Publications by authors named "Dane M Tatarniuk"

16 Publications

  • Page 1 of 1

Meropenem Administered via Intravenous Regional Limb Perfusion for Orthopedic Sepsis in Horses: A Clinical Retrospective Study.

Front Vet Sci 2021 26;8:629627. Epub 2021 Mar 26.

Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States.

Septic synovitis is a critical orthopedic condition in horses. Early intervention is key, with antibiotic therapy typically initiated prior to culture and susceptibility reports becoming available. The pharmacokinetics of several antibiotics have been studied in horses for use in intravenous regional limb perfusion (IVRLP) for septic synovitis, including the carbapenem antibiotic, meropenem. For a variety of factors, some veterinary clinicians may select IVRLP meropenem as therapy for these cases. Meropenem is a vital antibiotic in human medicine, making veterinary use divisive. However, verifying the efficacy of meropenem contrasted to other IVRLP antibiotics is essential for appropriate antimicrobial stewardship. To investigate this, equine patient medical records at a single veterinary teaching hospital were examined. Cases treated with meropenem or gentamicin via IVRLP for septic synovitis were retrospectively analyzed for demographics, diagnostics, treatments, outcomes, and adverse effects. Twenty-three meropenem and 37 gentamicin treated horses were analyzed; demographic information was similar between groups. In the meropenem group, nine horses received meropenem only; the remainder received another antibiotic initially then changed to meropenem. Structures infected included joints (meropenem = 13, gentamicin = 17), tendon sheaths (meropenem = 5, gentamicin = 8) and navicular bursae (meropenem = 2, gentamicin = 6). Overall survival to discharge was 86% (52/60), with meropenem 91% (21/23) and gentamicin 84% (31/37), with no statistically significant differences noted between meropenem or gentamicin groups for overall survival to discharge or outcome after discharge. Twenty-four of 26 bacterial isolates obtained from culture were reported as sensitive to imipenem, a carbapenem antibiotic similar to meropenem. Reported susceptibility to other antibiotics such as ceftiofur ( = 22/26), ampicillin ( = 18/26), amikacin ( = 15/26), or gentamicin ( = 12/26) was also frequently present. In the population of this study, antimicrobial activity augmented with IVRLP using either meropenem or gentamicin both appear to be an effective treatment for septic synovial structures, therefore, less critical antimicrobials may be a viable and more judicious treatment option.
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http://dx.doi.org/10.3389/fvets.2021.629627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033006PMC
March 2021

Transendoscopic Ventriculocordectomy Using Monopolar Electrosurgical Instrumentation for Conjunctive Treatment of Laryngeal Hemiplegia in Horses: 24 Cases (2017-2019).

Front Vet Sci 2021 1;8:628410. Epub 2021 Mar 1.

Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA, United States.

The objective of this study is to evaluate the safety, efficacy, and owner satisfaction following electrosurgical ventriculocordectomy (EVC), in conjunction with prosthetic laryngoplasty, in equine clinical cases affected with left- or right-sided recurrent laryngeal neuropathy. Retrospective data analysis of clinical signalment, surgery, athletic outcome, intra- and postoperative complications, and postoperative examinations from clinical cases wherein EVC was performed in conjunction with traditional prosthetic laryngoplasty from one practice. Owners were contacted by phone or email for a follow-up questionnaire. Twenty-four horses underwent unilateral EVC, performed transendoscopically under sedated restraint, using monopolar electrosurgical instrumentation successfully. One horse experienced excessive intraoperative hemorrhage. No horses demonstrated postoperative complications. Twenty cases had a history of increased airway noise prior to surgery. In 15 of these cases (15/20, 75%), the airway noise was reported as fully improved post-surgery. Eighteen cases had a history of exercise intolerance prior to surgery. In 15 of these cases (15/18; 83%), the exercise intolerance was reported as resolved. EVC, in conjunction with prosthetic laryngoplasty, can contribute to improvement of RLN symptoms and aid in the effective return to athletic work. Performing transendoscopic ventriculocordectomy with monopolar electrosurgical instrumentation provides comparable clinical outcomes to traditional techniques using a diode laser or direct excision via laryngotomy.
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http://dx.doi.org/10.3389/fvets.2021.628410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957056PMC
March 2021

Case Report: Trochlear Wedge Sulcoplasty, Tibial Tuberosity Transposition, and Lateral Imbrication for Correction of a Traumatic Patellar Luxation in a Miniature Companion Pig: A Case Report and Visual Description.

Front Vet Sci 2020 13;7:567886. Epub 2021 Jan 13.

Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States.

The objective of this case report was to describe successful surgical and post-operative management of a medial patellar luxation in a Vietnamese Potbellied Pig. A two-year old, castrated, Vietnamese Potbellied Pig presented to a veterinary teaching hospital for right pelvic limb lameness of 2 weeks duration. Upon physical examination a grade 3 patellar luxation was diagnosed on the right pelvic limb. Surgical repair included a trochlear wedge sulcoplasty, tibial tuberosity transposition, and lateral imbrication as described for canine patellar luxation. The pig was managed post-operatively with meloxicam and a physical therapy regimen of seven weeks duration. At recheck examination the pig was sound, no complications were observed, and the owners were satisfied with the outcome. As miniature companion pigs, such as Vietnamese Potbellied Pigs are currently increasing in popularity as pets, this case demonstrated that comparative techniques from other veterinary species should be considered when considering a treatment plan for a pig with a medial patellar luxation.
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http://dx.doi.org/10.3389/fvets.2020.567886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838352PMC
January 2021

Fibro-Osseous Lesions Of The Craniofacial Complex In Horses: 30 Cases (2001-2019).

Vet Surg 2021 Feb 5;50(2):383-392. Epub 2021 Jan 5.

Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA.

Objective: To describe the presentation, diagnosis, treatment, and outcome for horses with fibro-osseous lesions of the craniofacial complex.

Study Design: Retrospective multicenter case series.

Animals: Thirty horses evaluated for fibro-osseous lesions of the skull from January 1, 2001 through December 31, 2019 in four centers.

Methods: Medical records were reviewed for signalment, clinical presentation, histological and diagnostic imaging findings, treatment instituted, and outcome. Long-term outcome information was obtained by owner questionnaire or the medical record.

Results: Diagnoses included ossifying fibroma in 20 of 30 horses, osteoma in eight of 30 horses, and fibrous dysplasia in two of 30 horses. Twelve of 30 lesions were diagnosed in horses <1 year old, and 20 of 30 lesions originated from the rostral mandible. The most common treatment was rostral mandibulectomy. Recurrence was not reported after complete excision. Incomplete excision was confirmed in eight horses (four ossifying fibromas, three osteomas, and one fibrous dysplasia), and follow-up information was available for seven horses. Recurrence occurred in one horse, while six horses had long-term resolution of clinical signs. Prognosis for survival and return to use was excellent in 23 horses with long-term follow-up.

Conclusion: Fibro-osseous lesions were uncommon in this multicenter study; they were most commonly diagnosed in young animals and most frequently affected the rostral mandible. Long-term survival was excellent.

Clinical Significance: The definitive diagnosis of fibro-osseous lesions of the craniofacial complex in horses is made from results of histopathology and cannot be determined on the basis of clinical presentation alone. Surgical excision is indicated, and prognosis can be favorable even when complete surgical margins are not obtained.
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http://dx.doi.org/10.1111/vsu.13559DOI Listing
February 2021

Outcome following neurectomy of the deep branch lateral plantar nerve and plantar fasciotomy for hindlimb proximal suspensory desmopathy in western performance horses: 21 cases.

Vet Surg 2021 Feb 16;50(2):273-282. Epub 2020 Dec 16.

Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa.

Objective: To report the outcome of horses used in western performance disciplines after deep branch lateral plantar neurectomy/fasciotomy surgery for hind limb proximal suspensory desmopathy (PSD).

Study Design: Retrospective analysis.

Sample Population: Twenty-one client-owned horses.

Methods: Medical records were reviewed (2009-2019) for horses involved in western performance disciplines that had been treated with deep branch lateral plantar neurectomy and plantar fasciotomy for lameness due to hind limb PSD. Follow-up was obtained by reexamination and/or verbal interviews with owners >2 years postoperatively.

Results: Sixteen quarter horses and five paints were used for western pleasure (14/21), barrel racing (2/21), cutting (1/21), steer wrestling (1/21), working cow horse (1/21), team roping (1/21) and reining (1/21). A median duration of 8 months was required before horses were able to resume training or athletic work. Nine horses were able to return to a similar or higher level of athletic use, nine horses returned to a lower level of athletic performance, and three horses could not return to intended function. Owner satisfaction with outcome after the procedure was high (16/21), average (3/21), and low (2/21).

Conclusion: Deep branch lateral plantar neurectomy and plantar fasciotomy allowed most horses to resume some athletic function as western performance horses.

Clinical Significance: These results provide evidence of potential outcomes when considering surgical treatment of hind limb PSD in western performance horses.
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http://dx.doi.org/10.1111/vsu.13552DOI Listing
February 2021

Pharmacokinetics and Tissue Levels of Pantoprazole in Neonatal Calves After Intravenous Administration.

Front Vet Sci 2020 27;7:580735. Epub 2020 Nov 27.

Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States.

Neonatal calves are at risk of developing abomasal ulceration, but there is a lack of pharmacokinetic data for potential anti-ulcerative therapies, such as pantoprazole, in ruminant species. The study objectives were to estimate plasma pharmacokinetic parameters for pantoprazole in neonatal dairy calves after intravenous (IV) administration. A secondary objective was to quantify the concentrations of pantoprazole in edible tissues after IV dosing. Pantoprazole was administered to 9 neonatal Holstein calves at a dose of 1 mg/kg IV. Plasma samples were collected over 24 h and analyzed via HPLC-MS for determining pantoprazole concentrations. Pharmacokinetic parameters were derived via non-compartmental analysis. Tissue samples were collected at 1, 3, and 5 days after administration and analyzed via HPLC-MS. Following IV administration, plasma clearance, elimination half-life, and volume of distribution of pantoprazole were estimated at 4.46 mL/kg/min, 2.81 h, and 0.301 L/kg, respectively. The global extraction ratio was estimated at 0.053 ± 0.015. No pantoprazole was detected in the edible tissues 1, 3, or 5 days after administration. A metabolite, pantoprazole sulfone was detected in all the edible tissues 1 and 3 days after administration. The reported plasma clearance for pantoprazole is less than that reported for alpacas but higher than reported in foals. The elimination half-life in calves appears to be longer than observed in foals and alpacas. While pantoprazole sulfone was detected in the tissues after IV administration, further research is needed as to the metabolism and potential tissue accumulation of other pantoprazole metabolites in calves. Future pharmacodynamic studies are necessary to determine the efficacy of pantoprazole on abomasal acid suppression in calves.
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http://dx.doi.org/10.3389/fvets.2020.580735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728716PMC
November 2020

En-bloc Auriculectomy for Removal of a Large Pinna-Based Ear Mass in a Horse.

Front Vet Sci 2020 30;7:560379. Epub 2020 Oct 30.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ames, IA, United States.

A 15-year-old Pony of America (POA) gelding presented for evaluation of a large mass present on the right external pinna. Based on gross appearance, the right ear mass was suspected to be neoplastic. The most likely differential diagnosis was that of a fibroblastic sarcoid. Complete auriculectomy via use of a constricting latex-tourniquet performed under multimodal analgesia was proposed as an option to achieve complete resolution of mass growth and improve patient comfort. Benefits of latex tourniquet constriction included immediate lack of bleeding associated with amputation, gradual ischemic necrosis and sloughing of tissue distant to the site of constriction, and cost-effective application. The external pinna sloughed 3 weeks following application of the constricting latex tourniquet. Complete healing was achieved within 3 months from the time of tourniquet application. The middle ear canal sealed closed as a result of auriculectomy, with no observed long-term discomfort or morbidity aside from reduction in hearing. This is the first report of total external ear amputation in the horse. Complete auriculectomy via use of a constricting latex tourniquet is a feasible method for en-bloc removal of large, complicated ear masses.
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http://dx.doi.org/10.3389/fvets.2020.560379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661778PMC
October 2020

Comparative Stiffness of an Equine Distal Sesamoid Bone Fracture Model Stabilized with 3.5-mm versus 4.5-mm Cortical Bone Screws in Lag Fashion.

Vet Comp Orthop Traumatol 2019 Nov 6;32(6):440-446. Epub 2019 Jul 6.

Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, Ames, Iowa, Unites States.

Objective:  The aim of this study was to to determine the comparative stiffness following repair of an axial sagittal fracture model in equine distal sesamoid bones using either a single 3.5-mm or 4.5-mm cortical bone screw placed in lag fashion.

Study Design:  The present study was an biomechanical study.

Results:  The mean (±standard deviation) stiffness value for the 4.5-mm screw-bone construct (522.49 N/mm ± 168.21) was significantly greater than the 3.5-mm screw-bone construct (408.46 N/mm ± 131.13) ( = 0.047). This represents a 28% difference in mean stiffness.

Conclusions:  , the 4.5-mm screw-bone construct creates a stiffer repair of fractured distal sesamoid bones by a margin of 28%. The 4.5-mm cortical bone screw may better withstand forces imparted on the distal sesamoid bone sustained during anaesthetic recovery, normal weight bearing and athletic exercise, thereby minimizing the risk of implant failure.
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http://dx.doi.org/10.1055/s-0039-1692979DOI Listing
November 2019

Adaptation and evaluation of a monopolar electrosurgical triangle-tip knife for transendoscopic ventriculocordectomy in healthy horses.

Vet Surg 2019 May 13;48(4):481-487. Epub 2019 Jan 13.

Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa.

Objective: To evaluate the efficacy and safety of a transendoscopic monopolar electrosurgical triangle-tip knife as instrumentation to perform unilateral ventriculocordectomy (VC) in healthy adult horses.

Study Design: In vivo experimental study.

Study Population: Nine horses donated for medical conditions unrelated to respiratory system.

Methods: The triangle-tip knife was applied in contact fashion. Left VC was performed under standing sedation. Endoscopic images of the upper airway were graded for inflammation by 2 masked surgeons preoperatively and immediately, 24 hours and, in 2 cases, 7 and 14 days postoperatively. Four larynxes were examined for histological evidence of inflammation and collagen deposition at 24 hours (n = 2) and at 14 days (n = 2) after surgery.

Results: Ventriculocordectomy was successfully performed in all horses. Endoscopic evidence of inflammation was scored as normal (preoperatively), mild (immediately postoperatively), mild (24 hours postoperatively), mild (7 days postoperatively), and normal (14 days postoperatively). According to histopathology, inflammation of the surgical site and ventricularis muscle was generally increased (variable is common and is present in most high-power fields) 24 hours and 14 days postoperatively. Fibrosis and collagen deposition also seemed increased at the surgical site 14 days postoperatively.

Conclusion: Ventriculocordectomy was successfully performed with an electrosurgical triangle-tip knife and resulted in acceptable short-term outcomes.

Clinical Significance: The use of an electrosurgical triangle-tip knife alternative instrumentation may be offer an alternative option to perform VC in practices when diode laser is not available or is cost prohibitive. Longer term evaluation of the VC site is required to determine the effect on rima glottic cross-sectional area.
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http://dx.doi.org/10.1111/vsu.13154DOI Listing
May 2019

Tenotomy of the semitendinosus muscle under standing sedation versus general anesthesia: Outcomes in 20 horses with fibrotic myopathy.

Vet Surg 2018 Apr 13;47(3):350-356. Epub 2018 Feb 13.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa.

Objective: To compare outcomes after semitendinosus tenotomy performed under standing sedation versus general anesthesia.

Study Design: Retrospective case series.

Sample Population: 20 horses with fibrotic myopathy of the semitendinosus muscle.

Methods: Medical records (2002-2015) of horses undergoing tenotomy of the semitendinosus muscle for the treatment of fibrotic myopathy were reviewed. Signalment, history, affected muscles, restrain method, surgical procedures, and short-term outcome as well as complications were retrieved from records. Long-term outcome (gait and athletic function) was assessed at least 6 months postoperatively by conversation with the owners. Pearson's χ statistical analysis was used to compare restrain method and affected muscles with overall outcome. Significance was set at P < .05.

Results: Tenotomy of the semitendinosus muscle was performed under standing sedation in 8 horses and under general anesthesia in 12 horses. Follow-up period ranged from 9 months to 10 years. Gait was improved to variable degrees in 8 of 14 horses when the semitendinosus muscle alone was affected and in 4 of 6 horses when both the semitendinosus and semimembranosus muscles were involved (P = .11). Six of 8 horses treated under standing sedation and 6 of 12 horses treated under general anesthesia exhibited some improvement in the characteristic fibrotic gait (P = .4473). Five of 6 athletic horses treated under standing sedation and 6 of 9 athletic horses treated under general anesthesia returned to their preinjury level of athleticism. Horses treated under standing sedation had no incisional complications; 2 of 12 horses treated under general anesthesia exhibited incisional drainage.

Conclusion: Tenotomy of the semitendinosus muscle in horses with fibrotic myopathy leads to similar improvement in gait, whether performed under standing sedation or general anesthesia.
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http://dx.doi.org/10.1111/vsu.12767DOI Listing
April 2018

Extensive rostral mandibulectomy for treatment of ameloblastoma in a horse.

Vet Surg 2014 Feb 6;43(2):222-6. Epub 2014 Jan 6.

Veterinary Population Medicine Department, University of Minnesota, St. Paul, Minnesota.

Objective: To report long-term outcome in a mare that had extensive rostral mandibulectomy to remove an ameloblastoma.

Study Design: Clinical report.

Animals: A 21-year-old mare.

Methods: An ameloblastoma, located in the rostral aspect of the mandible, was removed by complete en-bloc resection of the tumor, removing most of the mandibular symphysis.

Results: The day after surgery, the remaining mandibular symphysis (<5 mm) fractured causing marked instability of the hemi-mandibles. Partial wound dehiscence occurred 5 days after surgery; however, the mare was able to eat well and the incision healed within 2 weeks. At 18 months, there was bony fusion of the hemi-mandibles and mild protrusion of the tongue.

Conclusion: Extensive rostral mandibulectomy (up to the caudal edge of the mandibular symphysis) can apparently be performed in a horse without internal or external stabilization, and yield a cosmetic and functional outcome.
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http://dx.doi.org/10.1111/j.1532-950X.2014.12110.xDOI Listing
February 2014

Laminar epidermal hyperplasia and hyperkeratosis in an equine hoof.

Can Vet J 2013 Sep;54(9):849-52

Department of Large Animal Clinical Sciences (Tatarniuk, Bracamonte, Wilson), Prairie Diagnostic Services (Perry), Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan, Canada; Veterinary Biosciences & Diagnostic Imaging (Sharma), University of Georgia, Athens, Georgia, United States.

A 6-year-old Canadian Warmblood gelding was presented for suspicion of keratoma growth, based on a history of recurring abscesses in the right front foot. Radiographic examination and computed tomography identified 2 bilaterally symmetrical, laminar epidermal ingrowths adhered to the hoof wall at the level of the lateral and medial heels.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743568PMC
September 2013

Comparison of the response to experimentally induced short-term inflammation in the temporomandibular and metacarpophalangeal joints of horses.

Am J Vet Res 2011 Dec;72(12):1586-91

Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada.

Objective: To investigate the relationship between inflammatory responses of the temporomandibular joint (TMJ) and the metacarpophalangeal (MCP) joint in clinically normal horses.

Animals: 7 mature horses.

Procedures: In each horse, 1 TMJ and 1 MCP joint were injected with lipopolysaccharide (LPS; 0.0025 μg). The contralateral TMJ and MCP joint were injected with saline (0.9% NaCl) solution. Synovial fluid samples were collected from all 4 joints over 24 hours after injection. Concentrations of interleukin-6, tumor necrosis factor-α, transforming growth factor-β, and total protein were measured via immunoassay. Horses were assessed for clinical signs of joint inflammation at each time point.

Results: Concentrations of interleukin-6 were not significantly different between LPS-injected MCP joints and TMJs at any time point. Transforming growth factor-β concentrations were significantly increased in MCP joints, compared with concentrations in TMJs, at 12 and 24 hours after injection. Tumor necrosis factor-α concentrations were significantly higher in LPS-injected TMJs than in LPS-injected MCP joints at 1 and 6 hours after injection. Total protein concentration did not differ significantly between LPS-injected MCP joints and TMJs. Injection of LPS induced clinical inflammation at all time points; additionally, 2 MCP joints (but no TMJs) had an inflammatory response to injection of saline solution.

Conclusions And Clinical Relevance: The inflammatory response to LPS appeared to be attenuated more quickly in TMJs than in MCP joints of horses. The difference in response suggested that a lack of clinical osteoarthritis in the TMJ of horses could be attributable to a difference in cytokine response.
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http://dx.doi.org/10.2460/ajvr.72.12.1586DOI Listing
December 2011

Induration of the cricoid cartilage complicates prosthetic laryngoplasty in a horse.

Vet Surg 2010 Jan;39(1):128-30

Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada.

Objective: To report intraoperative complications during needle penetration and suture placement through the cricoid cartilage during a prosthetic laryngoplasty procedure.

Study Design: Case report.

Methods: An 11-year-old American Paint gelding with grade IV left laryngeal hemiplegia underwent a terminal prosthetic laryngoplasty for teaching purposes. Passage of the needle through the cricoid cartilage was difficult and resulted in needle breakage before eventual success using a new needle. The larynx was examined postmortem.

Results: Palpation of the larynx revealed hardening of the cricoid cartilage. Radiographic examination indicated the presence of diffuse radiopaque speckling. Histologic examination did not find accumulations of calcium salts, rather it revealed a loss of proteoglycans within the cricoid cartilage.

Conclusions: Laryngeal mineralization occurs in the horse and human with advancing age. The loss of proteoglycan and subsequent stiffening of the cricoid cartilage likely resulted in the intraoperative complications noted in this report.

Clinical Relevance: Radiographic examination of the larynx before performing a prosthetic laryngoplasty may reveal the presence of areas of increased radiodensity. The interpretation of this is to be made with caution as it may represent mineralization, or hardening due to the changes in proteoglycan concentration, monomer size or charge.
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http://dx.doi.org/10.1111/j.1532-950X.2009.00575.xDOI Listing
January 2010

A description of the relationship between the nasomaxillary aperture and the paranasal sinus system of horses.

Vet J 2010 Nov 28;186(2):216-20. Epub 2009 Aug 28.

Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, 52 Campus Drive, University of Saskatchewan, Saskatoon, Canada SK S7N5B4.

Disease of the paranasal sinuses of the horse is common and treatment often involves lavage and sometimes surgery. The development of minimally-invasive, sinus-specific treatments, such as balloon sinuplasty, requires a thorough understanding of this complex anatomical region. To improve this understanding, 10 heads from dead horses of various ages were grossly dissected. The heads were transected sagittally and each half was dissected to expose the left and right nasomaxillary apertures and associated structures which were then photographed and measured. Entrances from the rostral and caudal maxillary sinuses into the maxillary aperture were found that led to a common exit at the middle nasal meatus. The caudal and rostral maxillary sinuses had their own, completely distinct outlets (entrances into the nasomaxillary aperture). There was no significant effect of side on measured variables.
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http://dx.doi.org/10.1016/j.tvjl.2009.07.023DOI Listing
November 2010