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Objective To evaluate the frequency of inadvertent penetration of the digital flexor tendon sheath (DFTS) and/or distal interphalangeal joint (DIPJ) when using a direct endoscopic approach to the navicular bursa, and to evaluate an alternate direct approach to the navicular bursa. Study Design Cadaveric study. Sample Population Equine cadaver limbs (n = 40 for direct; n = 12 for alternate approach). Methods Four surgeons performed the direct endoscopic approach to the navicular bursa on 10 limbs each. Frequencies of inadvertent synovial penetration and iatrogenic damage were compared between surgeons. Use of an alternate direct approach, adopting a straight parasagittal trajectory, was evaluated by 2 surgeons. Results Inadvertent synovial penetration occurred in 45% of limbs (DFTS 37.5%; DIPJ 17.5%; and both structures 10%). Successful bursa entry was achieved on the first attempt in 45% of limbs. Significant variation in frequency of inadvertent synovial penetration was observed between surgeons (range 10–80%). Inadvertent synovial penetration did not occur when using the alternate direct technique. Iatrogenic damage to navicular bone fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using the direct endoscopic approach and in 0% of limbs using the alternate direct approach. Conclusion Because of the considerable risk of inadvertent penetration of the DFTS and/or the DIPJ when making a direct endoscopic approach to the navicular bursa, it is advisable to investigate for inadvertent penetration when treating navicular bursa sepsis using a direct approach. The alternate direct technique may reduce the risk of inadvertent penetration; however, the view within the bursa may be restricted.

Summary A 9-year-old Welsh Section D gelding was referred to an equine hospital for evaluation and computed tomographic (CT) imaging of a left mandibular swelling. An expansile mass, found within the left mandible at the level of the caudal 2 cheek teeth, was surgically debulked and histology of the lesion identified it as an ameloblastic carcinoma. Radiotherapy using 4 fractions of 800 cGy, 7 days apart, was subsequently undertaken. The pony made excellent clinical progression following treatment. Repeat CT imaging at 7.5 and 19.5 months post surgery showed no apparent recurrence of the lesion and marked improvement in the remodelling of the mandible. In conclusion, radiotherapy in conjunction with surgical debulking appears to have been successful in treating an ameloblastic carcinoma in this pony and could be considered for similar tumours in other cases.

Summary Reasons for performing study Empyema of the nasal conchal bullae has recently been identified in horses suffering from chronic unilateral nasal discharge. The diagnosis and management of such cases has not been reported previously. Objectives To describe the diagnosis and treatment of cases suffering from empyema of the nasal conchal bullae and report the frequency of diagnosis from a population of horses referred for head computed tomography (CT). Study design Retrospective case review. Methods Records from cases diagnosed with nasal conchal bulla disease using CT were reviewed. Results Abnormalities of the nasal conchal bullae were identified by CT in 10 cases (8 ventral conchal bulla, 2 dorsal conchal bulla), from 102 equine head CT examinations. Eight cases were subsequently treated at the study clinic, 7 of which had concurrent paranasal sinus disease. In 3 cases, fenestration of the ventral conchal bulla per nasum facilitated drainage and clearance of empyema. Conclusions Disease of the conchal bullae should be considered as a potential cause of chronic unilateral nasal discharge in horses. Clearance of empyema within these bullae is unlikely to occur through lavage of the paranasal sinuses alone. Where necessary, fenestration of the bulla allows physical removal of infected material.