Older Horse Sinus Trephination and Tooth Extraction

[aboelter]

I’m looking for advice/experience with tooth extraction and sinus trephination in a 22 year old horse.

To preface separately from the tooth, in the fall of 2019 he developed a deep and persistent cough that never went away. We treated with ventipulmin/pred/dex/Lily combo/ Zyrtec, all the environmental changes etc. The cough never subsided. After multiple breathing tests and scope it was decided that he has asthma, there are no crackles or wheezing in his lungs. No cushings. We were considering a BAL or trach wash but then he developed new symptoms.

He began tossing his head, weight loss, and significant yellow left nasal discharge. We radiographed his skull and found his sinuses were full and a suspicious tooth, 209 the top left molar. We did a month of smzs and the infection came right back, and now it has a smell. I have reluctantly decided to pull the 209 tooth and am scheduling it for next week.

I have been assured by my vet, and a second opinion, that the cough is completely unrelated. However, I am very cautious of doing any type of surgery because in addition to his age, I feel his immune system is compromised with this cough. I want to do what is best for him, but I’m not convinced surgery will be without complications.

Has anyone had a similar experience? What were your results, complications? Anything you would have done differently or suggest? It is not a cut-and-dry answer for me with the tooth, the vets question if there could be a cyst in the sinus since the tooth doesn’t look that bad, although there is no evidence of one on the radiographs (They would scope with the trephination). Any advice is appreciated thank you!

[Jarpur]

My 31 year old had eight teeth removed; the veterinarian, who had been recommended to me for this procedure, specialized in geriatric horses - he said that the teeth were “ready to go,” due to the advanced age of the horse.

My gelding woke up amazingly quickly from the anesthetic, and healed well; the attending veterinarian sent him home from the clinic asap. My horse lived almost four more years, in good flesh to the end, although he required increasing management. I don’t think I’d hesitate to do this again and, in my world, 22 years is not that old.

However, my old man didn’t have the nasal discharge, weight loss, cough, etc., of the OP’s horse.

[TBMaggie]

My horse presented very much like yours - he was only 12 though. He had a sinus cyst and an upper cracked tooth that was leaking bacteria into his sinus cavity for months. Both were missed (there never was a smell to all the junk pooring out of his nose) and it was just thought that he had an upper respiratory infection. By the time the tooth was extracted, all the sinus walls had been eaten away and he was one sick horse. Lots of tubes and flaps, flushings 2 x day for weeks, and hopes and prayers that the huge hole left from the tooth extraction would heal over. It finally did, but I was lucky enough to find one of the leading equine dentists right here in my state for the extraction and after-care (this was after a much botched imho attempt by a regional university).
I’m relating all this because I think that your horse will feel ever so much better once the tooth is extracted and the sinus flushing begins/infection abates - 22 is not that old. The infection will do more to damage his long-term health than the tooth extraction. Just find someone who specializes in tooth extraction - don’t mess around with anything less.

[TBMaggie]

Edited to add: The actual extraction took less than 40 minutes,through the mouth, standing. It’s all in the technique! This was after the botched attempt that took over 4 hours, and 2 face flaps cut - and couldn’t get the tooth out.

[aboelter]

Jarpur and TBMaggie, thank you so much for your responses they really helped me. TBMaggie that must have been awful to go through. I’m surprised he had both the tooth and the cyst, I wonder if my horse could have both too. I am so happy you had a good resolution.

I started him on doxy last week since the infection came right back and scheduled the tooth extraction and sinus trephination for this Thursday. His chewing has seemed more difficult for him, so I am feeling more confident that it is the tooth. He has always been so healthy throughout his life that I hope he has plenty more years left. Its an in clinic standing sedation and I do believe I have found a great vet specializing in teeth. Then there is a different surgeon doing the sinuses. I am waiting to hear back from them on details of post op care. I’ve read that the surgical sites for the sinus lavage can become infected easily, but I am just hoping the benefits outweigh the risks here. I’ll post an update afterwards, thank you!

[TBMaggie]

Good Luck to you and your horse next Thursday! If you can afford it, and if it’s available to you, maybe opt to keep your horse at the vet clinic for a week or so while they do the flushes/after care for a bit or at least until you’re confident that you can handle things.( Because of where I live (little to no vet care) and the severity of my horse’s condition, I left him at the clinic for 5 months. He had trouble with the healing of one of the face flaps (he lost a huge chunk of jaw bone too) among other things.
Will your equine dentist be able to extract the tooth through the mouth, or will he/she have to cut flaps? The sinus flushes were done on my horse through a hole that was drilled through the middle of his forehead into his sinuses/tube inserted and tied into his forelock - sounds like a Frankenstein-idea lol, but I can’t even tell where the hole was. It healed over really fast. The flaps were another story.