Wry nose correction in foals

Single-stage orthognathic correction of campylorrhinus lateralis in foals using transection and fixation: Surgical description and outcome of four horses
Equine Vet J. 2026 Jul 18. doi: 10.1002/evj.70227. Online ahead of print.
Authors
Helio Vasco 1 , Jim Schumacher 2 , Jack Easley 1
Affiliations

1 Kentucky Equine Veterinary Dental Specialists, Versailles, Kentucky, USA.
2 College of Veterinary Medicine, Department of Large Animal Clinical Sciences, The University of Tennessee, Knoxville, Tennessee, USA.

PMID: 42470150
DOI: 10.1002/evj.70227

Abstract

Background: Campylorrhinus lateralis (‘wry nose’) is a rare congenital maxillofacial deformity of foals resulting in compromise of the airway and severe class 4 malocclusion. Various surgical techniques to correct the deformity have been described, but contemporary data on single-stage transection and fixation, including use of a rib graft, and long-term functional and cosmetic outcomes remain underreported.

Objectives: To describe the transection-and-fixation technique and perioperative management used to correct wry nose in horses, and to report postoperative complications and long-term outcomes of horses undergoing this treatment.

Study design: Retrospective case series.

Methods: Wry nose of four horses was corrected by using a single-stage transection-and-fixation technique. Pre-operative assessment included physical, oral, and radiographic examinations, and when available, CT imaging. The surgical procedure involved temporary tracheostomy and laryngotomy, resection of the nasal septum, osteotomy and fixation of the nasal bones, and orthognathic transection and fixation of the premaxillae and maxillae, with bone grafting and alar fold resection performed when indicated. The outcome of horses with complete records and ≥12 months follow-up is reported using descriptive statistics.

Results: All four horses were presented with respiratory difficulty. The transected premaxillae were stabilised with pins and wires, and the transected nasal bones were stabilised with plates/screws; only one horse received a rib graft. All horses developed a plate-associated infection, and one horse developed an oronasal fistula. At the time of follow-up, all grazed and masticated normally, maintained good body condition, and owners were satisfied with the functional and cosmetic outcome.

Main limitations: Small sample size, retrospective design.

Conclusions: Correcting wry nose of four foals using a single-stage transection-and-fixation procedure achieved satisfactory long-term outcomes. Respiratory function of all horses improved, and all horses grazed and masticated normally. Three horses were able to perform their intended athletic endeavour. All owners reported satisfaction with the functional and cosmetic outcome.

Keywords: class 4 malocclusion; horse; maxillofacial surgery; orthognathic surgery; transection and fixation; wry nose.

© 2026 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.