Littleton Equine Week 4

Hello all,
I am wrapping up my 4th week here at Littleton. Last night the clinic hosted the "In and Out BBQ". We just out a group of 4 new interns who are coming in and our 4 old interns are going out. The BBQ was a lot of fun and yummy food to say goodbye to our old interns and hello to our new interns. I had a good time, but left a bit early to catch some zzz's because I have a hard time transitioning from night shifts to day shifts. I spend this week in the ICU and got to spend one day with our surgeon, Dr. Hill.
I thought first I would tell you all about an interesting neuro case that presented last week and went home this week. A quarterhorse gelding came to the clinic for unknown neuro signs. He was ataxic, unstable at a walk,  had a lip droop, and had a head tilt. He eventually developed nystagmus. He reminded me of a dog with an inner ear infection. He was up to date on vaccines and there wasn't any history of trauma, but he did have history of cribbing. Cribbing is a bad habit where a horse chews on the wood in their stall or pasture.
All of the geldings bloodwork and physical exam perimeters (except for the neuro signs) came back within normal limits. The doctors on the case choose to shoot a few radiographs of his skull. The radiographs revealed bony proliferation around the temporohyoid joint. This lead them to the conclusion that this gelding had temporohyoid osteoarthropathy (THO). The cause of the THO was unknown, but it was a possibility that the cribbing lead to arthritis and damage of that joint. His clinical signs were due to the proximity of cranial nerves 7 (facial) and 8 (vestibulocochlear) to the damaged area. The bony proliferation was leading to nerve damage. The damage to CN 7 lead to the lip droop. The doctors also watched his eye on the affected side closely because CN 7 is also responsible for eye lid movement. If it is damaged it can commonly lead to ocular ulcers.  His other signs (nystagmus, ataxia, and head tilt) were attributable to CN 8. He was started on anti-inflammatory drugs and antibiotics. The antibiotics were in case the cause was bacterial in origin, which has been reported in some THO cases. When the gelding became more stable the doctors decided to do an endoscopic exam on him. The endoscope confirmed the THO diagnosis. After a conversation with the owner it was decided surgery was the gelding's best option.
The surgical option to treat THO is a ceratohyoidectomy. This procedure is done under general anesthesia and the goal is to remove the ceratohyoid bone, one of the bone that articulates with the hyoid apparatus. This helps to decrease pressure on the damaged joint and therefore decrease the pressure on the nerves. The surgery was successful with this gelding. He had mild clinical signs after the surgery, but they were slowly resolving. He went home this week and will continue to have routine rechecks to make sure he is making appropriate progress. It was a very interesting case to observe and a very happy ending for one of the sweetest geldings I've met.

Thanks for reading :)
Please let me know if you have any questions. Until next time!

Best,
Kaity