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  Discussion on Temporohyoid Disease
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New Member:
terric

Posted on Wednesday, Jun 19, 2013 - 1:08 pm:

My 18 year old mare has been diagnosed with Temporohyoid Disease by my vet. This started out of the blue in April 2013 after about a 30 minute dressage lesson (she was not very enthusiastic). When I went to remove her tack she shoot back like I was shocking her, flexed her head back to the left for about 10 minutes. And was scared to death and very hard to handle. She did this several times until I noticed it happened when she had a treat, apple slice or carrot, alfalfa will make this happen when she chews. She will chew once or twice and then just hold it. She had her teeth floated, radiographs, gutteral pouch endoscoped, x-rays were clear, scope showed slight irritation. She was on 30 days of Antibiotics and butte. She now is better but still very guarded, She has never shown any of the classic signs, except the shocking sign. She looks perfectly normal unless she is being shocked. She will stop chewing immediately if something bothers her sometimes spitting it out. I rode her very lightly for about 10 minutes with a bosal hackamore and then with her snaffle and she seems much more comfortable in the hackamore. When I used the snaffle she put her head right to the ground. } She has started shaking her head alittle when I ride left to right never up or down and her mid neck is clicking which is new. My vet thinks this is about as good as she'll be and to try to return her to easy work. Is there something else I should try to rule out or will I just be throwing away my money. We do have a very high tech clinic about 2 house away. But I would rather not trailer her that far if I don't need to. I think there may be something else there.
Moderator:
DrO

Posted on Thursday, Jun 20, 2013 - 5:23 pm:

Welcome Terric,
I am presuming the temporomandibular joints were well visualized on the radiographs and appeared normal. I agree that the symptoms are not quite right for TO. As to what to do next depends on your goals.

If an absolutely firm diagnosis is your goal you should get the referral to the hospital for a second opinion. Note from the article that the appearance of the stylohyoid bone and the associated soft tissues is best appreciated in the guttural pouch endoscopic appearance and that this was more diagnostic than radiographs. This might require a specialist to make a opinion on.

Otherwise you might consider a recheck of all the ground you have gone over, things sometimes change over time, add a exam and set of radiographs of the cervical spine (click, stiffness, and sidedness of the problem are suggestive) and if you are no further along on the diagnosis you and your vet could consider continuing the antibiotic and antiinflammatories to see if further improvement can be made.
DrO
New Member:
terric

Posted on Friday, Jun 21, 2013 - 5:00 pm:

Thank you for your response. Do horses with TO always show more clinical signs? I was also thinking that I may want to have a equine dentist do a very thorough exam with x-rays to make sure there is nothing that was missed. She did have her teeth floated and checked for TMJ but this was only visual and while she was sedated. I can't help but think it may be a tooth that is bothering her. Her vet does not think there is anything going on with her teeth or TMJ, so end of discussion on that. I don't know if the TMJ showed on the x-rays I only know that they were sent to the University of Colorado for review and came back clear for Hyoid. She is doing a lot better now, she has been off meds since 6/6/13, but I am afraid that this will reoccur and we will be right back at square one. Also your advise on the cervical spine is appreciated and I will make a point to have this checked more thoroughly.

Thank you for your help.
Moderator:
DrO

Posted on Wednesday, Jun 26, 2013 - 6:47 pm:

More clinical signs than what Terric?
DrO
New Member:
terric

Posted on Wednesday, Jun 26, 2013 - 10:55 pm:

I have read that horses with problems with their Hyoid bone show certain signs such as ataxia, facial paralysis, eye lid problems, ears not even, etc., she shows none of these signs.
She seems perfectly normal with the exception of being very careful when she eats. She eats all of her food but is very careful when something is too big and or stemy like alfalfa. I have not given her any apple slices since this started but she would go crazy (like she was being shocked) when she ate apple slices or hard treats.
Moderator:
DrO

Posted on Sunday, Jun 30, 2013 - 8:35 pm:

There are no diseases that always exactly look like there clinical description in a book. If the goal is for you to obtain a firmer diagnosis the next proper step is not to suppose anything but to collect more objective information.
DrO
Member:
terric

Posted on Sunday, Jan 5, 2014 - 8:20 pm:

Hi Dr O.

I have a question regarding my mare with THO, does the Stylohyoid bone ever reduce in size or will it always stay enlarged? My mare is on her 3rd course of meds (SMZ and bute) she responds well to the meds but after she has been off for a couple of months she starts to show some signs again. She looks perfectly normal, eats good, is turned out daily you would not know anything is wrong. The other morning when she was being turned out she kicked at the dog and turned her head at the same time and fell onto her side. The footing was good there was no reason she should have fallen. The next morning she was lying down when I went to get her, she got up just fine, but was acting as if there was something wrong with her left side (effected side) when I tried to move her in a circle to her left she just walked into me as if she was disoriented. She kept listing to the left and was very careful when walking. After about 30 minutes she was doing better and acting normal grazing in her field. This is the first time I have noticed this type of difficulty, her symptoms have always been associated with her mouth and eating.

Any advice would be appreciated.
Moderator:
DrO

Posted on Wednesday, Jan 8, 2014 - 6:33 pm:

Hello Terric,
To the degree that the enlargement is swelling from acute inflammation it will go down. In the case of chronic inflammatory changes the swelling will not improve markedly. Usually there will be some remodeling toward more normal but permanent enlargement is likely.

If the horses symptoms improve on antibiotics but then return when discontinued consider using longer courses or perhaps change the antibiotic regimen.
DrO
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