joint. The horse was free of lameness at the walk in the operated limb from the fourth until the tenth postoperative month, at which time lameness recurred as a result of sepsis in the region of the lateral implant. An additional complication was the development of a carpus varus deformity in the contralateral forelimb, presumably as a result of stretching of the lateral collateral carpal ligaments from excessive weight-bearing coupled with an abnormal posture (tripod stance) during convalescence. The horse was euthanatized 10 months after the arthodesis procedure because of severe lameness associated with sepsis in the region of the lateral implant.

Arthrodesis of the distal interphalangeal joint can be accomplished by inserting perforated stainless steel baskets into the joint.

Modifications in the surgical approach to avoid complications of sepsis need to be made before this technique can be recommended for clinical application.

Although the horse did not survive long-term, presentation of this technique should prove useful to other investigators as they attempt to devise techniques to fuse the distal interphalangeal joint.

Results of plate fixation of type 1b olecranon fractures in 24 horses

REASONS FOR PERFORMING STUDY

Previous olecranon fracture reports contain a small proportion of type 1b fractures, with only a few repaired by tension band plate fixation.

OBJECTIVES

To evaluate subject details, history, clinical findings and outcome of type 1b olecranon fractures in a large group of horses treated by tension band plate fixation.

METHODS

Medical records of 77 horses diagnosed with an olecranon fracture were reviewed. Twenty-four horses (31%) were classified as having type 1b olecranon fractures. Clinical details and follow-up results (4-128 months post operatively) were recorded.

RESULTS

Treatment included open reduction and internal fixation using a narrow dynamic compression plate (n = 20), conservative therapy (n = 2) and euthanasia (n = 2). Long-term follow-up was available for 16 plated horses. Four were sound and in training and 9 were sound and performing athletically. Articular surface involvement, comminution, open status or removal of anconeal process fragments did not appear to affect prognosis or soundness.

CONCLUSIONS

Internal plate fixation provides an excellent prognosis for an animal capable of athletic performance.

POTENTIAL RELEVANCE

Describing tension band plate fixation and results offers a method of fracture repair that will improve the treatment and prognosis for type 1b olecranon fractures.

Results of plate fixation of type 5 olecranon fractures in 20 horses

REASONS FOR PERFORMING STUDY

Previous olecranon fracture reports contain a small proportion of type 5 fractures, mostly treated with conservative therapy.

OBJECTIVES

To evaluate the clinical details and outcome of type 5 olecranon fractures in a large group of horses treated by tension band plate fixation and to compare results with other treatment methods.

METHODS

Medical records of 97 cases, including 32 (33%) classified as type 5, were reviewed. Subject details, history, radiographic findings, treatment and follow-up results (2-146 months post operatively) were recorded.

RESULTS

Treatment included open reduction and internal fixation using a narrow or broad dynamic compression plate (n = 20), conservative therapy (n = 7) and euthanasia (n = 5). Long-term follow-up was available in 15 cases treated surgically, of which 2 were sound and in training, 11 sound and performing athletically and 2 unsound. Distal semilunar notch involvement, comminution or open status did not appear to affect prognosis.

CONCLUSIONS

Internal plate fixation provides an excellent prognosis for an animal to be capable of athletic performance.

POTENTIAL RELEVANCE

Describing tension band plate fixation and results offers a method of fracture repair that should improve treatment and prognosis for type 5 olecranon fractures.

Osteomyelitis of the sustentaculum tali in horses: 10 cases (1992-1998)

OBJECTIVE

To determine outcome of horses with osteomyelitis of the sustentaculum tali (ST), with or without associated tarsal sheath tenosynovitis, following surgical debridement and lavage.

DESIGN

Retrospective study.

ANIMALS

10 horses in which a diagnosis of osteomyelitis of the ST had been made on the basis of history, physical examination findings, and results of radiography.

PROCEDURE

Information on results of diagnostic testing, surgical findings, postoperative treatment, and short-term outcome was obtained from the medical records. Long-term follow-up information was obtained through reevaluation of horses at the teaching hospital and telephone conversations with referring veterinarians, owners, and trainers.

RESULTS

Treatment consisted of surgical debridement, intra- and postoperative lavage, and long-term antimicrobial and anti-inflammatory treatment. Eight horses had evidence of involvement of the tarsal sheath. One horse was euthanatized after surgery because of a lack of response to treatment; the other 9 were discharged from the hospital. Severity of lameness had improved, but all still had grade-1 or -2 lameness at the time of discharge. One horse was euthanatized after discharge because of contralateral hind limb laminitis, and another horse was lost to follow-up. Of the remaining 7 horses, 6 returned to their previous use, and 1 was sound but retired for breeding for unrelated reasons.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that horses with osteomyelitis of the ST, with or without concomitant tarsal sheath tenosynovitis, can have an excellent to good outcome and may return to their previous use after surgical debridement of affected tissues and lavage of the tarsal sheath.

Osteitis of the axial border of the proximal sesamoid bones in horses: eight cases (1993-1999)

OBJECTIVE

To determine clinical, radiographic, and scintigraphic abnormalities in and outcome of horses with septic or nonseptic osteitis of the axial border of the proximal sesamoid bones.

DESIGN

Retrospective study.

ANIMALS

8 horses.

PROCEDURE

Data collected from medical records included signalment; history; horse use; severity and duration of lameness; results of perineural anesthesia, radiography, ultrasonography, and scintigraphy; and outcome following surgery.

RESULTS

Five horses did not have any evidence of sepsis; the other 3 had sepsis of the metacarpophalangeal or metatarsophalangeal joint or the digital synovial sheath. All horses had a history of chronic unilateral lameness. Three of 5 horses improved after diagnostic anesthesia of the metacarpophalangeal or metatarsophalangeal joint; the other 2 improved only after diagnostic anesthesia of the digital synovial sheath. Nuclear scintigraphy was beneficial in localizing the source of the lameness to the proximal sesamoid bones in 4 horses. Arthroscopy of the palmar or plantar pouch of the joint or of the digital synovial sheath revealed intersesamoidean ligament damage and osteomalacia of the axial border of the proximal sesamoid bones in all horses. All 5 horses without sepsis and 1 horse with sepsis returned to their previous uses.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that osteitis of the axial border of the proximal sesamoid bones is a distinct entity in horses that typically is associated with inflammation of the associated metacarpointersesamoidean or metatarsointersesamoidean ligament and may be a result of sepsis or nonseptic inflammation. Arthroscopic debridement may allow horses without evidence of sepsis to return to their previous level of performance.

Treatment response and athletic outcome of foals with tarsal valgus deformities: 39 cases (1988-1997)

OBJECTIVE

To evaluate the response to various treatments and long-term outcome of foals with tarsal valgus deformities.

DESIGN

Retrospective study.

ANIMALS

39 foals with tarsal valgus deformities.

PROCEDURE

Data collected from medical records, included signalment, history, reason for admission, and clinical findings. Radiographic views of the tarsus were evaluated for incomplete ossification of tarsal bones and were classified as normal in appearance, type-I incomplete ossification, or type-II incomplete ossification. Treatment and athletic outcome were documented for each foal.

RESULTS

Radiographic assessment revealed that 22 of 39 foals (56%) had concomitant tarsal valgus deformities and incomplete ossification of the tarsal bones. Eight of 19 foals with tarsal valgus deformities that were treated with periosteal stripping responded favorably. Foals < or = 60 days old were significantly more likely to respond to periosteal stripping than older foals. Five of 8 foals with tarsal valgus deformities that were treated with growth plate retardation responded favorably. Eleven of 21 foals with long-term follow-up performed as intended. Compared with foals with type-II incomplete ossification, foals with tarsal bones that had a normal radiographic appearance or type-I incomplete ossification were significantly more likely to perform as intended.

CONCLUSIONS AND CLINICAL RELEVANCE

Foals with tarsal valgus deformities should have lateromedial radiographic views of the tarsus obtained to assess the tarsal bones for incomplete ossification, which will affect athletic outcome. Because foals with type-II incomplete ossification of the tarsal bones respond poorly to periosteal stripping alone, treatment by growth-plate retardation is recommended.

Nonsurgical treatment of suprascapular nerve injury in horses: 8 cases (1988-1998)

OBJECTIVE

To determine the outcome of horses with suprascapular nerve injury treated with stall rest alone.

DESIGN

Retrospective case series.

ANIMALS

8 horses.

PROCEDURE

Information on signalment, history, limbs affected, severity of lameness, degree of muscle atrophy, gait abnormalities, and results of radiography and electromyography was obtained from medical records. All horses were treated with stall rest. Follow-up information on severity of lameness, gait abnormalities, degree of muscle atrophy, time between injury and resolution of gait abnormalities, and outcome was obtained during reexamination at the hospital or through telephone conversations with owners.

RESULTS

In 4 horses, the injury was a result of trauma; in the other 4, the injury was suspected to be a result of trauma. All horses had pronounced instability of the shoulder joint during the weight-bearing phase. Follow-up information was available for 7 horses. Shoulder joint instability resolved in all 7 horses within 3 to 12 months (mean, 7.4 months) after the original injury. Two horses had complete return of the supraspinatus and infraspinatus muscle mass 15 and 18 months after the injury. Two horses used as broodmares before the injury and 4 of 5 horses used for riding or in race training before the injury were able to return to preinjury activities.

CLINICAL IMPLICATIONS

Horses with suprascapular nerve injury treated with stall rest alone have a good prognosis for recovery of normal gait and return to performance; however, the recovery period may be prolonged.

Deep digital flexor tenotomy as a treatment for chronic laminitis in horses: 35 cases (1988-1997)

OBJECTIVE

To determine long-term prognosis for horses with laminitis treated by deep digital flexor (DDF) tenotomy and to identify factors affecting success of the surgical procedure.

DESIGN

Retrospective study.

ANIMALS

35 horses with laminitis treated by DDF tenotomy between 1988 and 1997.

PROCEDURE

Information was obtained from individual medical records and follow-up telephone interviews with owners and referring veterinarians. Cumulative proportions of horses that survived 6 months and 2 years after tenotomy were determined. Effect of Obel grade of lameness on 6-month and 2-year survival and effect of distal phalangeal rotation on survival and future performance were evaluated by chi 2 analysis. Body weights of horses that survived > or = 2 years were compared with those of horses that survived < 2 years by ANOVA.

RESULTS

27 of the 35 (77%) horses survived > or = 6 months, and 19 of 32 (59%) survived > 2 years. Obel grade of lameness and body weight at time of surgery had no effect on 6-month or 2-year survival. Degree of distal phalangeal rotation had no effect on 2-year survival or the ability of horses to be used for light riding. Twenty-two of the 30 (73%) owners interviewed indicated they would have the procedure repeated on their horses given similar circumstances.

CLINICAL IMPLICATIONS

DDF tenotomy is a viable alternative for horses with laminitis refractory to conventional medical treatment. In some instances, the procedure may be effective in returning horses to light athletic use.

Incomplete ossification of the tarsal bones in foals: 22 cases (1988-1996)

OBJECTIVE

To determine outcome for foals with incomplete ossification of the tarsal bones and to determine whether clinical and radiographic abnormalities at the time of initial examination were associated with outcome.

DESIGN

Retrospective study.

ANIMALS

22 foals.

PROCEDURE

Information on signalment, history, owner's initial complaint, clinical findings, whether tarsus valgus was evident, and radiographic abnormalities was obtained from medical records. Radiographic lesions were classified as type I (i.e., incomplete ossification with < 30% collapse of the affected bones) or type II (incomplete ossification with > 30% collapse and pinching or fragmentation of the affected bones). Follow-up information was obtained via telephone conversations with owners.

RESULTS

Foals were between 1 day and 10 months old when first examined. Eleven were premature (i.e., < 320 days of gestation) or were twins. Sixteen had tarsus valgus. Severity of radiographic lesions was associated with outcome; 4 of 6 foals with type-I incomplete ossification of the tarsal bones performed as intended, but only 3 of 16 foals with type-II incomplete ossification of the tarsal bones performed as intended.

CLINICAL IMPLICATIONS

For foals with incomplete ossification of the tarsal bones, severity of the radiographic lesions was associated with outcome. Foals with type-II incomplete ossification of the tarsal bones have a guarded prognosis for athletic soundness.

Traumatic dental disease and soft tissue injuries of the oral cavity

Trauma to the oral cavity can result in an array of injuries affecting teeth, bone, and soft tissue. A thorough examination of the oral cavity is often facilitated by employing a full-mouth speculum after the horse has been tranquilized. Identification of broken, loose, or split teeth; fractures of the premaxilla or mandible; and avulsion or laceration of soft tissue structures such as the lips or tongue is usually straightforward. Treatment options vary depending on the structure involved; however, appropriate treatment generally results in a functional and cosmetically acceptable end result.

Evaluation of postoperative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions

OBJECTIVE

To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.

STUDY DESIGN

Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.

ANIMALS OR SAMPLE POPULATION

12 horses.

METHODS

Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.

RESULTS

All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less (P < .0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.

CONCLUSIONS

Peritoneal lavage reduced the frequency of intraabdominal adhesions.

CLINICAL RELEVANCE

When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.

Surgical treatment of subchondral cystic lesions of the third metacarpal bone: results in 15 horses (1986-1994)

Subchondral cystic lesions (SCLs) in the condyle of the third metacarpal bone (MCIII) were surgically treated in 15 horses. The median age at presentation was 18 months (range 10 months-12 years) with 10 of 15 horses less than age 2 years. The SCLs were confined to the front limbs in all cases with 2 horses having bilateral lesions. Lesions were isolated to the medial condyle(s) of MCIII in 13 of 15 horses; a cystic lesion occurred in the lateral condyle in one horse and in the sagittal ridge in one horse. One horse with bilateral lesions had an additional cystic lesion located in the right medial femoral condyle. Fourteen of 15 horses had a history of moderate lameness attributable to the metacarpophalangeal joint; the lesion was an incidental finding in one horse. Duration of lameness ranged from 4 weeks to 8 months and was either acute in onset, or occurred intermittently and was associated with exercise. Fetlock flexion significantly exacerbated the lameness in all cases. Synovial effusion was absent in 8 (53%) cases. Cystic lesions were curetted arthroscopically in 12 horses, and through a dorsal pouch arthrotomy in 3 horses. Concurrent osteostixis of the cystic cavity was performed in 7 horses. Two horses were treated arthroscopically for osteochondral fragmentation of the proximodorsal aspect of the proximal phalanx one year following surgical curettage of the SCL. Twelve of 15 horses (80%) were sound for intended use following surgical treatment. Two horses did not regain soundness and follow-up information was unavailable for one horse. Total period of follow-up was 1-6 years. Follow-up radiographic examinations were available for 9 horses. Mild periarticular osteophyte formation and enthesiophyte formation at the dorsal joint capsular attachments was present in 5 of the 9 horses. Bony ingrowth of the cystic lesion was detectable in 8 horses and enlargement of the cystic cavity was observed in one horse. Based on the information gained from this study, it would appear that surgical treatment of SCLs in the distal metacarpus can result in a favourable outcome for athletic use.

Effects of postoperative peritoneal lavage on pharmacokinetics of gentamicin in horses after celiotomy

OBJECTIVE

To evaluate the effect of peritoneal lavage on pharmacokinetics of gentamicin sulfate in healthy horses after experimental celiotomy.

ANIMALS

13 clinically normal horses.

PROCEDURE

Horses were randomly assigned to control or experimental groups. All horses received gentamicin (6.6 mg/kg of body weight, IV, q 24 h) before surgery, underwent experimental abdominal surgery, and had abdominal drains placed percutaneously. Horses of the experimental group received postoperative peritoneal lavage; horses of the control group did not receive peritoneal lavage. The day after surgery, 24 hours after the preoperative dose of gentamicin, a second dose of gentamicin was administered. Three and 15 hours after this second dose of gentamicin, horses of the experimental group received peritoneal lavage. Venous blood was obtained, for determination of concentration of gentamicin, immediately before and at specified intervals during the 24-hour period after the second dose of gentamicin.

RESULTS

There were no differences in any of the pharmacokinetic values of gentamicin between horses of the control and experimental groups.

CONCLUSIONS

Peritoneal lavage had no effect on pharmacokinetics of gentamicin in healthy horses after abdominal surgery, in which localized nonseptic peritonitis was induced.

CLINICAL RELEVANCE

Peritoneal lavage in horses with localized nonseptic peritonitis or for the prevention of intra-abdominal adhesions should not necessitate alteration of the dosage of gentamicin to maintain predictable serum concentrations.

Racing-related factors and results of prerace physical inspection and their association with musculoskeletal injuries incurred in thoroughbreds during races

OBJECTIVE

To describe and compare data from Thoroughbreds that sustained musculoskeletal injuries while racing with data from matched control horses.

DESIGN

Matched case-control study.

ANIMALS

216 Thoroughbreds that sustained a musculoskeletal injury while racing and 532 horses from the same races that were not injured.

PROCEDURE

Data regarding racing history, race-entrant characteristics, racing events determined by analysis of videotapes of races, and results of prerace physical inspections were determined for all horses. Injured horses were compared with control horses by using conditional logistic regression.

RESULTS

Results of prerace inspection by regulatory veterinarians were significantly associated with injury. Odds of musculoskeletal injury, injury of the suspensory apparatus of the forelimb, and injury of the tendon of the superficial digital flexor muscle of the forelimb were 5.5 to 13.5 times greater among horses assessed to be at increased risk of injury by regulatory veterinarians on the basis of results of prerace inspection than for horses not considered to be at increased risk of injury. Odds of an abnormal finding in the suspensory ligament during prerace inspection were 3.4 times greater among horses that injured the suspensory apparatus than among control horses, and odds of an abnormal finding in the tendon of the superficial digital flexor muscle during prerace inspection were 15 times greater among horses that injured the tendon than among control horses.

CLINICAL IMPLICATIONS

Regulatory veterinarians can identify horses during prerace physical inspection that have an increased risk of injury during races. Prerace physical inspections could be used to reduce the risk of injury to Thoroughbreds during races.

Evaluation of skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses

OBJECTIVE

This study evaluates skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses.

STUDY DESIGN

The hair over one midcarpal joint and one distal interphalangeal joint on each horse was clipped. The contralateral joint served as the nonclipped comparison.

ANIMALS OR SAMPLE POPULATION

Twelve adult horses.

METHODS

A prescrub sample for microbial culture was taken from the dorsal surface of all four joints for each horse. Each site was aseptically prepared with povidone iodine and 70% alcohol, followed by postscrub sampling for microbial culture. Colony forming units (CFUs) were determined for each sample, 24 hours after inoculation of blood agar plates.

RESULTS

There was no significant difference (P > .05) in number of postscrub CFUs between clipped and nonclipped skin over the midcarpal or distal interphalangeal joints. Percent bacterial reduction (mean +/- SD%) after aseptic preparation differed significantly (P = .02) between clipped (99.8 +/- .003%) and nonclipped (96.2 +/- .05%) skin at the midcarpal joint, but not at the distal interphalangeal joint (clipped, 98.5 +/- .03% and nonclipped, 97.8 +/- 0.21%). There was a significant difference (P = .009) in number of prescrub CFUs obtained from clipped and nonclipped skin for the midcarpal joint. There was no significant difference in number of prescrub CFUs between clipped and nonclipped skin at the distal interphalangeal joint. Bacteria isolated from both clipped and nonclipped skin sampled postscrub included Bacillus sp, nonhemolytic Staphylococcus sp, and Micrococcus sp.

CONCLUSIONS

The presence of hair over the midcarpal and distal interphalangeal joints does not appear to inhibit the ability of antiseptics to effectively reduce bacterial flora to an acceptable level for arthrocentesis.

CLINICAL RELEVANCE

Aseptic preparation of the skin over the midcarpal and distal interphalangeal joints can be accomplished without hair removal in horses.

Risk factors for wound infection following celiotomy in horses

OBJECTIVE

To determine the prevalence of wound infection following celiotomy in horses and to determine risk factors associated with the development of such infections.

DESIGN

Prospective study.

ANIMALS

210 horses that had 235 celiotomies.

PROCEDURE

All horses that had celiotomies between March 1990 and March 1992 were considered for this study. Only horses that survived > or = 10 days after surgery were included in analysis of risk factors for postoperative wound infection.

RESULTS

Of the 210 horses, 161 (76.7%) were discharged; of the horses discharged, 147 horses had a single celiotomy and 14 had multiple celiotomies. Twenty-six (12.4%) horses were euthanatized during surgery and were, therefore, excluded from further analysis. Twenty-three horses died during the postoperative period. Of these 23 horses, 15 that died within 10 days of surgery also were excluded from further analysis. Thus, 169 horses were included in the analysis of risk factors for developing incisional infection. Evidence of incisional infection was observed in 43 of 169 (25.4%) horses. Increased concentration of fibrinogen in peritoneal fluid obtained prior to surgery, performing an enterotomy, and use of polyglactin 910 to close the linea alba were all significantly (P < or = 0.05) associated with increased risk of postoperative wound infection. Whether incisional herniation developed was recorded for 76 horses. The proportion of horses with hernias among those with postoperative wound infection was 19.1%, compared with 3.6% of horses without evidence of postoperative wound infection, indicating a significant association between postoperative wound infection and development of incisional hernias.

CLINICAL IMPLICATIONS

Increased concentration of fibrinogen in peritoneal fluid prior to surgery, performing an enterotomy, and use of polyglactin 910 to close the linea alba is significantly associated with increased risk for wound infection following celiotomy in horses.

Risk factors associated with development of diarrhea in horses after celiotomy for colic: 190 cases (1990-1994)

OBJECTIVE

To determine the incidence of the risk factors for developing diarrhea in horses after celiotomy for colic.

DESIGN

Retrospective cohort study.

ANIMALS

357 adult horses that had celiotomy for colic at the teaching hospital between Jan 1, 1990 and Sep 1, 1994.

PROCEDURE

Medical records of horses that had celiotomy for colic were reviewed to abstract information regarding development of diarrhea, signalment, history, and treatment.

RESULTS

In horses that had celiotomy for colic, the incidence of diarrhea was 53.2% (190/357). Using multiple logistic regression, horses with a disorder of the large intestine were approximately twice as likely to develop diarrhea after celiotomy as horses that had surgery for other types of intestinal lesions (P < 0.001). Even after accounting for the effects of large intestinal surgery, horses that also had an enterotomy were approximately 1.5 times as likely to develop diarrhea (P = 0.042). Diarrhea in horses associated with duration > 2 days, isolation of Salmonella spp from feces, or leukopenia was categorized as being severe. Incidence of severe diarrhea was 27.5% (98/357). Using multiple logistic regression, horses that had surgery of the large intestine were approximately 2.5 times as likely to develop severe diarrhea after celiotomy as horses that had surgery for other types of intestinal lesions (P = 0.006). In horses that had celiotomy for colic, those that were fed grass hay were approximately half as likely to develop severe diarrhea as were horses that were not fed grass hay (P = 0.018).

CLINICAL IMPLICATIONS

Although the risk factors identified for the development of diarrhea are not alterable, knowledge of them will enable clinicians to better advise clients and to better prepare for medical management of horses after surgery.

Viability of split-thickness skin grafts attached with fibrin glue

Full-thickness, circular, cutaneous wounds (4 cm diameter) were created on metacarpi and metatarsi of 5 horses. On day 6, all 4 wounds on each horse received a stored autogenous split-thickness sheet graft. Grafts were obtained from the horse's ventrolateral thorax with a pneumatic dermatome at the time the cutaneous wounds were created. Grafts were coapted to the granulation bed of 2 wounds of each horse with fibrin glue. Grafts were coapted to the cutaneous margin of all 4 wounds of each horse with cyanoacrylate glue. Bandages were changed daily until the study ended at 14 d. When the bandages were changed, ointment containing neomycin, polymyxin B, and bacitracin was applied to all wounds. The viable area of graft was measured on post-grafting d 14 and calculated with a micro-processor. Split-thickness sheet-grafts attached to granulation beds on the metacarpi and metatarsi with fibrin glue had no greater survival than did grafts attached without fibrin glue (P > 0.05).

Permanent tracheostomy in standing horses: technique and results

Permanent tracheal stomas were created in seven sedated, standing horses with severe upper airway obstruction. After local anesthesia, a 3-cm by 6-cm rectangle of skin was removed from the ventral surface of the neck, 3 cm distal to the cricoid cartilage. The sternothyrohyoideus muscles were clamped proximally and distally, then transected to expose the tracheal rings. The ventral third of four tracheal rings was dissected from the tracheal mucosa that was then incised in a double "Y." Two layers of suture were used to achieve mucocutaneous closure. Stomas healed without serious complications; two mares subsequently foaled, and three horses were used for riding.

Use of autogenous cancellous bone grafting in the treatment of septic navicular bursitis and distal sesamoid osteomyelitis in horses

Six horses with septic navicular bursitis or distal sesamoid osteomyelitis were treated by means of surgical debridement and lavage, followed by packing of the wound created in the bottom of the foot with an autogenous cancellous bone graft. Two horses were euthanatized, one 18 months after surgery because of complications in the contralateral support limb, and one 68 days after surgery because of continuing severe lameness. Four horses were alive 9, 16, 21, and 42 months after surgery. One horse was used as a broodmare and did not have observable lameness. Two horses were being ridden. The remaining horse had improved markedly, but was still lame. It appears that cancellous bone grafts can be used successfully, in conjunction with debridement and antimicrobial treatment, in horses with septic navicular bursitis and distal sesamoid osteomyelitis.

Treatment of olecranon bursitis in horses: 10 cases (1986-1993)

Medical records of 10 horses with olecranon bursitis were reviewed to examine treatments, evaluate a technique for en bloc resection of the bursa in standing horses, and determine outcome of the horses after treatment. Before admission, 6 horses had been treated by needle aspiration of fluid from the mass, followed by injection of corticosteroids. Subsequent treatment for 2 of these 6 horses included open drainage and packing of the cavity with gauze soaked in 7% iodine solution. None resolved after these treatments. After admission to the hospital, 5 horses were treated medically and 5 were treated by en bloc resection of the bursa. One horse that had received intralesional injection of a radionuclide was lost to follow-up evaluation. One horse treated conservatively by open drainage and packing and 1 treated by injection of a radionuclide had resolution of the olecranon bursitis. Only 1 of these 2 horses had a cosmetic result. The acquired bursae decreased in size in 2 horses (1 treated with a corticosteroid and 1 with orgotein), but were still visible 7 and 46 months after treatment, respectively. The surgery site of 4 horses that were treated by en bloc resection healed by primary intention, and the owners of these horses were pleased with the cosmetic results. The suture line of 1 horse dehisced 5 days after surgery. Proliferative granulation tissue was removed on 2 occasions, and the site healed by second intention after 2 months. A small knot and some white hair remained at the surgery site.

Case-control study of the association between various management factors and development of colic in horses. Texas Equine Colic Study Group

The association between various management factors and development of colic was studied in 821 horses treated for colic and 821 control horses treated for noncolic emergencies by practicing veterinarians in Texas between Oct 1, 1991 and Dec 31, 1992. History of previous colic and history of previous abdominal surgery were found to be significantly associated with colic. Change in stabling conditions during the 2 weeks prior to the time of examination, recent change in diet, and recent change in level of activity significantly increased the risk for development of colic. Changes in activity level, diet, and stabling conditions were identified as potentially alterable risk factors for colic. Logistic regression was used to adjust for the effects of all variables found to be significantly associated with colic by means of univariate analysis, and only history of previous colic, history of previous abdominal surgery, and history of recent change in diet remained significantly associated with colic. Results of this study indicate that a proportion of colic cases might be prevented by minimizing changes in management practices.

Digital flexor tendon lacerations in horses: 50 cases (1975-1990)

The medical records of 50 horses examined because of lacerations of the tendon of the superficial or deep digital flexor muscle were reviewed to determine whether any injury or treatment factors could be associated with outcome. Median age of horses treated was 4.5 years (range, 1.5 years to 15 years), and the median follow-up time was 5 years (range, 1.5 to 16 years) after injury. Horses were considered to have survived if they were alive more than 1 year after injury. Twelve of 16 horses that had 1 or the other tendon transected survived; 13 of 16 horses that had both tendons transected survived; and 14 of 18 horses that had partial tendon disruptions of 1 or both tendons survived. Of the 39 surviving horses, 27 horses returned to their original use, and 32 horses were sound for riding. Nine horses with 1 or both tendons transected were being used for athletic activities. Lacerated tendons were sutured in 16 horses, and 15 of these survived. Tendons were not sutured in 34 horses, and 24 of these survived. We were not able to detect any association between outcome and tendon sheath involvement or between outcome and limb involvement (forelimb vs hind limb).

Cauda equina syndrome, diskospondylitis, and a paravertebral abscess caused by Rhodococcus equi in a foal

A 4-month-old male Quarter Horse was referred for evaluation of urinary incontinence. Physical examination revealed clinical signs consistent with cauda equina syndrome. Radiography revealed diskospondylitis of S2 through S4. Infected bone was surgically curretted, and drainage was established for an associated paravertebral abscess. Rhodococcus equi was isolated from specimens of bone and from fluid samples obtained from the paravertebral abscess. Bethanechol was administered to stimulate urination. Erythromycin and rifampin were administered for 120 days. The foal's neurologic dysfunction resolved completely. Two years after discharge, the horse remained neurologically normal and did not have apparent effects as a result of its previous disorder.

Stringhalt secondary to trauma to the dorsoproximal region of the metatarsus in horses: 10 cases (1986-1991)

A review of medical records was used to identify 10 horses in which stringhalt developed subsequent to trauma to the dorsal metatarsus. Six horses developed stringhalt within 3 months after injury, 3 horses developed stringhalt > 3 months after injury, and time from injury to stringhalt was unknown for 1 horse. Horses were treated with exercise, including daily hand-walking with pasture turnout, followed by lunging; or surgically, using lateral digital extensor myotenectomy. Of the horses treated with exercise, 1 had resolution of stringhalt, 2 improved but had residual stringhalt, and 1 had no change. Two of the horses having lateral digital extensor myotenectomy had resolution of stringhalt. Two of the remaining 3 horses treated surgically had varying degrees of improvement, and in 1 horse there was no change. Stringhalt is a potential complication following trauma to the dorsal metatarsal region. Potential causes include tendon adhesions enhancing tarsocrural joint flexion or abnormalities in the myotatic reflex caused by tendon injury that result in abnormal flexion of the tarsocrural joint.

Arthroscopic approach and intra-articular anatomy of the plantar pouch of the equine tarsocrural joint

Arthroscopic examination of structures within the plantar pouch of the tarsocrural joint was accomplished via portals in both the plantaromedial and plantarolateral aspects of the joint. Flexion and extension of the tarsus while examining the joint through either portal allowed observation of the proximal and plantar aspects of the lateral and medial trochlear ridges, the trochlear groove, the caudal aspect of the distal tibia, and the deep digital flexor tendon (DDFT) in its sheath. From a plantarolateral portal, the plantar talocalcaneal ligament and the plantar aspect of the lateral malleolus could be observed. The caudal aspect of the medial malleolus could not be observed with flexion or extension of the joint from a plantaromedial portal, but in some horses, the caudal aspect of the lateral malleolus could be observed. The dorsolateral and dorsomedial aspects of the plantar pouch were best examined from a portal on the ipsilateral side of the joint. An instrument portal opposite either arthroscope portal allowed access to most regions of the joint except the abaxial surface of the trochlear ridge opposite the instrument.

Surgical treatment of egg retention in emus

We developed a surgical technique for management of retained eggs in emus. Clinical signs associated with egg retention include cessation of laying activity or failure to lay eggs, lethargy, anorexia, straining, and passing egg material, and diagnosis can be made by external palpation, abdominal radiography, and ultrasonography. The retained eggs were removed through a paramedian abdominal incision in all birds. One bird was euthanatized at surgery because of severe peritonitis resulting from uterine rupture at the site of obstruction by the retained egg. Three birds survived and were discharged from the hospital to the owners. Egg peritonitis resulting from eggs or egg remnants in the abdominal cavity was evident in the birds that survived surgery. Surgery and administration of antimicrobials were successful in resolving the peritonitis.

Proventriculotomy in ostriches: 18 cases (1990-1992)

Over a 3-year period, proventriculotomy was performed on 18 ostriches to relieve impaction of the proventriculus. Diagnosis was confirmed by abdominal palpation, abdominal radiography, and in some cases, exploratory proventriculotomy. In addition to proventriculotomy, an esophagotomy was performed in 5 birds that were debilitated to allow force-feeding during the postoperative period. The median age of ostriches treated surgically for proventricular impaction was 7.5 months (range, 3 months to 18 years). Impactions consisted of sand, rocks, or gravel in combination with grass, leaves, wood, or other fibrous materials. In 7 birds, small pieces of wire or nails were also removed from the proventriculus. In 1 bird, a large metal punch was removed via the proventriculotomy. Six ostriches died at the hospital in the immediate postoperative period. Four of these died within 24 hours of surgery. All 4 birds were emaciated and in a severely weakened condition at admission, and they continued to deteriorate after surgery. One bird died 8 days after surgery as a result of complications associated with a septic joint unrelated to the proventriculotomy procedure. Another bird was euthanatized 6 days after surgery because its condition failed to improve and the owners did not want to pursue further treatment because of expense. Follow-up information was obtained for 12 surviving ostriches 1 week to 29 months (median, 5.5 months) after they were discharged from the hospital. Four of the 12 birds died within 30 days of discharge from the hospital. The remaining 8 birds (44%) were alive at follow-up evaluation (median, 10.5 months after surgery; range, 5 to 29 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Dental surgery

Anatomy, physiology, and diseases of the teeth are presented. Signs of dental disease and techniques for oral and radiographic examination of the teeth are discussed. Surgical procedures described include extraction, repulsion, and endodontic therapy.

Arthroscopy of the coxofemoral joint of foals

An arthroscopic procedure for examination of the coxofemoral joint was developed in nine foals (four cadavers, five anesthetized) to determine if access was sufficient for evaluation and surgical treatment of intra-articular lesions. The joint was distended and the arthroscope inserted through the notch (incisura trochanterica) between the cranial and caudal parts of the greater trochanter. This portal allowed examination of the cranial, lateral, and caudal aspects of the joint. Mechanical distraction of the joint through an instrument portal located 2 to 4 cm cranial and 1 to 2 cm ventral to the arthroscope portal allowed examination of the ligament of the head of the femur, the femoral head, and articular and nonarticular surfaces of the acetabulum. Adduction and rotation of the limb improved visualization of the craniomedial and caudomedial portions of the femoral head. Traction applied to the distal limb allowed visualization of the same structures that were observed when mechanical distraction was used. Traction also created space for placement of surgical instruments into the joint through the instrument portal. Access to most regions of the joint was adequate, but access to the caudal and medial aspects of the joint was limited. Three foals were killed while they were anesthetized, and their coxofemoral joints were dissected. Two foals were allowed to recover from anesthesia and were observed for 30 days after surgery. One foal was mildly lame for 2 days after surgery. The other foal was not lame after surgery. The incisions healed, and the coxofemoral joints were radiographically normal by postoperative day 30.

Communication of the ulnaris lateralis bursa with the equine elbow joint and evaluation of caudal arthrocentesis

Elbows from cadaver limbs were evaluated to determine the presence of a communication between the ulnaris lateralis bursa (ULB) and the joint and the extent of the bursa. Thirty-two pairs of joints were studied: 12 pairs were frozen, then transversely sectioned and 20 pairs were injected with methyl methacrylate. The 12 frozen-section pairs revealed a communication between the ULB and the elbow joint in 9/24 joints (37.5%) and a true bursa (absence of communication) in 15/24 joints (62.5%). The mean bursal length in adult horses was 3.8 cm. There was no significant difference in the length of the bursa or presence of bursa-joint communication between the right and left limbs. In the acrylic specimens a communication between the ULB and the joint was found in 19/40 specimens (47.5%). There was no significant correlation between age or sex and frequency of communication. There was a significantly greater prevalence of communications present in Quarter Horse than in non-Quarter Horse (P < 0.05) joints. A communication between the ULB and the joint is not always present, and therefore injection of the elbow joint via the ULB may be unreliable.

Effects of split-thickness and full-thickness skin grafts on secondary graft contraction in horses

Full-thickness, circular (4-cm diameter) cutaneous wounds were created on the metacarpi and metatarsi of 6 horses. Immediately after wounding, 1 wound on each horse received a meshed, split-thickness skin graft (0.64 mm) obtained from the ventrolateral aspect of the horse's thorax by use of a pneumatic dermatome, whereas a second wound received a meshed, full-thickness skin graft obtained from the pectoral area. In addition, sections of split-thickness and full-thickness grafts were refrigerated in a solution of McCoy's 5A medium, to which equine serum (10%) and gentamicin sulfate solution (16 mg/dl) were added. Ten days after wounding, 1 granulating wound on each horse was grafted with a stored, meshed, split-thickness graft, and 1 granulating wound on each horse was grafted with a stored, meshed, full-thickness graft. Areas of wounds were calculated from photographs taken of wounds on days 1, 5, 10, 15, 20, 25, and 30 after wounding. Time course of contraction was determined by use of a first-order mathematic model of changes in area through time. Rate constants of contraction for fresh or granulating wounds receiving full-thickness grafts did not differ significantly from those for fresh or granulating wounds receiving split-thickness grafts. Rate constants of contraction for grafted fresh wounds, however, were significantly less than those of grafted granulating wounds, regardless of whether a split-thickness or full-thickness graft was applied.

Kinetics of healing of grafted and nongrafted wounds on the distal portion of the forelimbs of horses

Full-thickness, circular, cutaneous wounds (5 cm in diameter) were created on the distal portion of the forelimbs of 6 horses. One wound on each horse was treated with 6 full-thickness punch grafts that were obtained from the horse's neck with a 6-mm skin biopsy punch and inserted in the graft sites on day 14 after wounding. The wound on the contralateral limb was not grafted. A combination of ticarcillin disodium and clavulanate potassium was applied to the wounds when bandages were changed to control bacterial infection. Areas of each wound were measured on days 1, 7, 9, 11, 13 through 15, 17 through 22, 24, 26, 29, and 32 after wounding. Three distinguishable phases of healing were observed (expansion, contraction, and epithelialization), and the time course of each phase was evaluated, using formulas of first-order processes. Rate constants of each phase were not significantly (P less than 0.05) affected by punch grafts.

Communication between the femoropatellar and medial and lateral femorotibial joints in horses

Communications between the femoropatellar, medial femorotibial, and lateral femorotibial joints were studied, using fresh equine cadaver specimens. A total of 90 specimens from 45 horses were used. Horses were randomly assigned to 3 groups with 15 horses/group. Each group was assigned an injection site (femoropatellar joint, medial femorotibial joint, or lateral femorotibial joint), and red latex was injected into the respective location of each joint in each group. Immediately after injection, the joints were flexed and extended 100 times. The stifles were frozen in slight flexion, then cut into 1-cm sagittal sections. The communications between the femoropatellar and medial and lateral femorotibial joints were determined. None of the specimens in this study had communication between all 3 joint compartments. When the femoropatellar joint was injected, 18 of 30 joints (60%) communicated with the medial femorotibial joint, and 1 of 30 (3%) communicated with the lateral femorotibial joint. Injection of the medial femorotibial joint revealed 24 of 30 (80%) joints that communicated with the femoropatellar joint, and 1 of 30 (3%) that communicated with the lateral femorotibial joint. Injection of the lateral femorotibial joint resulted in communication with the femoropatellar joint in 1 of 30 (3%) joints. Communication did not exist between the medial and lateral femorotibial joints.

Surgical treatment of colic in American miniature horses: 15 cases (1980-1987)

A study of 15 American miniature horses (AMH) that underwent surgical treatment for colic was performed. Information obtained from the medical records included signalment, clinical signs, type and location of gastrointestinal lesion, and postoperative complications. All 15 AMH had intraluminal obstructions, attributable to feed impactions (11 horses), enteroliths (2), and sand (2). The most common location of obstruction was the small colon, which was involved in 9 of the 15 cases. All 15 AMH survived and were discharged from the hospital. Six of the 15 AMH underwent subsequent surgical treatment for abdominal disorders. Elapsed time between the first and second operations ranged from 1 month to 5 years. Intestinal adhesions were observed in all AMH that were surgically treated twice. Thus, despite the fact that most of the AMH had a simple intraluminal obstruction, 40% (n = 6) developed adhesions that required or complicated a second surgery. Of the 15 AMH, 87% (n = 13) survived at least 12 months after the initial exploratory celiotomy. These findings suggest that most surgical abdominal conditions in AMH can be corrected; however, precautions should be taken to avoid or minimize adhesion formation.

Septic arthritis of the distal interphalangeal joint in 12 horses

The medical records of 12 horses with septic arthritis of a distal interphalangeal joint were reviewed to determine clinical features and response to treatment. Sepsis was caused by trauma or an injection that resulted in an open or contaminated distal interphalangeal joint. All horses were severely lame. Treatment included broad-spectrum parenterally administered antimicrobial drugs (ten horses), percutaneous through-and-through joint lavage (eight horses), indwelling drains (three horses), immobilization of the limb in a cast (three horses), intraarticular injection of sodium hyaluronate (one horse), intraarticular injection of antimicrobial drugs (five horses), curettage of the distal phalanx (one horse), and cancellous bone grafting to promote fusion (one horse). Five horses were euthanatized. Ankylosis of the affected joint developed in five horses, four of which are pasture sound. Two horses treated medically are sound although one underwent subsequent palmar digital neurectomy for treatment of navicular syndrome.

Arthroscopic approach and intra-articular anatomy of the palmaroproximal or plantaroproximal aspect of distal interphalangeal joints

An arthroscopic approach to the palmaroproximal or plantaroproximal pouch of the distal interphalangeal joint was developed in six cadaver limbs and seven limbs of three clinically normal horses. The dorsal aspect of the proximal border and the proximal articular margin of the distal sesamoid (navicular) bone, the palmar aspect of the distal articular margin of the middle phalanx, the collateral sesamoidean ligaments of the distal sesamoid bone, and the joint capsule attachments were readily accessible. Distending the joints with fluid gave access to portions of the articular surface between the distal sesamoid bone and the middle phalanx in all joints, and to a small portion of the distal phalanx in two hind distal interphalangeal joints. Two horses allowed to recover from anesthesia were not lame on days 30 and 37, respectively. Problems encountered initially were difficulty entering the joint, hemarthrosis, and minimal iatrogenic cartilage damage.

Ultrasonographic imaging of a keratoma in a horse

Ultrasonography was used to confirm the tentative diagnosis of keratoma in a horse admitted for chronic progressive lameness. A definitive diagnosis of keratoma traditionally has been diagnosed by history, clinical findings, and radiographic evaluation. Confirmation of the keratoma by use of ultrasonography facilitated the formulation of a treatment plan that resolved the condition.

Mammary adenocarcinoma in four mares

Mammary gland adenocarcinoma in 4 horses was characterized by firm swelling of the gland and serosanguineous discharge from the teat orifice. Two of the mares had ulcerative lesions of the mammary gland. Palpation of the affected gland typically elicited signs of pain. Diagnosis was assisted by cytologic evaluation of the fluid discharge, but definitive diagnosis was based on histologic examination. Treatment included mastectomy and lymphadenectomy.

Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis

A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.

Standing surgical procedures of the foot

Several surgical conditions affecting the foot can be successfully managed with the horse standing. Many factors affect the clinician's choice of whether to perform surgery with the horse standing or anesthetized. Temperament or pregnancy of the horse and economics may influence the decision to perform surgery with the horse standing. This article discusses several foot conditions that can be treated successfully in the ambulatory horse.

Septic tenosynovitis in horses: 25 cases (1983-1989)

The medical records of 25 horses with septic tenosynovitis treated over 7 years (1983 to 1989) were reviewed to determine clinical features of the disease and response to treatment. The median age of horses with septic tenosynovitis was 5 years (range, 1 month to 21 years). Fourteen fore limbs and 11 hind limbs were affected. Sepsis was located in the sheath of the digital flexor tendons of 22 horses. Sepsis was located in the sheath of the extensor carpi radialis tendon (1 horse), sheath of the long digital extensor tendon (1 horse), or sheath of the common digital extensor tendon (1 horse) in the remaining horses. Nine horses received only medical treatment, using a combination of broad-spectrum parenterally administered antimicrobial drugs (8 of 9 horses), nonsteroidal anti-inflammatory drugs (8 of 9 horses), or irrigation of the wound (4 of 9 horses). Fourteen horses were treated surgically with either transection of the palmar/plantar annular ligament of the metacarpo/metatarsophalangeal joint (5 of 14 horses), lavage of the sheath after insertion of drains into the sheath (7 of 14 horses), or both (2 of 14 horses). All horses treated surgically were concurrently treated parenterally with broad-spectrum antimicrobial drugs and nonsteroidal anti-inflammatory drugs. Two horses with septic tenosynovitis were not treated and were euthanatized at the owners' request. Five horses were euthanatized before discharge from the hospital. Two horses (both treated medically) were lost to follow-up. Follow-up information was obtained for 18 horses, 6 to 55 months after discharge from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Proventriculotomy to relieve foreign body impaction in ostriches

A study was conducted to identify the clinical signs associated with impaction of the proventriculus in ostriches, to identify diagnostic aids, and to develop a surgical procedure for management of the disorder. Clinical signs indicating the need for surgical intervention included chronic inappetance, a change in fecal consistency or production, dehydration, weight loss, and failure to respond to laxatives. Diagnosis of impacted proventriculus was by abdominal radiography and external palpation. Impactions were caused by sand and rocks (5 ostriches), hay and sand (1 ostrich), and leaves (1 ostrich). After surgery, 5 of the ostriches were clinically normal within (mean) 1 week. One ostrich failed to regain a normal appetite until 2 weeks after surgery, and one juvenile ostrich died after surgery. Of the 6 ostriches that survived, 1 died 1 week after discharge from the hospital. The remaining birds survived without redevelopment of impaction.

Resection of a cervical tracheal bronchus in a foal

A 3-day-old Thoroughbred foal developed a large, air-distended, midcervical swelling that was diagnosed as a congenital tracheal bronchus with associated ectopic lung tissue. Clinical signs consisted of a compressible air-filled sac that enveloped the trachea. The nature and extent of the defect were evaluated endoscopically and radiographically. Surgical resection of the bronchus and associated air-filled sac resulted in a functionally and cosmetically acceptable outcome.