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  Discussion on Abcessed tooth infected sinus
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New Member:
sypher

Posted on Saturday, Feb 9, 2008 - 1:05 pm:

October horse developed nasal discharge, became thick and copious. vet scoped horse to examine gutteral pouch, which was fine. discharge was resolved with anti-allergans.
January nasal discharge returned, quickly became thick and breath was foul smelling. vet xrayed head and found "bad tooth". started antibiotics and after a few days delay (due to scheduling) vet drilled into the sinus, copious amounts of pus was found. vet has been coming daily to flush sinus. I have been cleaning wound about every three hours. yesterday (8 Feb) I noted that the lymphnodes under the jaw on that side were slightly enlarge, by 9pm they were noticeably enlarged. I called and left message for vet (he did not come that day due to emergency)
Drainage has become thinned and lessened since opening sinus route (5 Feb) but still foul smelling.
Horse has good appetite, alert and able to exercise without distress, no cough, no fever (I did not take a temp last night but will today)
vet wants to treat conservatively with hope that infection will get under control, tooth will seal off preventing further infection, and can be left in mouth. Vet is reluctant to a)do bone flap operation; b)to extract tooth through mouth; c)to extract tooth if it can be saved
1. he told me that these rarely become systemic, but with the enlarged lymphnodes, I am worried that it is now systemic.
2. what is your experience Re: the sinus bone flap procedure?
3. would you advise that we go ahead and remove the tooth now or continue course we are on?

thank you
Moderator:
DrO

Posted on Sunday, Feb 10, 2008 - 7:39 am:

Hello Christine,
Taking the questions in order:
1) The infection does normally not become systemic but there will be increasing destruction of the maxilla (bone around the tooth) and rarely some chronic sinus inflammatory conditions can develop.

2) They are messy and time consuming so I refer them to a surgical center. However improved extraction techniques makes them much less necessary than they use to be.

3) I cannot judge your case Christine and much depends on the nature of the problem particularly the health of the tooth but once a oro-nasal fistula is established, as evidenced by the putrid odor, most will need the tooth removed for a good chance at curing the problem.
DrO
New Member:
sypher

Posted on Sunday, Feb 10, 2008 - 5:57 pm:

I have done some browsing on the internet using oro-nasal fistula. Do I understand that this is a cleft palette?
My gut feeling at this point is to get the tooth out. There is a dramatic change today (improvement) in the discharge. It has slowed to a trickle (barely), is not so putrid that it makes me gag (I can stand to stay near and clean/medicate without holding my breath).
There is no equine surgery here. I live on an island (Oahu), so could you describe briefly some of the improved extraction techniques to enable me to discuss it with the vet?
Then I can send this information to my husband in Iraq and get his informed decision, too. He specializes in infection control and is an OR nurse.

Thank you Dr O.
Moderator:
DrO

Posted on Monday, Feb 11, 2008 - 9:37 am:

No you do not have a cleft palate. The definition of "fistula" is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. In your case the fistula is from the mouth to the sinus by way of the infected tooth alveolus.

In the past few years a combination of molar separators and a fulcrum device have been used in equine dentistry. The separator loosens the dentine ligaments while the fulcrum is placed on the arcade just rostral to (in front of) the bad tooth. The extractors can "see saw" on the fulcrum allowing the practitioner to develop more pulling (abductive) leverage while wiggling the tooth loose until it can be extracted. Teeth in a young that are well attached are still quite a chore but in older horses where the alveolus is not as deep removal is easier. I would refer your veterinarian to the 2004 AAEP Proceedings where the procedure is described in detail in the article Oral Extraction of Cheek Teeth in the Standing Horse.
DrO
New Member:
poopoo

Posted on Tuesday, Feb 12, 2008 - 11:39 pm:

Dr. O,
I have an older mare (19 or 20) with this same situation. It is two top molars. She is also compromised in the hind end - old pelvic fracture and horrible stifles, especially the RH. She lives on 2 Bute a day, I have gotten the sifle injected, and she is still short on that RH. She has trouble going down to roll and getting up, and we turn her into her stall very carefully when we bring her in from turnout - you get the idea.
She's been on and off SMZ'z for about 3 months now (mostly on), and we are now getting the nasty smell and putrid discharge while on SMZ's, as I guess we have already encountered resistance.
I don't think she's stabile enough to stand for tooth removal, and I cringe at the thought of her breaking her pelvis again trying to stand after the anesthesia of surgery. I don't think they'd take her as a surgical candidate anyway.
I am looking into trephining. Is this a big deal? Do you think it would buy much more time? Can I flush it myself after the first flushing by the vet? Other than Baytril and Naxcal, do you recommend other antibiotics? Do you think the maxilla is probably infected now too, judging from my description? How long can they live with an active sinus infection without pain?
I know I have a lot of questions, but I am really in a quandry right now. Thanks for your time.
Moderator:
DrO

Posted on Wednesday, Feb 13, 2008 - 9:05 am:

Welcome Susan,
Rather than placing your post at the bottom of another members post, you should "Start a New Discussion" to post questions about your horse. There will be no confusion with the response to christine's post and you will receive quicker and more responses that way.

This is a good topic for your post so using the navigation bar at the top of this page click on "Discussions on Respiratory System not covered by the above". This will take you to the discussion page. You will find at the bottom of list of already present discussions a "Start New Discussion" button.

For more on this see Help & Information ยป Posting Guidelines or where did my post go?.
DrO
New Member:
poopoo

Posted on Wednesday, Feb 13, 2008 - 11:31 am:

Dr. O,
Thanks for your help and kind welcome. I am sorry I posted here. I think I have now posted the topic in the correct place. I was so excited about joining that I did not read the posting instructions first. I am very impressed with your advice, knowledge, and this website. Again, sorry.
Susan
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